不明意义的非典型鳞状细胞患者中人类乳头瘤病毒检测的应用价值及意义  

Application Value and Significance of High-Risk Human Papillomavirus Detection in Women With Atypical Squamous Cells of Undetermined Significance

作　　者：孙笑非[1] 顾依群[1] 王荔[1] 卢利娟[1] 

机构地区：[1]北京市海淀区妇幼保健院病理科,100080

出　　处：《中华妇幼临床医学杂志（电子版）》2013年第6期665-668,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

摘　　要：目的 探讨高危型人类乳头瘤病毒（HR-HPV）检测对于细胞学诊断为不明意义的非典型鳞状细胞（ASC-US）患者的分流作用及临床价值.方法 选择2003年1月至2012年11月于北京市海淀区妇幼保健院行液基薄层细胞学检测（TCT）提示为ASC-US的患者,行HR-HPV检测并同时于阴道镜检查下行宫颈活检的患者1741例为研究对象,回顾性分析其临床病历资料并进行分析总结（本研究遵循的程序符合北京市海淀区妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意）.结果 1741例ASC-US患者中,宫颈浸润癌为0.1%（2/1741）,宫颈上皮内瘤变（CIN）为26.8%（466/1741）.1741例ASC-US患者中,HR-HPV呈阳性者和呈阴性者分别为69.67%（1213/1741）和30.33%（528/1741）.HR-HPV呈阳性者和呈阴性者对于CIN及以上病变（包括CIN Ⅰ,CIN Ⅱ~Ⅲ和宫颈浸润癌）检出率分别为35.0%（423/1213）,8.3%（43/528）.HR-HPV检测对于病理学检查诊断为CIN及以上病变的检出率比较,差异有统计学意义（χ2=132.641,P=0.000）.HR-HPV检测对ASC-US患者中CIN及以上病变的灵敏度、特异性、阳性预测值和阴性预测值分别为90.6%,38.0%,35.0%和91.7%.结论 ASC-US存在CIN的危险,而HR-HPV检测对ASC-US患者的分流管理具有重要的临床意义.Objective To explore clinical value of high risk human papillomavirus （HR-HPV） in atypical squamous cells of undetermined significance （ASC-US）. Methods From January 2003 to December 2012, a total of 1741 cases who were diagnosed as ASC-US were included into this study. They were further investigated by HR HPV testing and biopsy histopathological diagnosis. The results were compared and retrospectively analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Haidian Maternal and Child Health Hospital. Informed consent was obtained from all participates. Results Among 1741 cases, invasive cervical carcinoma cases were 0. 1% （2/1741）, cervical intraepithelial neoplasia （CIN） cases were 26.8% （466/1741）. And among 1741 ASC-US cases, positive and negative cases accounted for 69.67%（1213/1741） and 30.33%（528/1741）, respectively. The detection rates of positive and negative cases of CIN level and above, including CIN I , CIN Ⅱ-Ⅲ and invasive cervical carcinoma were 35.0% （423/1213） and 8.3% （43/528）, respectively. Statistically significant differences were existed in the different results of HR-HPV testing for CIN level and above of pathological diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value of CIN level and above in cases with ASC US by HR-HPV detection were 90.6%, 38.0%, 35.0%, 91.7%, respectively. Conclusions ASC-US exists within the risk of CIN lesions. It is beneficial for managing the patients of ASC-US based on HPV detection.

关 键 词：不明意义的非典型鳞状细胞 人类乳头状瘤病毒 宫颈上皮内瘤变 

分 类 号：R737.33[医药卫生—肿瘤]