DNA倍体分析对HPV阴性的ASCUS宫颈上皮内瘤变的诊断价值研究  

Value of DNA Ploidy Analysis in Diagnosis of Cervical Intraepithelial Neoplasia in HPV-negative ASCUS Patients

作　　者：宋文惠[1] 王丽[1] 冯莉[1] 崔文华[1] 米冬青[1] 于湄[1] SONG Wen-hui WANG Li FENG Li CUI Wen-hua MI Dong-qing YU Mei(Department of Obstetrics, the Fourth Hospital of Shijiazhuang, Shijiazhuang 050000, Chin)

机构地区：[1]石家庄市第四医院产科,石家庄050000

出　　处：《临床误诊误治》2016年第10期93-96,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的 探讨DNA倍体分析对人乳头状瘤病毒（human papillomavirus,HPV）阴性的不能明确意义的非典型鳞状上皮细胞（atypical squamous cells of undetermined significance,ASCUS）患者发生宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）的诊断价值。方法 对2014年1月—2015年12月在石家庄市第四医院行宫颈癌筛查的HPV阴性的ASCUS患者行DNA倍体分析,按照DNA指数（DI）分为〈2.5、2.5~5.0及≥5.0组。比较不同DI组CIN发生率,并进一步行单因素及多因素logistic回归分析寻找CIN的相关危险因素。结果 1不同DI组不同级别CIN发生率比较差异有统计学意义（χ^2=16.256,P〈0.01）,其中DI≥5.0组高级别CIN发生率高于DI〈2.5组和DI2.5~5.0组（Z=-3.820,P=0.000;Z=-2.798,P=0.005）。2多因素logistic回归分析显示,DI≥5.0与高级别CIN的发生呈正相关（OR=11.810,P=0.008）。结论 DNA倍体分析有利于HPV阴性ASCUS患者CIN的分流诊断,一定程度可避免高级别CIN漏诊;DI≥5.0可能适用于ASCUS早期预测及临床诊断高级别CIN,必要时行宫颈组织病理检查可明确诊断。Objective To investigate value of DNA ploidy analysis in diagnosis of cervical intraepithelial neoplasia （CIN） in human papillomavirus-negative （HPV-negative） atypical squamous cells of undetermined significance （ASCUS） patients. Methods DNA ploidy analysis was performed for cervical cancer screening in patients with HPV-negative ASCUS during January 2014 and December 2015, and the patients were divided into group A （ DI 〈 2.5 ） , group B （ DI 2.5-5.0） and group C （DI≥5.0） according to DNA index （DI）. Incidence rates of CIN in DI groups were compared, and univariate and multivariate logistic regression analyses were performed further to analyze risk factors of CIN. Results （1）There were significant differences in CIN incidence rates among three DI groups （ χ^2 = 16. 256, P 〈 0.01 ） , and incidence rate of advanced CIN In group C was significantly higher than those in group A and B （Z = - 3. 820, P =0. 000; Z = - 2. 798, P = 0. 005）. （2） Multivariate logistic regression analysis showed that advanced CIN was positively related with DI ≥ 5.0 （ OR = 11. 810, P = 0. 008）. Conclusion DNA ploidy analysis has effective triage value in treatment of CIN in HPV-negative ASCUS patients, and it may avoid missed diagnosis of advanced CIN in some degree. DI ≥5.0 may apply for ASCUS early prediction and advanced CIN diagnosis, and then following cervical biopsy should be performed for confirmed diagnosis when it is necessary.

关 键 词：DNA倍体 鳞状上皮细胞 宫颈上皮内瘤样病变 诊断 危险因素 

分 类 号：R737.33[医药卫生—肿瘤]