我国农村地区宫颈癌筛查中人乳头瘤病毒检测阳性女性的分流策略  

Triage of HPV-positive women in cervical cancer screening in rural China

作　　者：党乐[1,2] 马俊飞 郭董平 李八一 苏采峰 赵宇倩[5] 冯瑞梅[2] 张询[6] 潘秦镜[7] 胡尚英[2] 赵方辉[2] 乔友林[2] 

机构地区：[1]辽宁省大连医科大学公共卫生学院,大连116044 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院流行病学研究室,北京100021 [3]山西省襄垣县妇幼保健院,长治046200 [4]山西省晋城市阳城县妇幼保健院,晋城048100 [5]四川省肿瘤医院研究所四川省癌症防治中心电子科技大学医学院癌症防治办公室,成都610041 [6]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院病理科,北京100021 [7]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院细胞学室,北京100021

出　　处：《中国肿瘤临床与康复》2017年第3期257-261,共5页Chinese Journal of Clinical Oncology and Rehabilitation

基　　金：公益性行业科研专项-适合中国农村地区的宫颈癌筛查技术与示范研究(201502004);中国癌症基金会宫颈癌防治专项基金(zh0007)

摘　　要：目的探讨适用于我国农村地区宫颈癌筛查人乳头瘤病毒(HPV)阳性女性的分流策略。方法选取2015年7月至2015年10月间,在山西省襄垣县和阳城县招募35~64岁女性进行宫颈癌及其癌前病变筛查,采用宫颈癌快速筛查技术(care HPV检测法)进行初筛,后采用随机数表法将初筛结果阳性女性(248例)分成三组:细胞学分流(82例)、醋酸或碘染色肉眼观察法(VIA/VILI)分流(83例)和不分流直接转诊阴道镜(83例)。细胞学和VIA/VILI检查阳性者转诊阴道镜。阴道镜异常者在病变处取活检进行病理诊断。结果共有1 503名女性参加筛查,HPV阳性检出率为16.5%(248/1503),中度及以上宫颈上皮内瘤样病变(CIN2+)的检出率为0.7%(11/1503),248例中有237例完成分流检查,依从率为95.6%(237/248),细胞学分流组、VIA/VILI分流组和不分流直接阴道镜组检查的人数分别为81例、79例和77例。细胞学分流组中,分流结果阳性率、CIN2+检出率和阳性预测值依次为:19.8%、1.2%和11.1%;VIA/VILI分流组中上述指标依次为:17.5%、3.6%和21.4%;不分流直接阴道镜组中上述指标依次为:19.5%、8.4%和9.5%。上述阳性检出率和CIN2+检出率差异均无统计学意义(均P>0.05)。随着年龄的增加,HPV阳性率趋于上升趋势,而直接阴道镜组阳性检出率趋于下降趋势,差异均有统计学意义(均P<0.05)。细胞学分流组和VIA/VILI分流组随年龄的增加未发现显著的变化趋势,差异无统计学意义(P>0.05)。结论三组方法中,VIA/VILI较适用于我国农村地区宫颈癌筛查HPV阳性女性的分流。Objective To assess the triage strategy suitable for HPV positive women in cervical cancer screening in rural China, and provid scientific evidence for cervical cancer screening in the real world. Methods Women aged 35-64 years were recruited from Xiangyuan County and Yangcheng County in Shanxi Province between July 2015 and October 2015 for cervical cancer screening. Care HPV detection method was used as the primary screening technique, and after the initial screening, women with positive HPV results were randomly divided into three groups： cytology triage （82 patients） , VIA/VILI triage （83 patients） and direct colposcopy without triage （83 patients）. Cytology and VIA/VILI positive women trans- ferred to colposeopy. If colposeopy screening showed abnormal results, biopsy was performed for pathological doagnosis. Results A total of 1503 women were enrolled. The positive rate of HPV was 16.5% （248/ 1503）. The detection rates of moderate and above cervical intraepithelial neoplasia （CIN2 ＋ ） was 0. 7% （11/1503）. Among the 248 women, 237 women completed triage, and the compliance rate was 95.6% （237/248）. There were 81, 79 and 77 women in cytology triage group, VIA/VILI triage group and non shunt direct eolposcopy group respectively. The triage positive rate, CIN2 ＋ detection rate and positive pre- dictive value were 19. 8%, 1.2% and 11.1% respectively for cytology group, 17.5% ,3.6% and 21.4% respectively for VIA/VILI group, and 19. 5% , 8.4% and 9.5% for colposeopy group. There were no obvi- ous statistical difference in all the above positive rates and CIN2 ＋ detection rates （ all P 〉 0. 05 ）. There was an increasing trend of HPV positive rates with the increasing of age （ P 〈 0. 05 ）, but colposcopy group showed a down trend（ P 〈 0.05 ）. No obvious differences were found in changes of positive rates with the in- creasing of age between VIA/VILI group and cytology group （ P 〉 0. 05 ）. Conclusion Among the three methods, VIA/VILI may be a suitable tfiage

关 键 词：农村地区 宫颈肿瘤 筛查 HPV检测 分流 

分 类 号：R737.33[医药卫生—肿瘤]