人乳头瘤病毒检测在宫颈癌筛查中的作用  

The role of human papillomavirus detection in cervical cancer screening

作　　者：郝云涛[1] 郑小影[2] 张玉娟[1] 邵雪斋[1] HAO Yun-Tao ZHENG Xiao-Ying ZHANG Yu-Juan et al(Department of Gynecology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, Chin)

机构地区：[1]承德医学院附属医院妇科,河北承德067000 [2]承德医学院,河北承德067000

出　　处：《中国妇幼保健》2017年第14期3127-3129,共3页Maternal and Child Health Care of China

基　　金：河北省承德市科学研究与发展计划项目(20122148);河北省承德市科学研究与发展计划项目(20142031)

摘　　要：目的探讨人乳头瘤病毒(HPV)分型检测在宫颈癌筛查中的作用;了解该地区HPV感染情况,为未来HPV疫苗应用提供流行病学依据。方法应用流式荧光杂交技术对在该院妇科就诊的1 381例患者行宫颈脱落细胞HPV分型检测,对符合条件者行病理检查,探讨HPV分型检测在宫颈癌筛查中的作用。结果 HPV阳性率20.93%,HPV阳性率随宫颈病变程度加重明显增高,且宫颈癌及癌前病变的HPV阳性率与慢性宫颈炎比较差异有统计学意义(P<0.05);以CIN1及以上宫颈病变(CIN1+)为标准计算HPV分型检测的敏感度、特异度、阳性预测值、阴性预测值、误诊率、漏诊率和诊断符合率分别为71.62%、84.31%、95.21%、40.57%、15.69%、28.38%和73.99%;就诊患者中高危型HPV感染率居前5位的依次是16、58、52、33、18型;低危型HPV以6和43型为主;不同年龄组HPV感染呈"抛物线"状分布,41~50岁组感染率最高。结论流式荧光杂交HPV分型检测技术具有较好的敏感度和特异度,在宫颈癌筛查中具有积极作用;HPV亚型分布存在地域和年龄特异性,未来承德地区HPV疫苗的选择和应用需考虑病毒亚型和年龄两个因素。Objective To explore the role of human papillomavirus（ HPV） genotyping in cervical cancer screening,evaluate the infection state of HPV,and provide epidemiological evidence for application of HPV vaccines in future. Methods HPV genotyping of cervical exfoliated cells was performed by flow fluorescence hybridization for 1 381 patients in Department of Gynecology of the hospital. Pathological examination was performed for the patients meeting the inclusion criteria to explore the role of HPV genotyping in cervical cancer screening.Results The positive rate of HPV was 20. 93%,and it significantly increased with the severity of cervical lesions. There were statistically significant differences in the positive rate of HPV between cervical cancer,precancerous lesions and chronic cervicitis,respectively（ P〈0. 05）. Taking cervical intraepithelial neoplasia（ CIN） 1 and CIN1＋ as the standards,the sensitivity,specificity,positive predictive value,negative predictive value,misdiagnostic rate,missed diagnostic rate,and diagnosis coincidence rate of HPV genotypeing were 71. 62%,84. 31%,95. 21%,40. 57%,15. 69%,28. 38%,and 73. 99%,respectively. The high-risk HPV subtypes with the top five infection rates were 16,58,52,33,18 in sequence,and the low risk HPV subtypes were mainly 6 and 43. The distribution of HPV infection in different age groups showed a parabola shape,and the infection rate of patients aged 41-50 years old was the highest. Conclusion Flow fluorescent hybridization for HPV genotyping has a good sensitivity and specificity,which plays a positive role in cervical cancer screening. The distribution of HPV subtypes has specificity in region and age. HPV subtypes and age are the two main factors in selection and application of HPV vaccines in Chengde area in the future.

关 键 词：宫颈病变 HPV HPV疫苗 流式荧光杂交技术 

分 类 号：R711.74[医药卫生—妇产科学]