高危型HPV DNA单独检测及与薄层液基细胞学联合筛查对宫颈癌及宫颈高度病变的筛查效果比较  

Comparison of screening performance between primary high-risk HPV screening and high-risk HPV screening plus liquid-based cytology cotesting in diagnosis of cervical precancerous or cancerous lesions

作　　者：赵雪莲 热米拉·热扎克 胡尚英 张莉 徐小倩 陈凤 潘秦镜 张询 赵方辉 Zhao Xuelian, Remila Rezhake, Hu Shangying, Zhang Li, Xu Xiaoqian, Chen Feng, Pan Qinjing, Zhang Xun, Zhao Fanghui.(Department of Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, Chin)

机构地区：[1]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 [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细胞学室,北京100021 [3]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室,北京100021

出　　处：《中华预防医学杂志》2018年第5期469-474,共6页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金（81322040）

摘　　要：目的 比较高危型HPV DNA单独检测（HPV单独检测）及与薄层液基细胞学（LBC）联合筛查对宫颈癌及宫颈高度病变（CIN2＋）的筛查效果.方法 在1999—2008年,中国医学科学院肿瘤医院分别与美国克利夫兰医学中心、国际癌症研究署等机构合作,开展了以17项人群研究为基础的宫颈癌筛查横断面研究,采用整群抽样方法,以我国9个省份中5个城市和9个农村地区共计28777名女性为研究对象,所有研究对象均进行了LBC、HPV检测.分别比较各年龄组HPV单独检测及与LBC联合检测两种筛查方法对CIN2＋的筛查效果.结果 所有研究对象中,HPV单独检测CIN2＋的检出率为3.05%（879例）,其与LBC联合检测CIN2＋的检出率为3.13%（900例）;灵敏度分别为96.4%和98.7%（χ2=19.00,P〈0.001）;特异度分别为86.2%、78.8%（χ2=2067.00,P〈0.001）;受试者工作曲线面积（AUC）显示,HPV单独检测优于其与LBC联合检测（AUC分别为0.913、0.888;Z=6.16, P〈0.001）.与HPV单独检测相比,其与LBC联合检测CIN2＋的阴道镜转诊率提高（分别为16.5%、23.6%;χ2=132.00,P〈0.001）,检出1例CIN2＋所需检测阴道镜个数也高于HPV单独检测（分别为5.4和7.6）.25~29岁年龄组HPV单独检测CIN2＋的阴道镜转诊率（10.9%,199例）是检出率（1.3%,23例）的8.7倍,而与LBC联合检测时阴道镜转诊率（15.7%,288例）是检出率（1.3%,23例）的12.5倍.结论 与HPV单独检测相比,HPV与LBC联合检测对CIN2＋的筛查效果未明显提高,成本效益不佳,尤其是在低年龄组.Objective To evaluate and compare the screening performance of primary high-risk HPV（HR-HPV）screening and HR-HPV screening plus liquid-based cytology（LBC）cotesting in diagnosis of cervical cancer and precancerous lesions（CIN2＋）.Methods We pooled 17 population-based cross-sectional studies which were conducted across China from 1999 to 2008.After obtaining informed consent,all women received liquid-based cytology（LBC）testing, HR-HPV DNA testing. Totally 28 777 women with complete LBC, HPV and biopsy results were included in the final analysis. Screening performance of primaryHR-HPV DNA screening and HPV screening plus LBC co-testing in diagnosis of CIN2＋were calculated and compared among different age groups. Results Among the whole population, the detection rates of primary HR-HPV screening and HR-HPV screening plus LBC co-testing are 3.05% （879 CIN2＋） and 3.13%（900 CIN2＋）,respectively.The sensitivity were 96.4% and 98.7%（χ2=19.00,P〈0.001）,and the specificity were 86.2% and 78.8%（χ2=2 067.00,P〈0.001）,respectively.Areas under the receiver operating characteristic （ROC） curve （AUC） showed that the primary HR-HPV screening performed better than co-testing （AUC were 0.913 and 0.888; Z=6.16, P〈0.001）. Compared with primary HR-HPV screening, co-testing showed significantly higher colposcopy referral rates（16.5% and 23.6%,respectively,χ2=132.00, P〈0.001）and the number of colposcopy examination for detecting per CIN2＋（5.4 and 7.6,respectively）.In the group aged 25-29 , the colposcopy referral rates was 8.7 （10.9%（199 cases） vs 1.3%（23 cases））times as much as the detection rate of primary HR-HPV screening in diagnosis of CIN2＋,and was 12.5（15.7% （288 cases） vs 1.3%（23 cases）） times as much as the detection rate of HR-HPV screening plus cytology contesting.Conclusion Compared with primary HR-HPV screening, HR-HPV screening plus cytology co-testing does not show better results in the screening performance for CIN2＋ detection

关 键 词：宫颈上皮内瘤样病变 宫颈癌 高危型人乳头瘤病毒DNA检测 薄层液基细胞学检测 

分 类 号：R737.33[医药卫生—肿瘤]