高危型人乳头瘤病毒、液基细胞学检查联合电子阴道镜下宫颈活检在宫颈上皮内瘤变及宫颈癌诊断中的应用  

High-risk human papillomavirus,thin-prep cytologic test combined with digital colposcopy cervical biopsy in the diagnosis of cervical intraepithelial neoplasia and cervical cancer

作　　者：卫红霞 魏丽军[1] 赵瑞霞[1] 王晓燕[1] Wei Hongxia;Wei Lijun;Zhao Ruixia;Wang Xiaoyan(Department of Gynaecology,Shanxi Cancer Hospital,Taiyuan,Shanxi 030013,China)

机构地区：[1]山西省肿瘤医院妇一科,山西省太原030013

出　　处：《中国基层医药》2018年第15期1956-1959,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 分析高危型人乳头瘤病毒（HR-HPV）、液基细胞学（TCT）联合电子阴道镜下宫颈活检在宫颈上皮内瘤变（CIN）及宫颈癌诊断中的应用价值.方法 选取山西省肿瘤医院2014-2016年250例非典型鳞状细胞（ASCUS）和以上程度病变的患者,其中ASCUS患者148例、低度鳞状上皮内瘤变（LSIL）患者68例、高度鳞状上皮内瘤（HSIL）患者27例和鳞状细胞癌（SCC）患者7例.利用聚合酶链式反应（PCR）荧光探针法检测患者宫颈分泌物中HR-HPV是否表达,并通过电子阴道镜对患者进行Reid阴道镜评分,将宫颈组织病理学结果作为诊断标准进行判断.结果 单纯使用TCT对CIN及以上程度病变的诊断率为41.20%（103/250）, HR-HPV联合TCT对CIN及以上程度病变的诊断率为58.78%（77/131）,TCT联合电子阴道镜对CIN及以上程度病变的诊断率为67.42%（89/132）,均显著增加（χ2＝35.87,P＝0.00;χ2＝59.01,P＝0.00）;HR-HPV、TCT联合电子阴道镜诊断CIN以上程度病变的诊断率为79.82%（91/114）,明显比HR-HPV联合TCT的诊断率、TCT联合电子阴道镜检查的诊断率高（χ2＝15.54,P＝0.01;χ2＝8.05,P＝0.02）. CIN及宫颈癌的出现与HR-HPV感染有着密切的关系,同时随着病情的加重,其感染率呈现显著上升的趋势（ASCUS患者的HR-HPV感染率为39.86%、LSIL患者为61.76%、HSIL患者为88.89%、SCC患者为100.00%）.结论 HR-HPV、TCT联合电子阴道镜可以有效提高对CIN及以上程度病变患者的诊断率,同时随着病情的加重,HR-HPV感染率显著上升,能够在临床上对CIN及宫颈癌的检测提供诊断信息.Objective To analyze the application of the HR -HPV,TCT combined with digital colposcopy cervical biopsy in diagnosis of CIN and cervical carcinoma.Methods From 2014 to 2016,250 cases diagnosed as ASCUS and above the level of disease were selected in Shanxi Cancer Hospital ,including 148 cases of ASCUS,68 cases of LSIL,27 cases of HSIL and 7 cases of SCC.The HR-HPV copy number was detected by using PCR fluorescence measurement,the Reid colposcopy scores were measured by using digital colposcopy ,and the cervical histopathological diagnosis was regarded as a measurement rule.Results The diagnostic rate of simple use of TCT for the diagnosis of CIN and above lesions was 41.20%（103/250）, HR -HPV ＆ TCT in diagnosis of CIN and above lesions was 58.78%（77/131）,TCT ＆ digital colposcopy for the diagnosis of CIN and above lesions was 67.42%（89/132）, which were significantly increased （χ2＝35.87,P＝0.00;χ2＝59.01,P＝0.00）.The diagnostic rate of HR-HPV＆TCT combined with electronic colposcopy in diagnosis of lesions above CIN was 79.82%（ 91/114 ）, which was significantly higher than that of HR -HPV ＆ TCT[58.78%（77/131）],and the diagnostic rate of TCT ＆ digital colposcopy was 67.42%（89/132）（χ2＝15.54,P＝0.01;χ2＝8.05,P＝0.02）.The incidence of CIN and cervical cancer were closely related with HR -HPV infection and the rate of HR-HPV infection showed an increasing trend with the aggravating degree of disease （the HR-HPV infection rate of ASCUS was 39.86%,the HR-HPV infection rate of LSIL was 61.76%,the HR-HPV infection rate of HSIL was 88.89%,while the HR-HPV infection rate of SCC was 100.00%）.Conclusion HR-HPV,TCT combined with digital colposcopy can effectively improve the diagnosis rate of CIN and above the level of disease.At the same time,with the deterioration of the disease ,HR-HPV infection rate increases significantly ,which can provide diagnostic information and significance in the clinical diagnosis of CIN and cervical cancer.

关 键 词：人乳头瘤病毒 细胞学技术 阴道镜检查 活组织检查 宫颈上皮内瘤样病变 

分 类 号：R737.33[医药卫生—肿瘤]