HPV分型检测在HPV阳性ASC-US管理中的风险分层作用  

HPV genotypes testing in triage of HPV-positive women with atypical squamous cells of undetermined significance

作　　者：毕蕙[1] 裴志飞 刘燕[1,3] BI Hui;PEI Zhi-fei;LIU Yan(Department of Gynecology and Obstetrics,Peking University First Hospital,Beijing 100034,China;Department of Gynecology,The Maternal and Child Health Hospital of Xicheng District,Bering 100029,China;Department of Gynecology,The Second Hospital of Beijing,BeUing 100031,China)

机构地区：[1]北京大学第一医院妇产科,北京100034 [2]北京市西城区妇幼保健院妇科,北京100054 [3]北京市第二医院妇科,北京100031

出　　处：《中国妇幼健康研究》2018年第9期1101-1106,共6页Chinese Journal of Woman and Child Health Research

摘　　要：目的探索人乳头瘤病毒(HPV)阳性,细胞学不典型鳞状细胞-不能明确意义(ASC-US)者,不同HPV型别感染者的管理模式。方法回顾性总结2010年至2012年北京大学第一医院因子宫颈细胞学ASC-US且HPV分型检测阳性行阴道镜检查,同时行组织病理学检查的567例患者的临床资料,分析细胞学ASC-US者不同HPV型别感染的子宫颈上皮内瘤变2级及以上(CIN2+)及子宫颈上皮内瘤变3级及以上(CIN3+)风险。结果在567例HPV阳性的ASC-US中,共检出CIN2+99例,占17.50%(99/567),其中在HPV16/18型别、HPV31/33/45/52/58、HPV35/39/51/53/56/59/66/68感染者中分别检出CIN2+54例(29.20%,54/185)、37例(15.60%,37/237)及8例(5.40%,8/145),三者间的CIN2+检出率比较有统计学差异(χ2=41.49,P<0.05)。在HPV16/18/31/33/45/52/58型别感染者中共检出CIN2+91例,占91.90%(91/99),其检出CIN2+敏感性为91.90%,特异性为29.20%,阳性预测值为21.60%,阴性预测值为94.50%。在三类不同型别HPV感染者中共检出CIN3+36例,占6.30%(36/567),分别为29例(15.70%,29/185)、7例(3.00%,7/237)及0例,三者间CIN3+检出率比较有统计学差异(χ2=41.49,P<0.05),且不同年龄段的三者间CIN3+检出率比较有统计学差异(χ2=41.49,P<0.05)及在年龄<30岁、30~39岁、40~49岁及≥50岁者中的三种不同类型HPV感染者间CIN3+检出率比较均有统计学差异(χ2值分别为9.12、11.39、13.60、8.49,均P<0.05),HPV16/18/31/33/45/52/58型别感染者共检出CIN3+36例,占100.00%(36/36),检出CIN3+敏感性为100.00%,特异性为27.30%,阳性预测值为8.50%,阴性预测值为100.00%。结论 HPV分型检测用于HPV阳性的ASC-US管理时可起到进一步风险分层作用,在HPV16/18感染者中高级别鳞状上皮内病变(HSIL)风险最高,HPV31/33/45/52/58感染者中者次之,HPV35/39/51/53/56/59/66/68感染者中风险相对较低,管理时可区别对待。Objective To explore the triage strategies for HPV-positive women with atypical squamous cells of undetermined signification（ASC-US）.Methods This retrospective study included 567 patients who underwent colposcopy for ASC-US and HPVpositive as well as pathological test between 2010 to 2012 at Peking University First Hospital.We estimated the risk of cervical intraepithelial neoplasia（CIN）2,CIN2＋ and CIN3＋for the women with different HPV genotypes.Results Of the 567 ASC-US patients with HPV infection,99 cases（17.50%,99/567）had CIN2＋,including 54 cases（29.20%,54/185）with HPV16/18 genotype,37（15.60%,37/237）with HPV31/33/45/52/58 genotype,and 8（5.40%,8/145）with HPV35/39/51/53/56/59/66/68 genotype.The detection rate of CIN2＋ among three groups had significant difference（χ2=41.489,P〈0.05）.There were 91 cases of CIN2 detected with HPV16/18/31/33/45/52/58 genotype,occupying 91.90%（91/99）,and the sensitivity,specificity,positive predictive value and negative predictive value was 91.90%,29.20%,21.60% and 94.50%,respectively.While among all the patients included,36（6.30%,36/567）had CIN3＋,of which 29（15.70%,29/185）had HPV16/18 genotype,7（3.00%,7/237）had HPV31/33/45/52/58 genotype,and no one had HPV35/39/51/53/56/59/66/68 genotype.The detection rate of CIN3＋among three groups and that among three groups of different age had statistical significance（χ2 value was 41.49 and41.49,respectively,both P〈0.05）.Among groups of under 30 years of age,30-39 years of age,40-49 years of age,and over50 years of age,the differences were also significant（χ2 value was 9.12,11.39,13.60 and 8.49,respectively,all P〈0.05）.Of cases infected with HPV16/18/31/33/45/52/58 genotype,36（100.00%,36/36）were detected with CIN3＋ with sensitivity of100.00%,specificity of 27.30%,positive predictive value of 8.50% and negative predictive value of 100.00%.Conclusion HPV genotyping could be used as an optimal triage strategy for HPV positive women with ASCUS.The risk of cases of high gra

关 键 词：人乳头瘤病毒 型别 细胞学 子宫颈上皮内瘤变 子宫颈肿瘤(癌) 

分 类 号：R711.7[医药卫生—妇产科学]