高危型HPV检测作为初筛策略在宫颈筛查中的意义探讨  

Significance of high risk HPV detection as screening strategy in cervical screening

作　　者：王意[1] 余凡[1] 彭秀红[1] 曾俐琴[1] 罗喜平[1] WANG Yi;YU Fan;PENG Xiuhong;ZENG Liqin;LUO Xiping(Department of Gynaecology,Guangdong Women and Children Hospital,Guangzhou 510010,China)

机构地区：[1]广东省妇幼保健院妇科,广东广州510010

出　　处：《中国医药科学》2018年第7期17-21,共5页China Medicine And Pharmacy

摘　　要：目的分析人乳头瘤病毒(HPV-DNA)检测作为初筛策略在宫颈筛查中的意义及对hr HPV(+)进一步分流的方法选择。方法回顾性分析2014年7月~2015年7月在我院就诊的机会性筛查人群,均因细胞学异常或hr HPV(+)或临床症状转诊阴道镜检查,并均行阴道镜下活检的病例共1774例,对两种筛查方法进行比较。结果 (1)1774例患者中,共检出CIN1 679例,CIN2 193例,CIN3 145例,宫颈恶性肿瘤22例。HPV筛查以hr HPV(+)为阳性,细胞学以≥ASC-US为阳性,病理学以诊断≥CIN2为阳性,细胞学和hr HPV筛查的灵敏度分别为60.00%和90.00%,阴性预测值分别为86.32%和94.23%。hr HPV筛查的灵敏度及阴性预测值均明显高于细胞学筛查。(2)初筛hr HPV(+)者1150例,其中仅324例(28.17%)病理学证实为CIN2+。对于hr HPV初筛(+)者的进一步分流:以细胞学≥ASCUS或HPV16/18(+)为分流条件时,两者对CIN2+的诊断灵敏度分别为62.04%和48.15%,特异度为62.35%和72.64%,阳性预测值为39.26%和40.84%,阴性预测值为80.72%和78.13%.显示HPV16/18(+)作为分选条件的灵敏度低而特异性高,差异有统计学意义(P<0.01)。(3)1774例患者,共检出宫颈恶性肿瘤22例,其中2例(9.1%)HPV(-)。这2例HPV(-)的宫颈癌,1例为腺癌,细胞学结果为AGC,1例为鳞癌,细胞学结果为HSIL。(4)在细胞学(-)hr HPV(+)患者中,病理学正常、CIN1、CIN2、CIN3、宫颈恶性肿瘤中,HPV16/18阳性率分别为:30.15%、34.98%、41.18%、59.57%、87.50%,即随着宫颈病变的级别升高,其HPV16/18的感染率逐渐增加,且HPV16/18阳性的患者具有较高的CIN2+风险(27.39%),差异有统计学意义(P<0.01,OR为2.19)。结论 hr HPV作为初筛的灵敏度及阴性预测值均明显高于细胞学筛查;对于hr HPV初筛(+)的患者进一步选择细胞学≥ASCUS或HPV16/18(+)分流十分必要;而联合细胞学的筛查,则可以最大限度的减少HPV(-)宫颈癌的漏诊;对于细胞学(-)hr HPV(+)患者,进一步检测HPV16/18基因型可降低漏诊宫�Objective To investigate the significance of high risk HPV(HPV-DNA)detection as screening strategy in cervical screening,and to further select the method of hrHPV(+)triage.Methods From July 2014 to July 2015,totally 1774 women who underwent opportunistic screening in the Guangdong Women and Children Hospital were enrolled retrospectively to biopsy under colposcopy in their genital tracts,and all them were screened by colposcopy due to cytological abnormalities or hrHPV(+)or clinical symptoms.Both screening methods were compared.Results(1)Among the 1774 patients,CIN1 679 cases were detected,CIN2 193 cases,CIN3 145 cases,and 22 cases of cervical malignant tumors.HPV screening was positive for hrHPV(+),cytology was positive for more than ASCUS,and pathology was positive more than CIN2.The sensitivity of cytology and hrHPV screening were 60%and 90%respectively,and the negative predictive values were 86.32%and 94.23%respectively.The sensitivity and negative predictive value of hrHPV screening were significantly higher than cytologic screening.(2)HrHPV(+)was initially screened in 1150 cases,of which only 324 cases(28.17%)were pathologically proved to be CIN2+.Further shunting of hrHPV initial sifter(+):When the cytology was more than ASCUS or HPV16/18(+)as the shunt condition,the diagnostic sensitivity of two to CIN2+were 62.04%and 48.15%,the specificity were 62.35%and 72.64%,the positive predictive value were 39.26%and 40.84%,the negative predictive value were 80.72%and 78.13%.The sensitivity of HPV16/18(+)were low and specificity were higher as sorting condition,but the difference was statistically significant(P<0.01).(3)Among the 1774 patients,a total of 22 cases of cervical cancer were detected,including 2 cases(9.1%)of HPV(-).One case was adenocarcinoma,which has a cytology result for AGC,the other was squamous cell carcinoma,which has a cytology result for HSIL.4)Among the Pap(-)/hrHPV(+)patients,the positive rates of HPV16 and/or 18 with normal histology,CIN1,CIN2,CIN3 and malignant tumor of the cervix were 30.1

关 键 词：HPV 细胞学 宫颈筛查 分流 HPV16/18分型 

分 类 号：R737.33[医药卫生—肿瘤]