门诊病人人类乳头瘤病毒分型在宫颈病变筛查中的应用  

Application of HPV typing and high risk types in cervical lesions screening in outpatients

作　　者：叶芳 秦伟 张坦如 黄雄文 戴海明[4] 王宏志 YE Fang;QIN Wei;ZHANG Tanru;HUANG Xiongwen;DAI Haiming;WANG Hongzhi(Department of Medical Pathology,Hefei Cancer Hospital,Chinese Academy of Sciences,Hefei,Anhui 230031,China;Department of Science and Education,The First Affiliated Hospital of The University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui 230038,China;Department of Stomatology,The Second Affiliated Hospital of Anhui University of Chinese Medicine,Hefei,Anhui 230061,China;Molecular Pathology Laboratory,Hefei Research Institute of Chinese Academy of Sciences,Hefei,Anhui 230031,China)

机构地区：[1]中国科学院合肥肿瘤医院医学病理部,安徽合肥230031 [2]中国科学技术大学附属第一医院(安徽省立医院)科教科,安徽合肥230038 [3]安徽中医药大学第二附属医院口腔科,安徽合肥230061 [4]中国科学院合肥物质科学研究院分子病理研究室,安徽合肥230031

出　　处：《安徽医药》2020年第4期726-729,共4页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金(21772201)。

摘　　要：目的分析医院门诊就诊病人人类乳头瘤病毒(HPV)高危、中危及低危基因型分布状况,并探究高危型人类乳头瘤病毒(HR HPV)检测在宫颈病变筛查中的作用。方法选取2017年3月至2018年4月在中国科学院合肥肿瘤医院就诊的妇科门诊病人1814例,分别采用反向点杂交法技术检测及HPV分型检测,分析高危、中危及低危共28种基因型分布状况。另外选择同期进行HR HPV检测、宫颈薄层液基细胞学检查(TCT)和阴道镜及病理组织学检查病人210例,以病理组织学结果为参考标准,研究HR HPV、TCT以及两者联合检测用于宫颈病变筛查效能。结果1814例门诊病人共176例HPV检测阳性,阳性率为9.70%,其中高危型或高危型混合中、低危型阳性率为6.94%(126/1814);中、低危型及混合感染阳性率2.76%(50/1814)。基因型排名前十位分别是HPV 16、58、52、53、66、56、18、31、33、42,其中HPV 53、66和42是中低危型。HR HPV联合TCT诊断宫颈病变的灵敏度为97.01%(65/67),阴性预测值为96.78%(60/62),漏诊率为2.99%。HR HPV联合TCT检测分别与HR HPV、TCT比较,均差异有统计学意义(χ^2=5.220,5.372,P<0.05)。结论合肥地区HPV基因亚型分布不同其他地区,有待于进一步确认。HR HPV联合TCT检测优于单项检查,对早期发现宫颈病变的具有重要筛选意义,可值得在妇科门诊广泛应用推广。Objective To analyze the distribution of high risk,medium risk and low risk human papillomavirus(HPV)genotypes in outpatients of hospital,and to explore the role of high risk human papillomavirus(HR HPV)detection in cervical lesions screen ing.Methods A total of 1814 gynecological outpatients who were admitted to the Hefei Cancer Hospital of the Chinese Academy of Sciences from March 2017 to April 2018 were selected.The reverse dot hybridization method and HPV typing test were used to analyze the distribution of 28 genotypes with high risk,medium risk and low risk.In addition,210 patients were selected for HR HPV detection,cervical thin layer liquid based cytology(TCT),colposcopy and histopathological examination.The histopathological results were used as the reference standard to study the efficacy of HR HPV,TCT,and HR HPV combined with TCT in screening for cervical lesions.Results A total of 176 patients with 1814 outpatients had positive HPV test,with a positive rate of 9.70%.The positive rate of high risk type or mixed medium and low risk type was 6.94%(126/1814).The positive rate of medium risk,low risk,and mixed infections was 2.76%(50/1814).The top 10 genotypes were HPV 16,58,52,53,66,56,18,31,33 and 42,among which HPV 53,66 and 42 were medium risk and low risk types.The sensitivity of HR HPV combined with TCT in the diagnosis of cervical lesions was 97.01%(65/67),the negative predictive value was 96.78%(60/62),and the rate of missed diagnosis was 2.99%.HR HPV combined with TCT was compared with HR HPV and TCT,respectively.The differences were statistically signifi cant(χ^2=5.220,5.372,respectively,P<0.05).Conclusion The distribution of HPV genotypes in Hefei is different from other re gions,and further confirmation is needed.HR HPV combined with TCT detection is better than single examination,which has impor tant screening significance for the early detection of cervical lesions,and can be widely used in gynecological outpatient department.

关 键 词：α乳头状瘤病毒属 宫颈肿瘤 宫颈非典型增生 DNA探针 HPV 阴道镜检查 薄层液基细胞学 

分 类 号：R737.33[医药卫生—肿瘤]