河南省农村妇女宫颈癌筛查中不同筛查方法效果评价  

Evaluation of different screening methods for cervical cancer screening of rural women in Henan province

作　　者：徐晓辉[1] 白淑娟 王志红[3] 王帅兵 谢忱 梁肖 杨文杰[5] 陈露[1] XU Xiaohui;BAI Shujuan;WANG Zhihong;WANG Shuaibing;XIE Chen;LIANG Xiao;YANG Wenjie;CHEN Lu(Department of Gynecology and Obstetrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Health Department,Hami District maternal and Child Health Hospital and Family Planning Service Center,Hami 839000,China;Department of Gynecology and Obstetrics,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Department of People’s Livelihood Affairs Office,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Public Health Institute of Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第三附属医院妇产科,河南郑州450052 [2]哈密市妇幼保健计划生育服务中心保健部,新疆哈密839000 [3]郑州大学第二附属医院妇产科,河南郑州450014 [4]郑州大学第三附属医院民生实事办公室,河南郑州450052 [5]郑州大学公共卫生学院,河南郑州450001

出　　处：《肿瘤基础与临床》2020年第2期148-153,共6页journal of basic and clinical oncology

摘　　要：目的评估巴氏涂片、液基细胞学检查(LBC)、人乳头瘤病毒(HPV)检测与巴氏涂片联合筛查这3种方法在农村地区筛查人群中检出高级别宫颈上皮内瘤变(CIN)的效果。方法选取河南省158个区县自愿参加免费宫颈癌筛查的35~64岁农村户籍共2023484例妇女作为研究对象,89个区县采用巴氏涂片作为初筛方法(巴氏涂片组),29个区县采用LBC作为初筛方法(LBC组),40个区县采用HPV检测与巴氏涂片联合筛查的初筛方法(联合筛查组),以初筛阳性率和病理学结果作为评价标准,评估3种筛查方法检出CINⅡ+病变的效果。结果联合筛查组初筛阳性率(9.90%)高于LBC组初筛阳性率(4.16%),LBC组初筛阳性率(4.16%)高于巴氏涂片组初筛阳性率(3.74%),联合筛查组CINⅡ+检出率(0.70%)高于LBC组CINⅡ+检出率(0.29%),差异均有统计学意义(P均<0.01);LBC组CINⅡ+检出率(0.29%)略高于巴氏涂片组CINⅡ+检出率(0.25%),但差异无统计学意义(P>0.05)。结论由于各地经济发展不平衡,我国农村地区宫颈癌筛查适合走多元化之路。HPV检测联合细胞学的方法提高了CINⅡ+检出的敏感性,在细胞学筛查规范且质量有保证的情况下,全面转为HPV筛查尚需过渡。Objective To evaluate the efficacy of pap smear,liquid based cytology(LBC)and human papilloma virus(HPV)test combined with pap smear for detection of cervical intraepithelial neoplasia(CIN)in rural cervical cancer screening population.Methods A total of 2023484 women from 158 districts and counties in Henan province were selected as the study subject,who volunteered for free cervical cancer screening,aged from 35 to 64,came from rural area.The primary screening positive rate and pathological results were used as the evaluation criteria,to evaluate the effectiveness of different screening methods in detecting CINⅡ+case.Results The positive rate of initial screening in the combined screening group(9.90%)was higher than that in the LBC group(4.16%,P<0.05).The positive rate of the LBC group(4.16%)was higher than that in the smear group(3.74%,P<0.05).The relevance ratio of CINⅡ+in the combined screening group(0.70%)was higher than that in the LBC group(0.29%,P<0.05).The relevance ratio of CINⅡ+in the LBC group(0.29%)was less higher than that in the smear group(0.25%),but the difference was not statistically significant(P>0.05).Conclusion Due to the unbalanced economic development in different regions,the diversified screening methods should be guided by the specific characteristics of each region.The combined group increased the sensitivity of case detection.In the case of standard cytological screening and quality assurance,the full use of HPV screening needs to be transitioning.

关 键 词：宫颈癌 人群筛查 宫颈上皮内瘤变 

分 类 号：R737.33[医药卫生—肿瘤]