CareHPV检测用于江苏盐城基层妇女宫颈癌筛查的研究  

The research of CareHPV for cervical cancer screening in grassroots women in Yancheng city,Jiangsu Province

作　　者：王泓沄 仇楹茹[1,4] 谢意 徐修云 洪颖 WANG Hongyun;QIU Yingru;XIE Yi;XU Xiuyun;HONG Ying(Nanjing Drum Tower Hospital,Drum Tower Clinical Medical College of Nanjing Medical University,Jiangsu Nanjing 210008,China;Nanjing Drum Tower Hospital Affiliated to Medical College of Nanjing University,Jiangsu Nanjing 210008,China;Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Jiangsu Nanjing 210008,China;Nantong Third People\s Hospital,Jiangsu Nantong 226006,China)

机构地区：[1]南京鼓楼医院南京医科大学鼓楼临床医学院,江苏南京210008 [2]南京大学医学院附属鼓楼医院,江苏南京210008 [3]南京中医药大学中西结合鼓楼临床医学院,江苏南京210008 [4]南通市第三人民医院,江苏南通226006

出　　处：《中国妇幼健康研究》2020年第5期565-572,共8页Chinese Journal of Woman and Child Health Research

基　　金：江苏省卫生厅“十一五”国家科技支撑计划资助项目;江苏省卫生厅H200803课题资助项目;中国癌症基金会资助项目;江苏省科技厅科技支撑计划-社会发展课题(BE2012606)资助项目;国家卫生计生委科教司2015年公益性行业科研专项资助项目(201502004);南京市医学科技发展资助项目(YKK14079)。

摘　　要：目的评价宫颈癌快速筛查(CareHPV)检测的有效性,探索适合于基层妇女宫颈癌筛查的方法及方案。方法选取2013年在江苏省盐城地区东台市唐洋镇进行宫颈癌筛查的20岁以上已婚妇女1703人,于2015年再次随访筛查,并对筛查数据进行统计分析。结果2013年筛查显示,液基细胞学检查(TCT)结果异常者[≥非典型鳞状细胞-不能明确意义(ASC-US)]共68人,占总人数的3.99%;CareHPV检测结果异常者(>1.00RLU/CO)260人,占总人数的15.27%。2015年随访到筛查过的妇女1219例,CareHPV检测阳性178例,HPV感染率为14.60%;TCT异常22例。有阴道镜检查指征的给予活检,病理结果112例:宫颈可疑浸润癌有1例,宫颈上皮内瘤变3级(CIN3)有3例,CIN2~3有1例,CIN2有1例,CIN1有10例,慢性炎症伴鳞状上皮增生(挖空细胞、化生、萎缩等)86例,正常或慢性炎症6例,息肉1例,乳头样增生3例。2013年行CareHPV检测,2015年行CareHPV检测和TCT的受试者共1219例,根据HPV感染结果分为:持续感染组81例,非持续感染组110例,新感染组97例,无感染组931例。2013年CareHPV检测为阳性者,间隔两年HPV持续感染率为42.41%(81/191),2013年CareHPV检测为阴性者,间隔两年HPV新感染率为9.44%(97/1028);两者间的HPV感染率比较差异有统计学意义(χ^2=159.350,P<0.01)。间隔两年HPV清除率为57.59%(110/191)。在设计的基层宫颈病变筛查方法策略中,CareHPV初筛及TCT分流有最高的阴性预测值;TCT初筛及Care分型分流有最好的阳性预测值;CareHPV初筛及TCT分流的阴性预测值(99.02%)和阳性预测值(36.36%)是综合评价适用性最优方法。结论在江苏省基层地区开展以CareHPV检测为主的宫颈癌筛查方法,结合TCT分流,以阴道镜活检病理为准,能够有效检出≥CIN2的病变,CareHPV初筛TCT分流或CareHPV初筛CareHPV分型检测分流有很好的阴性预测值,CareHPV初筛及TCT分流是适用性最优方法。Objective To evaluate the effectiveness of CareHPV screening method,and explore the method and program of cervical cancer screening for grassroots women.Methods A total of 1703 married women over the age of 20 in Tangyang Town,Dongtai City,Yancheng city of Jiangsu Province were selected.All cases underwent the cervical cancer screening in 2013 and were followed up in 2015.The screening data was used to statistical analysis.Results The screening results in 2013 showed that 68 cases with abnormal results based on thinprep cytologic test(TCT)[≥atypical squamous cells-unclear significance(ASC-US)],accounting for 3.99%.260 cases with abnormal CareHPV results(>1.00 RLU/CO),accounting for 15.27%.In 2015,1219 cases were followed up,178 cases with positive results of CareHPV,the rate of HPV infection was 14.60%,22 cases with abnormal results of TCT.112 cases had indication for biopsy in colposcopy and the pathological results showed that 1 case diagnosed with suspected invasive cervical carcinoma,3 cases diagnosed with cervical intraepithelial neoplasia grade 3(CIN3),1 case diagnosed with CIN2-3,1 case diagnosed with CIN2,10 cases diagnosed with CIN1,and there were 86 cases of chronic inflammation with scale increasing(including koilocytes,metaplasia,atrophy),6 cases of normal results or chronic inflammation,1 case of polyps,and 3 cases of papillary hyperplasia.1219 cases underwent CareHPV screening in 2013 and underwent CareHPV and TCT screening in 2015 were divided into four groups according to HPV infection,including continuously positive infection group(81 cases),non-continuously positive infection group(110 cases),newly infection group(97 cases)and the group without infection(931 cases).The rate of continuously positive infection of HPV was 42.41%(81/191)in 2 years(both positive results of CareHPV in 2013 and 2015),and the rate of newly infection of HPV was 9.44%(97/1028)in 2 years(negative results of CareHPV in 2013 and positive results of CareHPV in 2015),there was a significant difference in the rate of HPV infe

关 键 词：人乳头瘤病毒 人乳头瘤病毒检测 液基细胞学检查 宫颈癌 宫颈癌筛查 

分 类 号：R737.33[医药卫生—肿瘤]