26970例适龄妇女宫颈病变筛查的分析  

Retrospective Analysis of Cervical Screening for 26970 Women of the Reproductive Age

作　　者：张燕 温国明 杨伟康 颜春荣 刘姜玲 郭悦慈 赖霞 梁红梅 彭汝娇 ZHANG Yan;WEN Guoming;YANG Weikang;YAN Chunrong;LIU Jiangling;GUO Yueci;LAI Xia;LIANG Hongmei;PENG Rujiao(Depatment of Pathology,Shenzhen Longhua District Maternal and Child Health Care Hospital,Shenzhen 518109,China;Depatment of Out-patient,Shenzhen Longhua District Maternal and Child Health Care Hospital,Shenzhen 518109,China;Depatment of Prevention and Healthcare,Shenzhen Longhua District Maternal and Child Health Care Hospital,Shenzhen 518109,China;Depatment of Obstetrics and Gynecology,Shenzhen Longhua District Maternal and Child Health Care Hospital,Shenzhen 518109,China)

机构地区：[1]深圳市龙华区妇幼保健院病理科,广东深圳518109 [2]深圳市龙华区妇幼保健院门诊部,广东深圳518109 [3]深圳市龙华区妇幼保健院预防保健科,广东深圳518109 [4]深圳市龙华区妇幼保健院妇产科,广东深圳518109

出　　处：《中国医药指南》2020年第22期1-3,6,共4页Guide of China Medicine

基　　金：2017年深圳市龙华区科技创新局基金项目[〔2018〕4(2017059)];2019年深圳市科技创新委员会基金项目(20180214150032959)。

摘　　要：目的调查研究本地区HR-HPV的感染率和宫颈病变发病情况的相关性,并探讨HPV感染及分型/载量等因素和宫颈病变之间的关系,利用大数据对深圳市龙华区育龄期妇女的宫颈疾病早防早治和宫颈病变筛查策略提供切实有效的参考。方法回顾性分析2017年1月至2019年12月在我院辖区内常住人口参加宫颈癌筛查的适龄妇女26970例进行宫颈癌HR-HPV DNA检测和液基细胞学联合筛查,筛查的方案为同时进行高危型人乳头瘤病毒基因(HR-HPV DNA)检测以及液基细胞学检测,HPV阳性或细胞学检测异常者建议召回转诊阴道镜及病理活检,有阴道镜及病理活检结果的为443例。结果26970例筛查妇女中HR-HPV阳性例数为2150例,阳性率为7.97%;液基细胞学检查异常例数为720例,异常率为2.67%;阴道镜及病理活检结果CIN197例,CIN2/346例,癌2例,宫颈病变率0.90%,HR-HPV结果与细胞学结果的总体符合率为93.00%;HR-HPV对CIN2/3以上宫颈病变的灵敏度为92.31%,特异度为65.98%;HPV16/18型相对于其他12种HR-HPV型与各级别宫颈病变更加密切;其相对病毒载量越高,样本与各级别宫颈病变就更加密切。结论适龄妇女的HR-HPV感染率、宫颈疾病发病率符合全国HPV流行病学调查的现状;HPV+液基细胞学检查联合筛查具有很高的灵敏度和特异度;HPV16/18型相对于其他12型HPV具有更高的宫颈病变风险,其病毒载量与宫颈病变级别的升高具有一定的相关性。Objective To explore the correlation between cervical disease and age and viral load caused by high-risk HPV infection(especially HPV16/18).Methods A retrospective analysis of 26970 women of appropriate age who participated in cervical cancer screening in the permanent population of our hospital from January 2017 to December 2019 was screened for cervical cancer by HR-HPV DNA testing and liquid-based cytology.HPV positive or cytological abnormalities were recommended to recall the colposcopy and pathological biopsy.Colposcopy and biopsy results were 443 cases.Results The positive cases of HR-HPV in 26970 cases of screening women was 2150,and the positive rate was 7.97%.The number of abnormal cases in liquid based cytology examination was 720 cases,the abnormal rate was 2.67%.Colposcopy and biopsy results were CIN197 cases,CIN2/346 cases,2 cases of cancer,cervical lesion rate 0.90%.The overall coincidence rate of results of HR-HPV positive and liquid based cytological results was 93.00%,HR-HPV’s sensitivity to cervical lesions above CIN1 was 92.31%.The HR-HPV test to cervical lesions above CIN2/3 was 92.31%and specificity was 65.98%.The HPV 16/18 subtype was more closely related to cervical lesions at all levels than the other 12 subtypes of HR-HPV.Furthermore,the higher the relative viral load of HR-HPV,the more relevance to cervical lesions at all levels.Conclusions The prevalence of HR-HPV infection and the incidence of cervical diseases in Longhua District of Shenzhen are in line with the national epidemiological survey of HPV.Compared with liquid based cytological examination,the sensitivity of HPV is higher,but the specificity is not as good as liquid based cytology.Compared with the other 12 subtypes of HR-HPV,the HPV16/18 subtype has higher risk related to cervical lesions.Viral load is also associated with increased risk of cervical lesions.

关 键 词：宫颈病变 高危型人乳头瘤病毒 人乳头瘤病毒16/18 病毒载量 液基细胞学 病理活检 

分 类 号：R711.74[医药卫生—妇产科学]