宫颈液基细胞学检查联合高危型人乳头瘤病毒检测在宫颈癌筛查中的应用价值  

Value of thinprep cytologic test combined with detection of high-risk human papillomavirus in screening of cervical cancer

作　　者：周扬帆[1] 杨晓扬 朱成全 王爱武[1] 陈艳宇[1] 谭夕[1] 陈钰[3] 迮浩城 刘艳红 ZHOU Yangfan;YANG Xiaoyang;ZHU Chengquan;WANG Aiwu;CHEN Yanyu;TAN Xi;CHEN Yu;ZE Haocheng;LIU Yanhong(Department of Pathology,Second People’s Hospital of Guangdong Province,Emergency Hospital of Guangdong Province,Guangzhou,Guangdong,017317;th Army Hospital of Land Force of People’s Liberation Army,Guangzhou,Guangdong,017317;Department of Gynaecology,Second People’s Hospital of Guangdong Province,Emergency Hospital of Guangdong Province,Guangzhou,Guangdong,010317)

机构地区：[1]广东省第二人民医院/广东省应急医院病理科,广东广州410317 [2]中国人民解放军陆军第七十四集团军医院,广东广州015115 [3]广东省第二人民医院/广东省应急医院妇科,广东广州010317

出　　处：《实用临床医药杂志》2020年第15期46-50,54,共6页Journal of Clinical Medicine in Practice

基　　金：广东省医学科学技术研究基金项目(B2017096)。

摘　　要：目的探讨宫颈液基细胞学检查(TCT)联合高危型人乳头瘤病毒(HR-HPV)核酸检测在宫颈癌筛查中的应用价值。方法回顾性分析332例经TCT诊断为意义不明确的非典型鳞状细胞(ASC-US)患者的HR-HPV核酸检测结果和组织病理检查结果,将ASC-US患者按不同年龄段分为青年组及中老年组,比较2组HR-HPV结果及宫颈组织病理检查结果。结果 TCT(ASC-US)且HR-HPV(+)组的宫颈组织病理学符合率高于TCT(ASC-US)且HR-HPV(-)组、TCT(阴性)且HR-HPV(+)组,差异有统计学意义(P <0.001);青年组的HR-HPV核酸阳性率、组织病理学阳性率与中老年组比较,差异有统计学意义(P <0.05);2组ASC-US患者HR-HPV核酸检测的准确率、灵敏度及阳性预测值比较,差异无统计学意义(P> 0.05),但HR-HPV核酸检测的特异度、约登指数、阴性预测值比较,差异有统计学意义(P <0.05);全组、青年组、中老年组患者中,不同级别宫颈病变的HR-HPV阳性率比较,差异均有统计学意义(P <0.05)。结论 TCT诊断为ASC-US的患者联合采用HR-HPV检测可以提高宫颈鳞状上皮内病变的检出率,尤其适用于中老年人群。Objective To analyze the application value of nucleic acid detection of thinprep cytologic test(TCT)combined with nucleic acid detection of high-risk human papillomavirus(HR-HPV)in screening of cervical cancer.Methods The results of nucleic acid of HR-HPV and histopathology test in 332 cases confirmed as atypical squamous cells of undetermined significance(ASC-US)by TCT were retrospectively analyzed.These confirmed patients were divided into young group and middle and higher aged group according to age.The results of HR-HPV and cervical histopathology were compared between the two groups.Results The patients confirmed as ASC-US by TCT combined with positive HR-HPV had significantly higher histopathological coincidence rate of than those confirmed as ASC-US by TC combined with negative HR-HPV and those without ASC-US combined with positive HR-HPV(P<0.001).The positive rates of HR-HPV nucleic acid and histopathology tests in the young group showed significant differences compared to those of the middle and higher aged group(P<0.05).There were no significant differences in the accuracy,sensitivity and positive predictive value of nucleic acid test of HR-HPV in ASC-US patients of two groups(P>0.05),but there were significant between-group differences in the specificity,Jordan index and negative predictive value of HR-HPV nucleic acid test(P<0.05).There was significant difference in the HR-HPV positive rate of different levels of cervical lesions in the whole group,the young group or the middle and higher-aged group(P<0.05).Conclusion The combination of HR-HPV improves the detection rate of cervical squamous intraepithelial lesions in ASC-US patients confirmed by TCT,and it is especially suitable to middle and higher aged group.

关 键 词：高危型人乳头瘤病毒 意义不明确的非典型鳞状细胞 宫颈液基细胞学检查 宫颈癌筛查 

分 类 号：R737.33[医药卫生—肿瘤]