高危型人乳头瘤病毒联合宫颈液基薄层细胞学检测在宫颈上皮内瘤变筛查中的应用价值  

High Risk HPV Test Combined with TCT in the Screening of Cervical Intraepithelial Neoplasia

作　　者：李婷婷[1] 王翠峰[1] LI Tingting;WANG Cuifeng(Clinical Laboratory,the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院检验科,内蒙古自治区包头市014010

出　　处：《中国全科医学》2021年第9期1106-1110,共5页Chinese General Practice

摘　　要：背景据2018年全球数据统计,每年约有56万宫颈癌新发病例,宫颈癌在发展中国家的病死率尚居高位。某些欠发达地区无法满足全面开展宫颈上皮内瘤变筛查工作的需要,单项检测项目漏检风险较大。目的探讨通过第三代杂交捕获定量分型(DH3)技术检测高危型人乳头瘤病毒(HPV)联合宫颈液基薄层细胞检测(TCT)在宫颈上皮内瘤变筛查中的应用价值。方法选择2020年1—6月于包头医学院第一附属医院进行宫颈筛查的女性患者1620例作为研究对象,使用DH3技术对患者进行14种HPV型别检测;依据伯塞斯达系统(TBS)宫颈细胞学分类法对TCT结果进行判读;以宫颈组织病理学检查为金标准,对结果进行统计分析。结果在1620例患者中,HPV检测阳性者619例,阴性者1001例;TCT阳性者449例,阴性者1171例;HPV检测联合TCT阳性者205例,阴性者1415例;病理学检查阳性者187例,阴性者1433例。HPV检测联合TCT对宫颈上皮内瘤变筛查的灵敏度(96.79%)、特异度(98.32%)、阳性预测值(88.29%)和阴性预测值(99.56%)均高于HPV检测(81.28%、67.41%、24.56%和96.50%)和TCT(75.40%、78.51%、31.40%和96.07%)。结论HPV检测联合TCT对宫颈上皮内瘤变筛查的灵敏度、特异度、阳性预测值和阴性预测值均高于单项检测,HPV检测联合TCT筛查宫颈上皮内瘤变可以降低单项检查的误诊率、漏诊率,具有较高的临床应用价值。Background According to global statistics 2018,there are about 560000 new cases of cervical cancer every year,and the mortality rate of cervical cancer in developing countries is still high.In some underdeveloped regions without appropriate conditions for carrying out comprehensive cervical cancer screening,single screening test for cervical cancer may have a high risk of missed diagnosis.Objective To explore the value of HPV test with TCT in the screening of cervical intraepithelial neoplasia.Methods We enrolled 1620 female patients who underwent cervical screening in the First Affiliated Hospital of Baotou Medical College from January to June 2020.Hybrid captureⅢassay was used to detect 14 types of HPV.TCT test results were interpreted according to the cytologic classification of the Bethesda System.The cervical histopathological diagnosis was used as the gold standard to evaluate the diagnosis accuracies of HPV test,TCT,and HPV test combined with TCT.Results Among the 1620 patients,619 were positive for HPV and 1001 were negative;449 were positive for TCT and 1171 were negative;205 were positive for HPV combined with TCT and 1415 were negative;histopathological diagnostic results were positive in 187 cases and negative in 1433 cases.In diagnosing cervical intraepithelial neoplasia,the HPV test combined with TCT showed higher sensitivity(96.79%vs 81.28%),specificity(98.32%vs 67.41%),positive predictive value(88.29%vs 24.56%)and negative predictive value(99.56%vs 96.50%)than HPV test.And it also demonstrated higher sensitivity(96.79%vs 75.40%),specificity(98.32%vs 78.51%),positive predictive value(88.29%vs 31.40%)and negative predictive value(99.56%vs 96.07%)than TCT.Conclusion Compared with HPV test or TCT,HPV test combined with TCT showed higher sensitivity,specificity,positive and negative predictive values,thereby reducing the possibilities of rates of missed diagnosis and misdiagnosis,demonstrating higher clinical value.

关 键 词：子宫颈 宫颈肿瘤 人乳头瘤病毒 液基薄层细胞检测 宫颈上皮内瘤变 核酸杂交 女性 筛查 

分 类 号：R737.3[医药卫生—肿瘤]