DNA倍体分析联合HPV-DNA分型检测对宫颈高级别鳞状上皮内病变的意义  

Significance of DNA ploidy analysis combined with HPV-DNA 23 typing test for high-grade cervical lesions

作　　者：孙春杰 余小蒙[2] 杨洁 张金影 王学会 张中秋 贺文 SUN Chun-jie;YU Xiao-meng;YANG Jie;ZHANG Jin-ying;WANG Xue-hui;ZHANG Zhong-qiu;HE Wen(Department of Pathology,Tongzhou Maternal&Child Health Hospital of Beijing,Beijing 101101,China;Department of Pathology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Statistics,Tongzhou Maternal&Child Health Hospital of Beijing,Beijing 101101,China)

机构地区：[1]北京市通州区妇幼保健院病理科,北京101101 [2]首都医科大学附属北京友谊医院病理科,北京100050 [3]北京市通州区妇幼保健院统计科,北京101101

出　　处：《诊断病理学杂志》2021年第6期473-476,481,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨液基细胞涂片检查(LBP^(*)),DNA倍体分析检测(DNA^(*))及HPV-DNA 23分型检测(HPV^(*))对诊断宫颈高级别鳞状上皮内病变的意义。方法收集492例宫颈活检病例,要求同时有LBP^(*)、DNA^(*)、HPV^(*)及宫颈组织活检结果。用宫颈刷刷取细胞标本,制成LBP^(*)涂片两张,一张用作LBP^(*)TBS分级诊断,另一张用作DNA^(*)。再次刷取细胞标本用于HPV^(*)。以宫颈活检组织病理诊断结果作为评价标准。拟定判读ASC-US及以上病变为LBP^(*)阳性,DI值≥2.5为DNA^(*)阳性,纯高危型为HPV^(*)阳性。宫颈活检结果以低级别(含CIN1、CIN1+HPV感染、HPV感染)及以上病变为阳性。结果以组织病理诊断作为标准,在492例活检病例中88例为宫颈高级别鳞状上皮内病变,LBP^(*)、DNA^(*)及HPV^(*)不同检测方法对高级别鳞状上皮内病变敏感度、特异度、阳性预测值、阴性预测值及总准确率分别为:LBP^(*):53.41%、79.95%、36.72%、88.74%、75.2%;DNA^(*):57.95%、80.94%、39.84%、89.84%、76.83%;HPV^(*):90.91%、21.78%、20.20%、91.67%、34.15%。LBP^(*)、DNA^(*)特异度、阳性预测值及总准确率都高于HPV^(*),HPV^(*)敏感度最高。结论在细胞学标本诊断宫颈高级别鳞状上皮内病变中,DNA^(*)与HPV^(*)联合检测可提高宫颈高级别鳞状上皮内病变的敏感度和特异度。Objective To investigate the significance of liquid based smear( LBP^(*)),DNA ploidy analysis( DNA^(*))and HPV-DNA 23 typing( HPV^(*)) in the diagnosis of high-grade cervical lesions. Methods 492 cases of the first cervical brushing samples were collected. LBP^(*),DNA^(*),HPV^(*)and cervical biopsy result were required. Two pieces of LBP^(*)smears were made by brushing cervical cells. One was used for LBP^(*)TBS grading diagnosis,and the others was used for DNA^(*). The second brushing cervical cells were used for HPV^(*). The pathological diagnosis result of cervical biopsy were used as evaluation criteria. It is suggested that ASC-US and above lesions are LBP^(*)positive,DI ≥ 2. 5 is DNA^(*) positive,and pure high-risk type is HPV^(*)positive. Cervical biopsy result with low grade( including CIN1,CIN1 +HPV infection,HPV infection) and above lesions were positive. Results The sensitivity,specificity,positive predictive value,negative predictive value and total accuracy of LBP^(*),DNA^(*) and HPV^(*) were 53. 41%,79. 95%,36. 72%,88. 74% and 75. 2%, 57. 95%, 80. 94%, 39. 84%, 89. 84% and 76. 83% respectively, and HPV^(*),respectively90. 91%、21. 78%、20. 20%、91. 67%、34. 15%.The specificity,positive predictive value and total accuracy of LBP^(*) and DNA^(*) were higher than those of HPV^(*),and HPV^(*)had the highest sensitivity. Conclusion In cytological diagnosis of high-grade cervical lesions,DNA^(*) and HPV^(*) combined detection can improve the sensitivity and specificity of high-grade cervical lesions.

关 键 词：液基细胞学 DNA倍体分析 HPV-DNA 23分型检测 

分 类 号：R711.3[医药卫生—妇产科学]