HPV分型与TCT联合筛查对阴道镜分流时机探索  

Exploration on timing of colposcopy shunt by HPV typing and TCT combined screening

作　　者：姚晔 李丽萍 徐细花 YAO Ye;LI Liping;XU Xihua(Department of Clinical Laboratory,Nanchang Municipal First Hospital,Nanchang,Jiangxi 330008,China)

机构地区：[1]江西省南昌市第一医院检验科,330008

出　　处：《重庆医学》2022年第24期4203-4207,共5页Chongqing medicine

基　　金：江西省卫生健康委员会科技计划项目(202211622)。

摘　　要：目的分析江西省南昌地区人乳头瘤病毒(HPV)流行病学特点,探究适用于该地区女性宫颈癌的筛查策略和方案。方法选取2020年7月至2022年1月该院收治的进行宫颈癌机会性筛查的8987例女性作为研究对象,对8987例患者进行宫颈液基细胞学(TCT)检测,对自愿且经济允许的6269例患者进行HPV分型检测。评估HPV分型和TCT筛查结果,对符合转诊阴道镜检查的患者进行阴道镜及病理组织活检。以宫颈组织病理活检结果为“金标准”,评价HPV阳性结果在阴道镜分流中的应用价值。结果6269例HPV筛查患者中HPV阳性1104例,HPV感染者占17.61%,高危HPV感染者占75.54%(834/1104),单一亚型感染者占75.72%(836/1104)。834例高危HPV感染者中占比居前列的亚型为HPV 52、16、58。8987例TCT筛查患者中结果异常182例,占2.03%,意义不明的非典型鳞状上皮细胞(ASC-US)、非典型鳞状上皮细胞不除外高度鳞状上皮内病变(ASC-H)、低级别鳞状上皮内病变(LSIL)、高级别鳞状上皮内病变(HSIL)、宫颈癌分别占58.79%(107/182)、3.30%(6/182)、20.33%(37/182)、13.19%(24/182)、4.40%(8/182)。筛选出TCT结果阴性、高危HPV分型检测阳性患者106例进一步分流阴道镜及病理组织活检,宫颈上皮内瘤变(CIN)Ⅰ57例,CINⅡ25例,CINⅢ8例,宫颈癌16例。在宫颈高级别病变患者中HPV感染以16、58、33、52型为主。结论该地区女性HPV感染最多见为HPV 52、16、58型,宫颈高级别病变中HPV 16、58、33、52型具有较强的致病力,应高度重视阴道镜分流管理,避免出现宫颈癌的漏检。Objective To analyze the epidemiological characteristics of HPV in Nanchang area of Jiangxi Province,and to study the screening strategy and scheme suitable for female cervical cancer(CC)in this area.Methods A total of 8987 women undergoing the opportunistic screening of cervical cancer in this hospital from July 2020 to January 2022 were selected as the research subjects.The thin-prepcytology test(TCT)was performed in 8987 cases,and 6269 cases voluntarily and financially allowed conducted the HPV typing detection.The HPV typing and TCT screening results were evaluated.The patients conforming to convert to colposcopy conducted the colposcopic and pathological tissue biopsy.The results of cervical tissue pathological biopsy served as the gold standard.The application value of HPV positive results in the colposcopic shunt was evaluated.Results Among 6269 cases of HPV screening,the HPV positive was in 1104 cases with the HPV infection rate of 17.61%,the high-risk HPV infection rate was 75.54%(834/1104),and the single subtype infection rate was 75.72%(836/1104).Among 834 cases of high-risk HPV infection,the leading subtypes were HPV 52,16 and 58.Among 8987 cases of TCT screening,the results were abnormal in 182 cases,accounting for 2.03%,in which ASU-US,ASU-H,LSIL,HSIL and CC accounted for 58.79%(107/182),3.30%(6/182),20.33%(37/182),13.19%(24/182)and 4.40%(8/182)respectively.A total of 106 case of TCT results negative and high-risk HPV typing positive were screened out,which were further shunted to colposcopy and pathological tissue biopsy,showed 57 cases of CINⅠ,25 cases of CINⅡ,8 cases of CINⅢand 16 cases of CC.Among the patients with high-grade cervical lesions,HPV infection was mainly subtype 16,58,33 and 52.Conclusion The most common subtypes of HPV infection in females of this area are HPV52,16 and 58.Among the high-grade cervical lesions,HPV16,58,33 and 52 have strong pathogenicity.Therefore,the colposcopy shunt management should attach great importance to avoid missed detection of CC.

关 键 词：高危人乳头瘤病毒 人乳头瘤病毒亚型 阴道镜分流 筛查 江西 

分 类 号：R446[医药卫生—诊断学] R34[医药卫生—临床医学]