人乳头瘤病毒16/18阳性联合阴道镜检查在宫颈细胞学阴性宫颈病变诊断中的应用  

Application of human papillomavirus 16/18 positive combined colposcopy in the diagnosis of cytologically negative cervical lesions

作　　者：宋文榕[1] 崔焱[1] 潘琳 Song Wenrong;Cui Yan;Pan Lin(Department of Gynecology,Hepingli Hospital,Beijing 100013,China)

机构地区：[1]北京市和平里医院妇科,100013

出　　处：《山西医药杂志》2023年第4期265-269,共5页Shanxi Medical Journal

摘　　要：目的观察人乳头瘤病毒(HPV)16/18阳性联合阴道镜检查在宫颈细胞学阴性的宫颈病变诊断中的应用。方法选取我院妇科门诊2018年6月至2021年6月收治的宫颈细胞学检测结果为阴性且HPV 16/18阳性结果的患者120例,所有患者均接受阴道镜检查及宫颈活检联合宫颈管搔刮术(ECC),以病理学诊断为标准,分析诊断效果。结果组织病理学结果显示,120例患者中宫颈炎85例(70.8%),宫颈上皮内瘤变(CIN)Ⅰ15例(12.5%),CINⅡ13例(10.8%),CINⅢ5例(4.2%),宫颈癌2例(1.7%)。120例宫颈细胞学检测结果为阴性且HPV 16/18阳性的患者中,HPV 16型感染90例(75.0%),HPV18型感染20例(16.7%),HPV16/18型同时阳性感染10例(8.3%)。90例HPV 16阳性患者中,宫颈炎72例,CIN 8例,CINⅡ6例,CINⅢ3例,宫颈癌1例;20例HPV 18阳性患者中,宫颈炎10例,CINⅠ5例,CINⅡ4例,CINⅢ1例,宫颈癌0例;10例HPV 16/18同时阳性患者中,宫颈炎3例,CINⅠ2例,CINⅡ3例,CINⅢ1例,宫颈癌1例。HPV 16/18 HPV同时阳性患者≥CINⅡ级比例为50.0%,高于HPV16/18单一阳性患者的11.1%和25.0%,差异具有统计学意义(P<0.05)。阴道镜诊断宫颈细胞学阴性、HPV 16/18阳性患者的宫颈病变准确率为95.0%,灵敏度为96.0%,特异度为85.5%。结论对于宫颈细胞学阴性、HPV 16/18阳性患者宜进一步行阴道镜宫颈活检,以减少宫颈高级别鳞状CIN甚至癌变的漏诊。Objective To observe the application of human papillomavirus 16/18 positive combined colposcopy in diagnosis of cervical cytological negative cervical lesions.Methods One hundred and twenty patients with negative cervical cytology and positive 16/18 high-risk HPV were selected from the department of Gynecology outpatient department of our hospital from June 2018 to June 2021.All patients received colposcopy and cervical biopsy combined with cervical canal scratching(ECC),and the diagnostic effect was analyzed based on the pathological diagnosis.Results The histopathological results showed that 85 cases(70.8%)had cervicitis,15 cases(12.50%)had cervical intraepithelial neoplasia(CIN)Ⅰ,13 cases(10.8%)had CINⅡ,5 cases(4.2%)had CINⅢ,and 2 cases(1.7%)had cervical cancer.Among the 120 patients with negative cervical cytology and 16/18 HPV positive,90(75.0%)were HPV16,20(16.7%)HPV18,and 10(8.3%)were both HPV16 and 18 positive.There were 72 cases of cervicitis,8 cases of CINⅠ,6 cases of CINⅡ,3 cases of CINⅢand 1 case of cervical cancer.Among the 20 high-risk HPV-positive patients,10 were cervical inflammation,5 were CINⅠ,4 were CINⅡ,1 was CINⅢ,and 0 was cervical cancer.Among the 10 high-risk patients who were also HPV positive,there were 3 cases of cervicitis,2 cases of CINⅠ,3 cases of CINⅡ,1 case of CINⅢand 1 case of cervical cancer.The proportion of high-risk HPV16 and 18 patients with HPV positive≥CINⅡwas 50.0%,which was higher than 11.1%and 25.0%of high-risk HPV16 and 18 patients,and the difference was statistically significant(P<0.05).The accuracy,sensitivity and specificity of colposcopy were 95.0%,96.0%and 85.5%in cervical cytological negative patients with high-risk HPV 16/18 positive.Conclusion Colposcopic cervical biopsy should be further performed in patients with negative cervical cytology and 16/18 high-risk HPV positive,to reduce the missed diagnosis of high-grade squamous intraepithelial lesions or even cancerization of the cervix.

关 键 词：宫颈疾病 技术细胞学 人乳头瘤病毒16 人乳头瘤病毒18 阴道镜检查 

分 类 号：R737.33[医药卫生—肿瘤]