TCT和HPV-DNA在绝经女性宫颈癌筛查中的应用价值  

The application of thin-layer liquid-based cytology and human papillomavirus typing in the physical examination screening of cervical precancerous lesions in postmenopausal women

作　　者：王书彩[1] 王艳芳[1] 王茉 温寒[1] 袁彩欣[1] 徐小莉[1] WANG Shucai;WANG Yanfang;WANG Mo(The Fourth Hospital of Hebei Medical University,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院,石家庄市050011

出　　处：《河北医药》2023年第6期861-864,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20150811)。

摘　　要：目的 探讨薄层液基细胞学(TCT)检测和人乳头瘤病毒(HPV-DNA)分型检测对于绝经女性宫颈癌前病变筛查中的应用价值,为体检中心开展筛查、随访及健康教育工作提供依据。方法 以2018年8~10月体检中心参加宫颈癌筛查、年龄≤65岁的绝经女性200例作为研究对象,研究对象均参加TCT检测和HPV-DNA分型检测,排除TCT和HPV双阴性的绝经女性,对有任一阳性的绝经女性均进行阴道镜下病理活检,比较TCT和HPV的阳性检出率及灵敏度;TCT阴性组和TCT阳性组的病理学阳性检出率及HPV的阳性检出率;进一步分析HPV-DNA不同分型病理学阳性检出率及TCT阳性组和HPV-DNA阳性组、联合阳性组的病理学阳性检出率。结果 TCT和HPV双阴性的检出人数82例,TCT和HPV任一阳性检出人数118例,其中,TCT阳性的68例;HPV阳性的98例,双阳性48例,病理学阳性人数65例。TCT阳性检出率低于HPV,差异有统计学意义(P<0.01);65例病理学阳性患者中,TCT和HPV阳性人数为41例、58例,灵敏度为63.1%、89.2%,差异有统计学意义(P<0.01);TCT阴性组中检出病理学阳性人数24例、HPV阳性人数50例,TCT阳性组检出病理学阳性人数41例、HPV阳性人数48例,2组病理学阳性检出率(48%、60.3%)比较差异无统计学意义(P>0.05),HPV的阳性检出率(100%、70.6%)比较差异有统计学意义(P<0.01);HPV-DNA分型检测结果中,HPV-DNA分型为16、18单一或混合阳性43例,病理学阳性人数31例;其他型阳性55例,病理学阳性人数27例,二者的病理学阳性检出率(72.1%、49.1%)比较差异有统计学意义(P<0.05);TCT阳性组和HPV阳性组及联合阳性组的病理学阳性检出率比较差异有统计学意义(P<0.05)。结论 HPV-DNA分型检测对绝经女性宫颈癌筛查灵敏度高,单用TCT筛查会造成漏诊,联合筛查有助于提升健康体检绝经女性的早期筛查效率,对体检中心开展筛查管理具有重要意义。Objective To explore the application value of thin-layer liquid-based cytology(TCT)and human papillomavirus(HPV-DNA)typing in the screening of cervical precancerous lesions in postmenopausal women,and to provide basis for screening,follow-up visits and health education in physical examination centers.Methods A total of 200 postmenopausal women aged younger than 65 years who participated in cervical cancer screening from August to October 2018 in the physical examination center were selected as subjects.All the subjects participated in TCT test and HPV-DNA typing test,and those with both negative TCT and HPV were excluded.Colposcopic biopsy was performed in postmenopausal women with either positive TCT or positive HPV.The detection rate and sensitivity of TCT and HPV were compared.The detection rate of positive pathological findings and positive HPV in postmenopausal women with TCT negative or positive were compared.The detection rate of positive pathological findings in postmenopausal women with different typings of HPV-DNA,positive TCT,positive HPV-DNA and positive TCT combined with HPV-DNA was compared.Results There were 82 postmenopausal women with both negative TCT and HPV,and 118 with either positive TCT or HPV,including 68 with positive TCT,98 with positive HPV and 48 with both positive TCT and HPV.Positive pathological findings were detected in 65 postmenopausal women.The detection rate of positive TCT was significantly lower than that of HPV(P<0.01).Among 65 postmenopausal women with positive pathological findings,there were 41 and 58 cases of positive TCT and HPV,respectively.The sensitivity in detecting positive TCT was significantly lower than that of HPV(63.1%vs.89.2%,P<0.01).In postmenopausal women with negative TCT,there were 24 and 50 with positive pathological findings and positive HPV,respectively.In postmenopausal women with positive TCT,there were 41 and 48 with positive pathological findings and positive HPV,respectively.The detection rate of positive pathological findings in postmenopausal wo

关 键 词：薄层液基细胞学 人乳头瘤病毒 绝经女性 宫颈癌 体检 

分 类 号：R711.74[医药卫生—妇产科学]