不同亚型高危型人乳头瘤病毒对子宫颈细胞学意义未明的不典型鳞状细胞患者进行分流的临床意义  

Performance of high-risk human papillomavirus genotyping in triaging women with atypical squamous cell of undetermined significance

作　　者：李雪[1] 康程[1] 孔为民 徐春晓[1] 宋玉晅 邢堃 李磊 LI Xue;KANG Cheng;KONG Wei-min;XU Chun-xiao;SONG Yu-xuan;XING Kun;LI Lei(Department of Gynecology and Obstetrics,Bejing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院妇产科,北京100076

出　　处：《中国实用妇科与产科杂志》2023年第7期749-752,共4页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的 研究最终被病理学确诊为子宫颈高级别鳞状上皮内病变(HSIL)的细胞学为意义未明的不典型鳞状细胞(ASC-US)患者与不同亚型高危型HPV(HR-HPV)感染的关系,并探讨不同亚型HR-HPV组合模型对ASC-US患者的分流作用。方法 回顾性分析2014年至2020年北京航天总医院子宫颈细胞学为ASC-US、HR-HPV阳性的患者,所有患者均行阴道镜检查及(或)子宫颈活组织检查,研究终点为病理组织学结果为子宫颈HSIL,包括子宫颈上皮内瘤变2级及更高级别病变(CIN2+),分析不同亚型HR-HPV的感染率、感染不同亚型HR-HPV最终诊断为CIN2+的比例,CIN2+的危险因素,建立不同的HR-HPV模型,患者出现模型中的任一HR-HPV感染即需转诊阴道镜,并根据阴道镜结果计算不同HR-HPV模型诊断CIN2+的敏感度、特异度、阳性预测值及阴性预测值。结果 共411例患者子宫颈细胞学检测为ASC-US、HR-HPV阳性,并行阴道镜检查。其中,HPV16型感染率最高(27.2%),其次为HPV52(22.9%)、HPV58(19.0%)、HPV39(9.0%)、HPV56(9.7%)、HPV68(8.8%)、HPV18(7.3%)、HPV33(7.3%)、HPV31(5.1%)。在411例患者中有101例最终被诊断为CIN2+,占比24.6%。感染不同亚型HR-HPV最终诊断为CIN2+的比例分别为:HPV16,39.3%;HPV52,23.4%;HPV58,17%;HPV33,36.7%;HPV18,26.7%;HPV31,33.3%;HPV56,15.0%;HPV51,14.3%;HPV68,11.1%;HPV39,8.1%;HPV66,18.8%;HPV35,6.7%;HPV59,6.3%;HPV45,0%。仅HPV16是子宫颈HSIL的危险因素,OR值为2.879(1.574~5.268),且有统计学意义。HPV16/18组合模型仅能检测到51.5%的CIN2+患者,HPV16/18/52/58/33/31组合模型的敏感度及阴性预测值高达94.1%及93.9%。结论 HR-HPV感染的患者中HPV16、52、58、18、33、31的感染率高,发展为CIN2+的风险高,HPV16/18/52/58/33/31组合模型可以检测到94%的CIN2+患者,因而HPV16/18/52/58/33/31组合模型可作为ASC-US人群的分流指标,能够有效地检出子宫颈高级别病变,并减少不必要的转诊。Objective To determine the performance of different high-risk human papilloma-virus(HR-HPV) in patients with cytology being atypical squamous cells of undetermined signicance(ASC-US) and cervical intraepithelial neoplasia,and to evaluate the effectiveness of triage with different HR-HPV genotype models among women with ASCUS.Methods Retrospective analysis of clinical data was carried out on patients with HR-HPV-positive and ASC-US in Beijing Aerospace General Hospital from 2014 to 2020.All these patients underwent colposcopy and biopsy.The study endpoint was histological detection of cervical intraepithelial neoplasia grade 2 or worse(CIN2+).The infection rates of different HR-HPV genotype,percentage of patients infected with different genotype of HR-HPV who were eventually diagnosed with CIN2+,and CIN2+risk factors were analyzed.Different HR-HPV models were established.The patients with any HR-HPV infection of the models were referred to receiving colposcopy,and according to the colposcopic results the sensitivity,specicity,positive predictive values and negative predictive values of different HRHPV genotype models in diagnosing CIN2+.Results Totally 411 women were identified as having ASC-US and HR-HPV-positive,and all of them underwent colposcopy.HPV16 had the highest infection rate(27.2%),followed by HPV52(22.9%),HPV58(19.0%),HPV56(9.7%),HPV39(9.0%),HPV68(8.8%),HPV18(7.3%),HPV33(7.3%)and HPV31(5.1%).In the 411 petients,101 women were identified as having CIN2+lesions,accounting for 24.6%.The proportion of final diagnosis of CIN2+with different HR-HPV subtypes was:HPV16,39.3%;HPV52,23.4%;HPV58,17%;HPV33,36.7%;HPV18,26.7%;HPV31,33.3%;HPV56,15.0%;HPV51,14.3%;HPV68,11.1%;HPV39,8.1%;HPV66,18.8%;HPV35,6.7%;HPV59,6.3%,and HPV45 0%.Only HPV-16 was a risk factor for CIN2+lesions,and the OR value was 2.879(1.574-5.268),which was statistically significant.HPV16/18 model could only detect 51.5% of CIN2+patients,and the sensitivity and negative predictive value of HPV16/18/52/58/33/31 model were as high as 94.1%and 93.9%.

关 键 词：高危型HPV分型检测 意义未明的不典型鳞状细胞 子宫颈高级别鳞状上皮内病变 

分 类 号：R737.33[医药卫生—肿瘤]