摘要
目的评价细胞学、HPV高危型检测对宫颈病变的筛查效力。方法对门诊1 436例细胞学异常(TBS系统诊断≥ASC-US)的患者,同时应用HC-Ⅱ(Hybrid CaptureⅡ)方法检测高危型HPV(HR-HPV),对其中841例进行阴道镜检查并取活检,以病理学为标准,比较两种方法在宫颈病变筛查中的意义。结果细胞学异常1 436例中,HR-HPV阳性率分别为ASC 28.6%(269/939),LSIL 74.0%(288/389)、HSIL 88.0%(95/105)。行阴道镜检查的841例中,病理学诊断NILM、CINⅠ/HPV、CINⅡ/Ⅲ分别为236、540、65例,其HR-HPV阳性率分别为9.7%(23/236),60%(324/540),96.9%(63/65)。410例HR-HPV阳性病例中,病理学≥CINⅠ/HPV占94.4%(387/410),其中CIN/ⅠHPV 83.7%(324/387),CINⅡ/Ⅲ16.3%(63/387);431例HR-HPV阴性病例中,病理学≥CINⅠ/HPV占50.6%(218/431),其中CINⅠ/HPV占99.1%(216/218),CINⅡ/Ⅲ(0.09%)。对宫颈低度以上病变,细胞学(≥LSIL)、HR-HPV、HR-HPV+细胞学(≥LSIL)三种方法的敏感性分别为0.498,0.640,0.726;特异性分别为0.987,0.903,0.890;不同检查方法有显著统计学差异(P<0.001)。对宫颈高度病变,细胞学(≥LSIL)、HR-HPV、HR-HPV+细胞学(≥LSIL)的敏感性分别为0.938、0.969、1.000,不同方法无显著统计学差异(P>0.05);特异性分别为0.687,0.552,0.485,不同方法间有显著统计学差异(P<0.001)。结论细胞学、HPV高危型检测是有效的宫颈癌筛查方法,二者结合应用将更有利于科学的管理宫颈病变。
Objective To evaluate the significance of cytology and high risk -human pappilomavirus （HR-HPV） testing in screening cervical lesion. Methods A total of 1436 cases with abnormal cervical smear were examined for HR-HPV by hybrid capture Ⅱ , then 841 cases of them received colposcopy with biopsy. Results In the 1436 cases, the positive rate of HR-HPV of ASC was 28.6% （269/939）, LSIL 74.0% （288/389） and HSIL 88.0% （95/105）. Among 841 cases undergone colposcopy, the pathology diagnosis as NILM, CIN Ⅰ/HPV, CIN Ⅱ/Ⅲ were 236, 540 and 65 cases, respectively. And the positive rates of HR-HPV of the above three groups were 9.7% （23/236）, 60% （324/540） and 96.9% （63/65）, respectively. In the 841 cases, 410 cases was HR-HPV positive, 94.4% （387/410） of which were or severer than CIN Ⅰ/HPV, including 83.7% （324/387） CIN Ⅰ/HPV and 16.3% （63/387） CIN Ⅱ/Ⅲ. In the 841 cases, 431 cases were HR-HPV negative, 50.6% （218/431） of which were or severer than CIN Ⅰ/HPV, including 99.1% （216/218） CIN Ⅰ/HPV and 0.09% （2/218） CIN Ⅱ/Ⅲ For the detection of cervical intraepithelial neoplasia （ ≥ CIN Ⅰ/HPV）, the sensitivity of cytology, HR-HPV, cytology combined with HR-HPV were 0.498, 0.987, 0.726, respectively and the specificity were 0.640, 0.903, 0.890, respectively. Significant differences among the three methods were observed （ P 〈 0.001 ）. For the detection of high-grade cervical intraepithelial neoplasia （ ≥CIN Ⅱ/Ⅲ ）, the sensitivity of cytology, HR-HPV, cytology combined with HR-HPV were 0.938, 0.687, 1.000, respectively and the specificity were 0.%9, 0.552, 0.485, respectively. Significant difference among the three methods was found in specificity （ P 〈 0.001） , but not in sensitivity（P〉0.05）. Conclusions Cytology and HR-HPV testing are the praetical methods for detecting cervical lesion. Cytology combined with HR- HPV testing is the optimal screening approach of cervical lesion.
出处
《中国妇产科临床杂志》
2006年第2期89-93,T0001,共6页
Chinese Journal of Clinical Obstetrics and Gynecology
