HPV DNA/液基细胞学检测诊断宫颈病变的临床意义

Clinic significance of combination of human papillomavirus DNA test and ThinPrep liquid based cytology in diagnosis of early cervical cancer and precancer lesions

目的 探讨HPVDNA检测联合液基细胞学诊断宫颈病变的临床意义。方法对在本院妇产科门诊就诊的4248名妇女用HPV DNA（HC-Ⅱ）方法检测高危型HPV DNA（FIR-HPV）；对HPV阳性的妇女进行宫颈超薄液基细胞学检测（ThinPrep，TCT）；对HR-HPV和TCF两者均为阳性者再进行阴道镜检查和病理学检查；并与同期在门诊就诊仅行宫颈TCF检查者比较。对HR-HPV阳性而细胞学正常者1241例随访。结果①HR-HPV阳性者1682名（38．32％），平均年龄（33．68±9．60）岁；细胞学检查LSIL（CINI）178例（10．58％）；HSIL（CIN Ⅱ和CIN Ⅲ）63例（3．75％）；鳞状细胞癌和腺癌9例（0．54％）；②对HR-HPV和TCF均为阳性者250例再行阴道镜下活组织检查，病理结果为CIN Ⅰ 151例（8．98％），CIN Ⅱ34例（2．02％），CIN Ⅲ25例（1．49％），浸润癌13例（0．77％）；③同期门诊仅行TCF检查的11000名女，LSIL 449例（4．08％）、HSIL 85例（0．77％）、癌15例（0．14％），行HR-HPV/TCT检查阳性各组与TCT检查阳性各组进行了对比，经统计学处理，差异均有显著性（P〈0．05）；④HR-HPV阳性而细胞学正常者1241例随访，初检后4-12个月449名（36．18％）持续HR-HPV阳性，其中18例（1．45％）组织学诊断为HSIL，19例（1．53％）为LSIL。HPV持续阳性者和转阴者之间年龄比较，经统计学处理无明显差别（X^2=2．94，P〉0．05）。结论HPV检测可以明显提高细胞学检查的敏感性，HR-HPV／TCT联合检测是筛查早期宫颈病变的最佳选择；其结果对宫颈病变有预警作用。

Objective To investigate clinic significance of human papillomavirus DNA testing and Thinprep liquid based cytology in diagnosis of early cervical cancer and precancer lesions. Metihods A total of 4 248 women with high risk factors were tested for high -risk types of HPV by Hybrid Capture Ⅱ （HC-Ⅱ） assay. Women with positive HPV DNA underwent a Thin-Prep liquid based cytology test （TCT）. Women with positive HPV DNA and TCT were referred for colposcopy and biopsy. Results A total of 1682 （38.32%） women were proved to have been infected by high-risk HPV, aged （33.68±9.60） years （ 19-60 years）, 33.3 % （537/1628） of which were younger than 30 years old. Among the 250 women with positive HPV and positive TCT received colposcopy and biopsy, 151 were CIN Ⅰ , 34 CIN Ⅱ , 25 CIN Ⅲ and 13 invasive cervical cancer. Conclusions HPV DNA testing may increase sensitivity of cytologic screening. Combination of HC-Ⅱ and TCT is the optimal approach for diagnosis of early cervical cancer and precancer Lesions. HPV DNA testing may forewarn CIN.