影视阴道镜在诊断宫颈亚临床HPV感染中的价值

Value of Video colposcopy in diagnosis of cervical subclinical papillomvirus infection

目的 分析宫颈亚临床人乳头瘤病毒感染（SPI）的阴道镜图象特征，探讨影视阴道镜在其诊断中的应用价值。方法 2003年11月至2004年9月间我院宫颈病门诊病人4146例，均行阴道镜检查并活检，对其中215例肉眼无湿疣表现，但阴道镜检查显示有SPI特征性图象的临床资料与116例经病理检查确诊为人乳头瘤病毒（HPV）感染的临床资料进行回顾性分析。结果 部分无临床表现，但阴道镜下所显示的特征图象与病理诊断确诊为宫颈上皮HPV感染存在着密切的关系。在最后确诊为宫颈HPV感染的116例病人中，细胞学提示HPV感染为2例（1．7％），醋酸白试验阳性图象表现的有60例（51．7％），镶嵌加点状血管图象表现的有14例（12．1％），仅有点状血管表现的10例（8．6％），白斑块或表面粗糙不平的10例（8．6％），具混合性特征图象表现的有22例（8．9％）。215例中确诊为HPV感染的116例。其试验灵敏度为53．9％，特异性为99．4％，阳性预测值为84．6％。结论 影视阴道镜在诊断子宫颈SPI感染中有一定的临床价值，具有简便、价廉、符合率高等优点。

Objective To study the accuracy and efficiency of video colposcopy in diagnosis of cervical subclinical papillomavirus infection（SPI）. Methods In 4146 outpatients with cervix uteri diseases between Nov, 2003 and Sep, 2004, cervical biopsies of all patients were performed under the guidance of video colposcopy for pathological study. Of 215 patients without condyloma features, 116 patients that the examinations of colposcopy showed the characteristic changes of subclinical papillomavirus infection and human papillomavirus （HPV） infection were retrospectively analyzed. Results The characteristic changes of colposcopy was closely associated with SPI of pathological diagnosis or HPV infection of cervix uteri. In 116 patients, cytological examination showed 2 patients （1.7%） with HPV infection. 60 （51.7%） were positive acetowhite epithelium test, and other patients had different changes. Of 215, 116 were HPV infection. The sensitivity, specificity and positive predictive value of video colposcopy in evaluation of cervical subclinical papillormavirus lesion were 53.9%, 99.4%, and 84.6%, respectively. Conclusions Video colposcopy might be an accurate diagnostic method in clinical practice. It is quite sensitive in diagnosis of cervical subclinical papillomavirus infection.