高危型人乳头瘤病毒检测在子宫颈病变筛查和处理中的意义及作用

Role of High-risk Human Papillomavirus Testing in the Screening and Management of Cervical Cancer Precursors

人乳头瘤病毒(HPV)感染是子宫颈癌发生的必要因素,HPV检测可最大程度优化子宫颈筛查和子宫颈异常细胞学的临床处理。对于30岁以上妇女,如HPV检测为阴性且子宫颈细胞学检查正常,可安全地将子宫颈筛查间隔延长至3年。但是,由于HPV病毒感染在年轻妇女中常见且多为一过性感染,因此不建议将HPV检测作为年龄小于30岁妇女的子宫颈筛查内容。对于任何年龄妇女,建议将HPV检测作为未明确诊断的不典型鳞状上皮细胞患者的分流检测方法,同时对于不能除外高度鳞状上皮内病变的不典型鳞状上皮细胞、鳞状上皮内低度病变或不典型腺细胞而未发现中或重度不典型增生的患者,HPV也是随诊方法之一。对于治疗后患者,HPV检测也和阴道镜及子宫颈细胞学一样,可作为随诊方法。HPV检测的正确使用可促进异常子宫颈细胞学的处理。

Human papillomavirus （HPV） infection is an essential cause of cervical cancer. HPV testing therefore may maximize the clinical benefits of cervical screening and abnormal cervical cytology management. A negative HPV test in combination with a normal Pap test result in women age 30 years or older allows the safe extension of the cervical screening interval to 3 years. However, because HPV infection is common in young women and is usually transient, HPV testing is not recommended as part of primary cervical screening for women younger than 30 years. HPV testing is recommended for women of any age as a triage test with atypical squamous cells of undetermined significance （ASC-US） results and as an option for follow-up of women with HPV-positive ASC-US, atypical squamous cells ＂cannot rule out high-grade,＂ low-grade squamous intraepithelial lesions, or atypical granular cells not found to have CIN 2/3. HPV testing is also recommended as an alternative to colposcopy and/or cytology for follow-up of treated cases. Proper use of HPV testing improves the management of women with cytologic abnormalities.