TCT联合HC-Ⅱ HPV筛查宫颈病变及药物干预的方法

Combining TCT and HC-Ⅱ HPV to Screen Cervical Lesions and Drug Intervention Methods

目的探讨应用液基薄层宫颈刷片细胞学检测（Thinprep cytologicaltest，TCT）及杂交捕获二代（Hybridcapture Ⅱ，HC-Ⅱ）人乳头瘤病毒（Humanpapilloma virus，HPV）分型检测筛查宫颈病变的意义和对高危病例进行药物干预的方法。方法2004年4月～2005年8月，采用TCT和HPVDNA分型检测对17320例患者进行宫颈病变的筛查，并以病理组织学活捡为标准来验证筛查结果，同时应用氟尿嘧啶（5-Fu）可吸收缓释药膜对适宜病例进行局部干预治疗。结果TCT结果异常者1754例，其中高危型HPV-DNA阳性450例；431例TCT提示无HPV感染病例中有172例高危型HPV-DNA阳性；TCT或TCT联合HC-ⅡHPV筛查宫颈上皮内瘤样病变（Cervical intraepithelial neoplasia，CIN）Ⅱ级及以上病变的敏感性和特异性分别为81．12％、89、65％和72．08％、97．99％；采用5Fu可吸收缓释药膜治疗25例CINI级HPV高危型感染患者后，其病毒负荷量下降幅度、转阴率和病理逆转率均明显高于对照组，差异具有统计学意义（P〈0．05）。结论TCT和HPV分型检测联合应用于宫颈病变筛查可提高CINⅡ级及以上病变的特异性检出；5-Fu可吸收缓释药膜治疗CINI级HPV高危型感染患者可降低其病毒负荷量，甚至清除。

Objective To approach the screening efficacy of the combination of thinprep cytological test （TCT） and hybrid capture Ⅱ （HC-Ⅱ） HPV for cervical lesions and the drug-intervention methods. Methods From April 2004 to August 2005,TCT and HC- Ⅱwere applied to screen cervical lesions in 17320 cases. And the pathologic results after cervix biopsies were considered as standard to verify the screening efficiency; the absorbable and sustained-release fluorouracil （Fu） medicine membranes were used as intervening treatment to eligible cases. Results 1754 cases with abnormal results were detected by TCT, and 450 positive samples by HC-Ⅱ HPV. 172 high risk HPV cases were detected by HC-Ⅱ HPV from 431 cases without infection of HPV proved by TCT. The sensitivity and specificity of screening by TCT or TCT combined with HC-Ⅱ HPV for cervical intraepithelial neoplasia （CIN） II and above are 81.12%,89. 65% and 72. 08% ,97.99%. After treated with the absorbable and sustained-release Fu medicine membranes, the descending extent of viral loading dose and negative rate and relief rate of 25 CINI cases were obviously superior to control group. The disparity is conspicuous for statistics significance （P%0. 05）. Conclusion The combination of TCT and HC-Ⅱ HPV are able to enhance the specific detection rate of CINII and above. And it is able to decrease the loading dose of HPV or even get rid of it by the absorbable and sustained- release 5-Fu medicine membranes for CINI cases.