基层单位筛查子宫颈癌方法探讨

Study on methods for general investigation of cervical cancer in grass roots medical treatment

目的：建立一种比较适用于基层医疗单位对子宫颈癌筛查的高效、便捷的方法，并初步探讨HPV-16，HPV-18与宫颈癌之间的关系。方法：2001年5月至2007年8月，对6802例年龄在18-65岁的厦门郊区妇女采用传统PCR检测HPV-DNA和宫颈脱落细胞涂片检查方法进行筛查，同时对HPV-DNA阳性标本进行高危险型HPV16、HPV18荧光定量PCR检测。结果：6802例宫颈脱落细胞普查中有宫颈原位癌29例、CIN（癌前病变）Ⅰ-Ⅲ级215例；PCR定性筛查这些标本中有783例阳性，阳性率为11．5％。对这783例阳性标本进行荧光基因分型和定量，发现209例HPV-16、18型阳性，在HPV-16、18型阳性的患者中宫颈原位癌22例（占75．8％）、CIN Ⅰ-Ⅲ级153例（占71．6％），病毒定量值在3．6×10^3 copies／ml到6．74×10^7copies／ml之间。结论：常规宫颈脱落细胞涂片检查联合HPV-DNA检测可提高宫颈癌前病变的检出率，适用于基层单位展开大规模子宫颈癌筛查，是一种高效、便捷的筛查方法。HPV16，HPV18与子宫颈癌具高度相关性。

Objective：To establish a fast and convenient method for general investigation of cervical cancer in grass roots medical treatment and to study the relationship between HPV-16, HPV-18 and the cervical cancer. Methods：Cytotaxonomy and traditional PCR were used to detect 6802 women ranging from the age of 18-65 in suburb Xiamen City during the time of 2001.5-2007.8. Positivity of the above samples was performed for the gene type and gene quantity by fluorescence quantitative PCR （FQ-PCR）. Results：Among the 6802 cases ,29 were cervical cancers and 215 cervical intraepithelial neoplasia （CIN） Ⅰ-Ⅲ ; 783 cases were positive by traditional PCR and the positive ratio was 11.5%. While 209 cases were HPV 16 or HPV 18 ,among which 22 were cervical cancers（75.8% ）and 209 CIN Ⅰ - Ⅲ（71.6% ）. The gene quantity was between 3.6 × 10^3 copies to 6. 74×10^7 copies per milliliter. Conclusion：The cytotaxonomy combined with HPV-DNA PCR test is a fast and convenient method for general investigation of cervical cancer in grass roots medical treatment and the cervical cancer had high relationship with 16 and 18 genotype of the human papilloma virus.