高危型人乳头瘤病毒DNA检测在宫颈癌筛查中的应用

Application of high-risk human papillomavirus DNA test in cervical cancer screening

目的:评价高危型人乳头瘤病毒(HPV)DNA检测在宫颈癌筛查中的应用价值。方法:2004～2006年期间,在连云港市第一人民医院健康体检、无妇科临床症状的已婚妇女1628例进行宫颈癌前病变筛查,采用PCR荧光定量检测高危型HPV(HR-HPV)DNA,以病理组织学诊断结果为金标准,应用约登指数比较HPVDNA和薄层液基细胞学(TCT)筛查效果。结果:受检者平均年龄(35±10.2)岁,经病理学诊断HPV感染51例(3.24%),宫颈上皮内瘤变(CIN)Ⅰ级18例、CINⅡ12例,CINⅢ6例,浸润癌3例,内膜癌1例,湿疣15例;以病理学确诊为金标准,HR-HPVDNA检测CINⅡ、Ⅲ的敏感度94.44%、特异度96.76%,阳性预测值25.0%,阴性预测值99.93%,约登指数0.91;HR-HPVDNA检测+TCT检测敏感度100.0%,特异度96.82%,阳性预测值26.47%,阴性预测值100.0%,约登指数0.97。HR-HPVDNA在健康妇女和不同宫颈病变中的阳性率分别是正常/炎症3.24%(51/1572)、CINⅠ84.21%(16/19)、CINⅡ91.67%(11/12)、CINⅢ100.0%(6/6)、浸润癌100.0%(3/3)、湿疣80%(12/15)、内膜癌1例未检出。结论:HR-HPVDNA检测在宫颈癌的筛查中具有敏感度高、阴性预测值高的特点,TCT与HR-HPVDNA联合检测可提高筛查的敏感度和阴性预测值。

Objective： To evaluate the application value of high- risk human papillomavirus （HPV） DNA test in cervical cancer screening. Methods： 1 628 married women without gynecological symptoms received physical examination in the First People＇s Hospital of Lianyungang and detected for precancerous lesions of uterine cervix, high - risk HPV DNA of the total women were detected by fluorescence quantitatiye polymerase chain reaction, histopathologic diagnosis was golden standard, HPV DNA and the effect of liquid - based thinprep cytology test （TCT） were compared with Youden index. Results： The average age of the women was （35 ±10. 2） years. 51 cases （3.24%）, 18 cases, 12 cases, 6 cases, 3 cases, 1 case and 15 cases were diagnosed as H PV infection, cervical intraepithelial neoplasia （CIN） Ⅰ , CINⅡ , CIN Ⅲ, infiltrating carcinoma, endometrial carcinoma and condyloma, respectively. Based on histopathotogic diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value of high - risk HPV DNA test for detecting CIN Ⅱ , CIN Ⅲ were 94.44% , 96. 76% , 25.0% and 99. 93% , respectively, the Youden index was 0. 91 . By the combination of high - risk HPV DNA test and TCT, the sensitivity, specificity, positive predictive value and negative predictive value for detecting CIN 11, CIN m were 100%, 96. 82%, 26. 47% and 100. 0%, respectively, the Youden index was 0. 97. The positive rates of HPV in normal inflammation, CIN Ⅰ, CIN Ⅱ, CIN Ⅲ, infiltrating carcinoma and condyloma were 3.24% （51/1572）, 84. 21% （ 16/19）, 91.67% （11/12）, 100% （6/6）, 100% （3/3） and 80. 0% （ 12/15 ）, respectively. Conclusion ： High - risk HPV DNA test has high sensitivity and negative predictive value. The combination of high - risk HPV DNA test and TCT increases the sensitivity, negative predictive value of cervical cancer screening.