1786名妇女宫颈薄层液基细胞学与高危型人乳头瘤病毒DNA检测结果分析

Analysis of ThinPrep liquid based cytology combined with human papillomavirus DNA test in diagnosis of cervical lesions from 1786 cases

目的:了解遵义市部分妇女宫颈高危型人乳头瘤病毒(high-risk human papillomavims,HR-HPV)感染的主要类型、年龄分布、感染状况,探讨HPV DNA检测联合液基细胞学诊断宫颈病变的临床意义。方法:对1786名妇女用人乳头瘤病毒核酸扩增分型检测试剂盒检测16种HR-HPV病毒亚型,同时行宫颈薄层液基细胞学检测(TlfinPrep liquid based cytology test,TCT);对TCT和(或)HR-HPV为阳性者再进行病理学检查。结果:①HR-HPV阳性者376例占21.1%,细胞学结果有异常者342例为筛查人数的19.15%,意义不明确的不典型鳞状细胞(ASCUS)、低度鳞状(LSIL)是异常细胞学结果中最常见的两种约为73.1%;②对TCT和(或)HR-HPV为阳性者再行阴道镜下活组织检查,随着TCT的级别越高,阴道镜下活检符合率越高。LSIL级别以上TCT、HR-HPV以及两者均为阳性检出率3组间差异无统计学意义;③正常人群中年轻的性活跃妇女HPV感染率高(P<0.05);④遵义市妇女HPVl6型感染率最高(P<0.05),其次为HPV51型及18型。结论:①女性生殖道HR-HPV感染是宫颈癌及宫颈上皮内瘤样病变(cervical intraepithelial neoplasm,CIN)发病的主要危险因素之一,提示宫颈癌的防治重点应放在防止HPV感染和对HPV感染的筛查以及密切监测已感染HR-HPV人群;②TCT与HPV结合对检测宫颈癌前病变有相当积极的意义。

Objective： To analyzed main types, age distribution, infection condition of cervical high - risk human papillomavirus （HR- HPV ） and further explore the clinic value of HPV DNA test combined with liquid based cytology in diagnosis of cervical lesions. Methods： A total of 1786 women were tested for 16 types of HR -HPV by PCR and ThinPrep liquid based cytology test （TCT） . Women with positive TCT and positive HR - HPV were referred for colposcopy and biopsy. Results： （1）A total of 376 women （21.1% ） were proved to be infected by HR -HPV. 342 women （19. 1% ） were identified wittr positive cytology, of which were atypical squamous cells of undetermined significance （ASCUS） and low -grade intraepithelial lesions （LSIL） （73.1% ） . （2） Among the women with positive TCT and positive HR - HPV received colposcopy and biopsy, the higher the grade of TCT was and the more consistent with colposcopy and biopsy. The infection rate of HPV was higher in young women of actively sexual life among the normal crowd （ P 〈 0. 05 ） . There was no significant difference among positive TCT, positive HR - HPV and both positive TCT and positive HR - HPV above the grade of LSIL. （3）The rate of HPV16 was higher than the rate of HPV18 and HPV51 in Zunyi （P 〈0.05） . Conclusion： The HR - HPV infection in female genital tract is one of the major risk factors in cervical cancer and cervical intraepithelial neoplasm （ CIN）, it is suggested that the prevention and cure of uterine cervical cancer be emphasized on the prevention of HPV infection, the screening of HPV infection and the intimately monitoring of the crowd HPV infected. The detection of TCT combined with HPV DNA is the optimal approach for the diagnosis of cervical lesions, which is promising to be used in further large samples in this area.