高危型HPV DNA检测在宫颈病变诊治中意义的研究

Study on high-risk HPV DNA detection in the diagnosis and treatment of ervical lesions

目的:评价高危型HPVDNA检测在宫颈病变及宫颈癌筛查中的意义。方法:以2004年1月～2005年5月在辽宁省肿瘤医院妇科门诊就诊的357例患者为研究对象,以阴道镜下活检病理为诊断标准,用杂交捕获的方法检测HPVDNA,比较高危型HPVDNA在CINⅠ、CINⅡ、CINⅢ及宫颈癌组的检出率。结果:高危型HPVDNA在CINⅠ、CINⅡ、CINⅢ及宫颈癌组的检出率分别为49.1%、57.9%、92.5%和98.3%,呈现上升趋势,与对照组比较有统计学意义(P<0.05);高危型HPVDNA检测筛查CINⅢ以上病变的灵敏度为96.0%,特异度为59.3%,阳性预测值为48.0%,阴性预测值为97.5%;在≥30岁的病例中,高危型HPV感染率(44.8%～90.0%)与CINⅢ及以上病变患病率(23.8%～66.7%)的趋势基本一致。结论:高危型HPV感染率随着宫颈病变程度的加重而逐渐升高,高危型HPVDNA检测对诊断CINⅢ+病变有较高的灵敏度及阴性预测值,HPV筛查宫颈癌在30岁以上的妇女中进行更有意义。

Objective： To study the value of high - risk HPV in cervical intraepithelial neoplasia （CIN） and cervical cancer. Methods： 357 cases outpatients from Liaoning Cancer Hospital during January 2004 to May 2005 were studied. The cervical lesion were confirmed by colposcopy biopsy and HPV DNA was tested with hybrid capture method. Results： The ratio of high - risk HPV detected in CIN Ⅰ , CIN Ⅱ , CIN Ⅲ group and cervical cancer group was 49. 1% , 57. 9% , 92. 5% , 98. 3% respectively. There was significant difference between test group and control group （ P 〈 0. 05 ） ; The sensitivity of diagnosis of CIN Ⅲ and cervical cancer by high - risk HPV test was 96. 0% , the speciality was 59.3% , the positive predictive value was 48.0% , the negative predictive value was 97.5% ; The ratio of high - risk HPV in those older than 30 years was 44. 8% - 90. 0% , which was consistent with the occureee of CIN Ⅲ and cervical cancer. Conclusion ： Infection rate of high - risk HPV is ascending with serious degree of cervical disease ; The sensitivity and negative predictive value of high -risk HPV test in diagnosing CINⅢ and cervical cancer is high; Test of high -risk HPV DNA is very useful to screen cervical cancer in the women over 30 years old.