高危型人乳头瘤病毒检测联合细胞学检查在宫颈上皮内瘤变诊断中的临床价值

Clinical value of high risk HPV test combined with cytological examination in diagnosis of cervical intraepithelial neoplasia

目的:探讨高危型人乳头瘤病毒(HPV)检测和宫颈液基细胞学检查(TCT)在宫颈上皮内瘤变(CIN)诊断中的临床价值。方法:分析142例行高危型HPV检测和TCT检查,同时行阴道镜定位活检并有病理结果患者的临床资料。结果:142例患者中HPV阳性57例,阳性率40.14%。病理诊断为慢性宫颈炎79例,HPV感染率为10.13%,CIN63例,其中CINⅠ38例、CINⅡ14例、CINⅢ11例,HPV感染率分别为71.05%、85.71%、90.91%,随着宫颈病变程度加重,HPV感染率随之上升,CINⅠ～Ⅲ与慢性宫颈炎的HPV感染率差异有统计学意义。TCT检测,异常涂片72例,其中ASC37例,CINⅡ检出3例(8.11%),无CINⅢ检出;LSIL23例,CINⅡ、CINⅢ检出共10例(43.47%);HSIL12例,CINⅡ、CINⅢ检出共11例(91.67%),随着细胞学异常级别的升高,宫颈高度病变(CINⅡ、CINⅢ)检出率显著增加。病理学、细胞学、HPV检测同时比较,TCT和HPV均阴性的患者中,无1例CINⅡ以上的病例。结论:高危型HPV与宫颈癌及CIN的发生有关,高危型HPV联合TCT检测,用于宫颈病变筛查漏诊率低,若再有针对性地行阴道镜检查、定位活检,可早期、准确诊断宫颈癌前病变。

Objective：To explore the clinical value of high risk human papillomavirus（HR-HPV）test and thinprep cytology test（TCT）in diagnosis of cervical intraepithelial neoplasia（CIN）.Methods：Clinical data of 142 cases receiving HR-HPV test,TCT and colposcopic biopsy with pathological results were analyzed retrospectively.Results：57 cases were found with positive HPV among 142 cases,the positive rate was 40.14%;79 cases were diagnosed as chronic cervicitis by pathological examination,the infection rate of HPV was 10.13%;63 cases were diagnosed as CIN,including 38 cases of CIN I,14 cases of CINⅡ and 11 cases of CIN Ⅲ,the infection rates of HPV were 71.05%,85.71% and 90.91%,respectively;the infection rate of HPV increased with the aggravation of cervical lesions;there was significant difference in the infection rate of HPV between CINⅠ~Ⅲ and chronic cervicitis.TCT results：72 abnormal smears were found,including 37 cases of ASC,3 cases were found with CINⅡ（8.11%）,no CIN Ⅲ was found;23 cases of LSIL,including 10 cases of CIN Ⅱ and CIN Ⅲ（43.47%）;12 cases of HSIL,including 11 cases of CIN Ⅱ and CIN Ⅲ（91.67%）,the detection rate of hyper lesions of cervix（CIN Ⅱ and CIN Ⅲ）increased with the increasing of grades of cytological abnormalities;comparing pathology,cytology and HPV,no case with CIN II or above occurred in negative TCT and HPV group.Conclusion：HR-HPV is related to occurrence of cervical cancer and CIN,the missed diagnosis of HR-HPV test combined with TCT is low in screening of cervical lesions,if colposcopy and biopsy are conducted specifically,precancerous lesions of uterine cervix will be diagnosed early and accurately.