高危型人乳头瘤病毒检测在宫颈病变筛查中的临床意义

Detection of high risk human papillomavirus in screening of cervical lesions

目的:探讨高危型人乳头瘤病毒(high-riskhuman papillomavirus,HR-HPV)检测在宫颈病变筛查中的应用价值。方法:采用液基细胞学(TCT)对1175例妇女宫颈癌及其癌前病变进行初筛,细胞学异常者或TCT正常、HR-HPVDNA阳性且高度怀疑宫颈病变患者进行阴道镜和宫颈多点活检组织病理学检查,结合病理结果分析宫颈病变。用二代杂交捕获法(hybirdcaptureⅡ,HC-Ⅱ)对所有标本进行高危型HPVDNA的检测,对结果进行回顾性分析。结果:1175例样本中TCT检测结果正常或炎症968例,ASC-US(未明确诊断意义的不典型鳞状上皮细胞)62例,ASC-H(不典型鳞状上皮细胞,不能除外高度鳞状上皮内病变)39例,LSIL(低度鳞状上皮内病变)87例,HSIL(高度鳞状上皮内病变)19例。207例细胞学异常者经阴道镜下多点组织活检证实炎症116例,宫颈上皮内瘤变(CIN)Ⅰ级27例,Ⅱ级34例,Ⅲ级19例,浸润癌5例,湿疣6例。HC-Ⅱ法检测HR-HPV DNA发现207例细胞学异常者HPV感染率分别为:正常或炎症17.24%,CINⅠ22.22%,CINⅡ32.35%,CINⅢ61.39%,浸润癌100.10%,湿疣30.23%。82例TCT正常、HR-HPV DNA阳性患者病理结果显示炎症67例,CINⅠ11例,CINⅡ6例。结论:随着病变的加重,HR-HPV感染率逐渐增高,其感染与宫颈病变级别相关,HR-HPV检测可辅助筛查宫颈病变,与细胞学联合检测为较好的宫颈癌筛查方案。

Objective： To investigate the clinic significance of high-risk human papillomavirus in screening of cervical lesions. Methods： The test study was carried out in which 1175 women who received treatments from January 2009 to february 2010 were recruited. Total 1175 women were subjected to detect Thinprep Cytology Test （ TCT） and high-risk HPV DNA by hybrid capture II and to have established diagnoses by cervical coloposcopy-directed biopsy test. Results： among 1175 cases with TCT examination,969 specimens showed normal cells or cervicitis ,62 ASC-US,39 ASC-H,87 LSIL,19 HSIL. HR-HPV DNA was detected by second generation Hybrid Capture （Hybrid Capture-Ⅱ,HC-Ⅱ）.207 cases with precancerous lesions of uterine cervix proven by cytological examination and histopathological examination , including 116 cases of cervicitis , 27 cases of cervical intraepithelial neoplasia （CIN）Ⅰ, 34 cases of CIN Ⅱ,19casesofCINⅢ,15cases of infiltrating carcinoma and 6 cases of condylomata.The infection rate of HPV in normal cells or cervicitis was 17.24%,in CINⅠ22.22%,in CINⅡ32.35%,in CIN Ⅲ 61.39%, in infiltrating carcinoma 100% and in condylomata 30.23%. In 82 patients with normal TCT and HR-HPV DNA positive,the final pathological diagnosis was cervicitis in 67 cases, CIN I in 11 cases and CIN Ⅱ in 6 cases. Conclusions： There is significant correlation between elevated high risk HPV DNA and severity of cervical lesion. Combined with cytology and HR-HPV test provide very helpful information for the screening of cervical lesion.