高危型HPV检测在宫颈癌筛查中对ASC-US病例的分流作用

Shunting effect of high risk human papillomavirus test in screening of cervical cancer for cases with ASCUS

目的:探讨高危型人乳头瘤病毒(HPV)检测对无明确诊断意义的不典型鳞状上皮细胞(ASC-US)分流监测的临床价值。方法:应用第二代杂交捕获实验(HC-Ⅱ)对261例宫颈细胞学检查结果为ASC-US的患者进行高危型HPVDNA检测,以光镜下病理学诊断作为宫颈上皮内瘤样病变(CIN)的分级标准。结果:261例ASC-US患者CIN检出率为60.92%(159/261),其中高级别CIN16例,检出率为6.13%。261例ASC-US患者高危型HPV DNA检测呈阳性者141例,阳性率为54.02%,高级别CIN中HPV DNA阳性率高达93.75%,高危型HPV阳性组和阴性组ASC-US患者宫颈病变为CINⅡ及其以上病变的检出率分别为11.35%和0.83%,差异具有统计学意义(P<0.01)。结论;ASC-US患者中包括部分高级别病变甚至宫颈癌,并存在相当比例的HPV感染,高危型HPV-DNA检测是一种有效的ASC-US分流管理手段。

Objective：To explore the clinical value of high risk human papillomavirus（HPV） test in shunting monitoring of atypical squamous cell of undetermined significance（ASCUS）.Methods：Hybrid capture Ⅱ（HC-Ⅱ） was used for high risk HPV test among 261 cases whose cervical cytological test result was ASCUS;pathological diagnosis under light microscope was used as grading standard of cervical intraepithelial neoplasia（CIN）.Results：The detection rate of CIN among 261 cases with ASCUS was 60.92%（159/261）,16 cases had CIN of high grades,the detection rate was 6.13 %;141 cases were found with positive high risk HPV,the positive rate was 54.02%,and the positive rate was 93.75% among the cases with CIN of high grades;the detection rates of CIN Ⅱ and CIN Ⅲ in ASCUS cases with positive high risk HPV and negative high risk HPV were 11.35% and 0.83%,respectively,there was significant difference（P〈0.01）.Conclusion：ASCUS includes partial CIN of high grades and cervical cancer,and the proportion of HPV infection is large,detection of high risk HPV-DNA is an effective shunting management method of ASCUS.