人乳头状瘤病毒DNA检测在宫颈病变筛查中的应用研究

Application of DNA Test of Human Papilloma Virusin in Cervical Lesion Screening

目的:探讨高危型人乳头状瘤病毒(HR-HPV)DNA检测方法在宫颈病变筛查中的应用意义。方法:580例妇女同时进行薄层液基细胞学(TCT)、第2代杂交捕获法(HC Ⅱ)和阴道镜下宫颈组织活检,并以病理组织学检查结果作为确诊标准进行对比分析。结果:①580例受检者中病理诊断为炎症207例(35.69%),CIN Ⅰ 224例(38.62%),CIN Ⅱ 96例(16.55%),CIN Ⅲ 38例(6.55%),浸润癌15例(2.58%);②TCT检测异常者中炎症52例(25.12%),CIN Ⅰ 177例(79.02%),CIN Ⅱ 85例(88.54%),CIN Ⅲ36例(94.74%),浸润癌15例(100%),其中CIN Ⅱ和CIN Ⅲ组间差异无统计学意义(P>0.05),但显著高于炎症组和CIN Ⅰ组,低于湿润癌组(P<0.01或0.05);③HPV DNA检测阳性者中炎症66例(31.88%),CIN Ⅰ 152例(67.86%),CIN Ⅱ 83例(86.46%),CINIII 35例(92.11%),浸润癌组15例(100%),除CIN Ⅱ和CIN Ⅲ组间差异无显著性外(P>0.05),其余各组间差异均有统计学意义(P<0.05或0.01),且HPV-DNA检测阳性组CIN和浸润癌发病率明显高于阴性组(P<0.01);④30岁以下高危险型HPV感染率(65.53%)显著高于30岁以上34.47%感染率(P<0.01);⑤联合应用TCT、HPV-DNA检测诊断宫颈癌及癌前病变的敏感度和特异度分别为96.14%和69.28%,高于TCT或HPV-DNA的单独检测。结论:宫颈高危险型HPV感染是CIN及宫颈癌的主要发病因素,并与病变严重程度密切相关,而HPV-DNA和TCT联合应用可提高宫颈癌及癌前病变的检出率。

Objective：To evaluate the application of human papillomavirus（HPV） test in screening cervical epithelial lesions.Methods：580 cases were tested by thinprep cytology test（TCT）,hybrid capture（HC-Ⅱ） and histopathology,then comparative analysis was performed by using the results of pathologic examination as diagnosis criteria.Results：①By pathological examination,207（35.69%）,224（38.62%）,96（16.55%）,38（6.55%）and 15（2.58%）women were diagnosed as inflammation,CIN Ⅰ,CIN I,CIN Ⅲ and cervical cancer,respectively.② Among cases with abnormal cytology,52（25.12%）were inflammation,177（79.02%）CIN I,85（88.54%）CIN Ⅱ,36（94.74%）CIN Ⅲ,and 15（100%）cervical cancer,and there was a significant difference within groups（P0.05）.③ Among the HPV DNA positive cases,66（31.88%）were inflammation,152（67.86%）CIN I,83（86.46%）CIN Ⅱ,35（92.11%）CIN III,and 15（100%）cervical cancer,and significant difference were found among the groups（P0.05 or 0.01）,but not between CIN Ⅱ and CIN III（P0.05）.Notably,the incidence of CIN and cervical cancer in HPV positive group were higher than HPV negative group（P0.01）.④HPV detection rates in ≥30 years group was 65.53%,significantly higher than 34.47% in 30 years group（P0.01）.⑤The combination of TCT and HPV-DNA test had better sensitivity（96.14%） and specificity（69.28%） than used alone.Conclusion：HPV infection is the main risk factor for CIN and cervical carcinoma,and plays an important role in the pathogenesis.The combination of HPV-DNA and TCT could improve detection rate of preinvasive and invasive cervical carcinoma.