年龄与HPV载量对细胞学阴性宫颈上皮内瘤变的辅助诊断价值

The role of age and HR-HPV load in evaluation of cervical intraepithelial neoplasm with negative Liquid-Based Cytology results

目的探讨年龄因素与高危型HPV载量对宫颈液基细胞学阴性妇女的宫颈上皮内瘤变（CIN）的辅助诊断价值。方法收集宫颈液基细胞学联合HC2法检测高危型HPV DNA进行宫颈癌筛查的细胞学阴性、HPV阳性的妇女906例,并行阴道镜下宫颈活检。将高危型HPV检测的RLU/CO值〈10、10~99.99之间和≥100划分为病毒低、中、高载量,分析年龄和高危型HPV载量与宫颈癌及CIN的关系。结果 906例女性中,病理诊断宫颈癌4例（其中浸润性鳞癌3例、腺癌1例）,CIN3 29例,CIN2 50例,CIN1 155例,VAIN1 2例;无CIN妇女666例。30~49岁年龄段≥CIN3的患病风险是〈30岁妇女的3.4（1.02~11.40）倍;HPV检测的RLU/CO值≥100的患病风险是RLU/CO〈10者的12.44（2.89~53.5）倍。30~49岁组HPV病毒低、中、高载量者≥CIN3的患病率分别为1.0%、4.0%和8.8%（χ2=14.978,P=0.001）;≥CIN2的患病率分别为4.3%、7.5%和19.1%（χ2=27.270,P=0.000）。无CIN女性中,年龄〈30岁者HPV DNA载量高于较高年龄段女性,HPV平均载量RLU/CO值分别为244.04±547.20和149.59±328.39（P〈0.05）。结论宫颈癌及CIN的高发年龄段女性HPV病毒载量随CIN级别的升高而升高。在高发年龄段,感染HPV病毒而细胞学检查正常者,HPV病毒载量作为辅助诊断指标协助确定是否需要行阴道镜检查及活检,有利于减少宫颈癌与CIN的漏诊。

Objective To discuss the role of age and HR-HPV in evaluation of cervical lesions with negative Liquid-Based Cytology.Methods 906 women with positive HPV DNA and negative cytology results were included.The sampling methods were standardized.All cases underwent colposcopic indicated biopsy and pathological diagnosis.Analysis were based on the final results.Results The average age was（36.69±9.06）years old.Pathological results showed 3 invasive cancer（2 micro-invasive cancer included）,1 adenocarcinoma,29 cases of CIN3,50 of CIN2,155 of CIN1,2 of VAIN1 and 666 of normal.The odds ratio of ≥CIN3 between 30~49 years and 30 years was 3.4（1.02~11.40） while HR-HPV DNA load between ≥100 and 10 was 12.44（2.89~53.5）.Prevalence rate of ≥CIN3 in low,median,high HR-HPV load group 30~49 age group was 1.0%,4.0%,8.8%（χ2 =14.978,P=0.001） while the prevalence rate of ≥CIN2 was 4.3%,7.5% and 19.1%（χ2 =27.270,P=0.000）respectively.The average HR-HPV load of non-CIN patients in 30 years group and ≥30 years group were 244.04±547.20 and 149.59±328.39（P0.050）.Conclusions Increased HR-HPV load are generally associated with an increasing risk of high-grade CIN.Women who are in the high risk age group should be assessed by HR-HPV load and be performed colposcopy to minimize the missed diagnostic cases of high grade lesions.