阴道镜检查及HPV-DNA分型检测在HSIL患者诊断中的作用

The role of colposcopy and HPV-DNA test in the diagnosis of HSIL patients

目的了解阴道镜检查和HPV-DNA分型检测在高度鳞状上皮内病变（HSIL）患者诊治中的作用。方法对2005年1月至2007年12月北京大学第一医院妇产科宫颈细胞学检测为HSIL的患者551例行阴道镜检查,对于镜下有异常发现者519例行多点活检,对于不满意的阴道镜检查,多点活检同时加宫颈管诊刮术,分析单次阴道镜检查检出CIN2及以上级别病变（≥CIN2）的情况,并对其中376例同时行HPV-DNA分型检测的结果进行分析。结果 551例HSIL患者中,阴道镜下多点活检检出CIN 1患者58例（10.5%）;CIN2、3患者344例（62.4%）;宫颈浸润癌11例（2.0%）。〈30岁、30~39岁、40~49岁、50~59岁和〉60岁不同年龄组检出率比较,差异有统计学意义（P=0.034）。376例有HPV-DNA分型的HSIL患者中,HPV-DNA高危亚型感染率为87.5%,其中16亚型感染占第一位（45.7%）;在HR-HPV阳性组尤其是HPV-16亚型阳性组,检出≥CIN2与HR-HPV阴性组比较,差异有统计学意义（P=0.000）。结论在HSIL患者中,经单次阴道镜检查仅检出62.4%的≥CIN2患者,HPV-DNA分型检测可增加阴道镜的检出率,对于单次阴道镜检查未发现异常的HSIL患者应给予重视。

Objective To understand the role of single-time colposcopy and HPV-DNA genotyping test in the diagnosis of HSIL patients.Methods 551 patients whose cervical cytology test results were HSIL underwent immediate colposcopy detection from January 2005 to December 2007,multiple punch biopsy was taken for 519 patients who had abnormal findings under colposcopy,for those unsatisfied colposcopy test,cervical curettage were added.Results Among the 551 cases of HSIL patients,there were 58（10.5%） cases of CIN 1,334（62.4%） cases of CIN 2 and CIN 3,11（2%） cases of cervical cancer diagnosed by multi-point biopsy under single-time colpscopy.The occurrence in different age groups had significant difference（P=0.034）.Meanwhile 376 HSIL patients received HPV-DNA genotyping test,the positive rate of high-risk HPV was 87.5%,and the most common subtype was HPV 16（45.7%）.In HR-HPV positive group,especially HPV 16 subtype positive group,the detection rate of CIN2 was significant higher than that in the HR-HPV negative group（P=0.000）.Conclusions Only 62.4% patients of CIN2 and more advanced lesion were diagnosed under single-time colposcopy.HPV-DNA genotyping test may help increasing the detection rate of CIN and cervical cancer.We should pay more attention to HSIL patients whose colposcopy test has no abnormal findings.