高危型人类乳头瘤病毒检测对意义不明确的非典型鳞状上皮细胞分层管理的临床价值

Evaluation of high-risk human papillomavirus testing in hierarchical management of patients with atypical squamous cells of undetermined significance

目的评价高危型人类乳头瘤检测对意义不明确的非典型鳞状上皮细胞(ASCUS)分层管理的临床价值。方法对518例宫颈细胞学检查结果为ASCUS的患者进行高危型HPV检测和阴道镜检查,镜下定位活检可疑病灶,以病理学诊断作为金标准。结果 518例ASCUS患者中,高危型HPV阳性者为328例,其阳性率为63.32%。经病理学确诊高危型HPV阳性者CIN的发生率为50.19%,宫颈浸润癌的发生率为2.51%;高危型HPV阴性者CIN的发生率为2.90%,无宫颈浸润癌发生,两组比较差异有统计学意义(P<0.05)。ASCUS患者中阴道镜检查对CINⅡ、Ⅲ级检测的灵敏度、阴性预测值分别为78.84%、88.70%;高危型HPV检测对CINⅡ、Ⅲ级检测的灵敏度、阴性预测值分别为97.00%、96.84%。结论 ASCUS患者中高危型HPV阳性者宫颈病变的检出率较高,同时高危型HPV对CINⅡ、Ⅲ级检测的阴性预测值高,ASCUS患者的分层管理中高危型HPV检测起着重要的作用。

Objective To evaluation of high-risk human papillomavirus（HPV） testing in hierarchical management of women with atypical squamous cells of undetermined significance（ASCUS）.Methods High-risk HPV testing was performed reflexively on 518 cases liquid-based Papanicolaou smears that had been interpreted as ASCUS.Final diagnosis were made by biopsy under the colposcopy.Results Of the 518 cases with cytological ASCUS,328（63.32%） cases were positive by high-risk HPV testing.In high-risk HPV positive patients,incidence of CIN was 50.19% and invasive cervical carcinom was 2.51%;high-risk HPV negative patients were 2.90%,and no invasive cervical carcinoma,the difference was statistically significant（P0.05）.The sensitivity of colposcopy detecting CINⅡ and CINⅢ was 78.84%,and negative predictive value was 88.70%,the sensitivity of high-risk HPV was 97%,and negative predictive value was 96.84% in women with ASCUS.Conclusion High-risk HPV positive patients with ASCUS have higher detection rate of cervical lesions.High-risk types HPV has high negative predictive value for identification of CINⅡ and CINⅢ in women with ASCUS.The application of HPV DNA testing plays an important role in hierarchical management of patients with ASCUS.