两种检查方法在宫颈环形电切术随访中的评价

Significance of HPV and TCT in LEEP

目的探讨高危型HPV DNA检测、细胞学检查在宫颈环形电切术后随访中的意义。方法回顾性分析广西岑溪市人民医院2006年1月～2009年12月因宫颈上皮内瘤变（Ⅱ／Ⅲ）患者于宫颈环形电切术后半年、1年、2年，采用高危型HPVDNA检测、细胞学检查进行随访，对两种检查方法中任何一种异常者均在阴道镜下宫颈多点活检，分析两种检查方法的随访意义。结果158例因宫颈上皮内瘤变（Ⅱ／Ⅲ）患者行宫颈锥切术，其中资料完整且随访至少1次者105例，阴道镜下宫颈多点活检78例，诊断复发37例。高危型HPV DNA检测阳性48例中32例复发；细胞学检查阳性47例中29例复发。高危型HPV DNA检测的准确性73．08％、特异性60．98％、阳性预测值66．67％、阴性预测值83．73％；细胞学检查的准确性66．67％、特异性56．12％、阳性预测值61．75％、阴性预测值74．19％。高危型HPV DNA检测的准确率较细胞学检查稍高，但两者比较差异无统计学意义（X^2=12．87，P〉0．05）。单因素分析显示，早婚、多个性伴侣、过早性生活、早年分娩影响高危型HPV DNA检测的准确性；年龄、多个性伴侣、过早性生活影响细胞学检查的准确性；手术切缘阳性、术前高危型HPV感染均不影响两种检查方法的准确性。结论宫颈上皮内瘤变Ⅱ／Ⅲ级患者行宫颈环形电切术后复发率较高，术后采用高危型HPV DNA检测及细胞学检查随访准确性较高，但需同时结合患者的年龄、婚龄、多个性伴侣、过旱性生活、早年分娩等综合判断。

Objective To explore the significance of high-risk human papillomavirus （HPV） DNA test and cytological examination in the follow-up after loop electrosurgical excision procedure （LEEP）. Methods Patients suffering cervical intraepithelial neoplasia （CIN） （Ⅱ/ Ⅲ） underwent LEEP from January 2006 to December 2009 in Cenxi People＇ s Hospital. They were followed up a half year, one year and two years after procedure with high-risk HPV DNA test and cytological examination. Multiple punch biopsy with vaginoscope was carried out if any abnormal results were found by any of the methods. All of the results were retrospectively analyzed to discuss the significance of two methods. Results Among 158 patients suffering CIN （Ⅱ/ Ⅲ） and receiving LEEP, 105 were followed up for at least one time and their data was kept completely. Vaginoscopic multiple punch biopsy was carried out for 78 cases and 37 cases recurred. Among 48 cases whose high- risk HPV DNA testing was positive, 32 cases recurred. Among 47 cases whose cytological examination was positive, 29 cases recurred. The accuracy, specificity, positive predictive value and negative＂ predictive value of high-risk HPV DNA testing were 73.08%, 60.98%, 66.67% and 83.73% respectively, while those of cytological examination were 66.67%, 56.12%, 61.75% and 74.19% respectively. Although the accuracy of high-risk HPV DAN testing was slightly higher than that of cytological examination, the difference was not statistically significant （X^2 = 12.87 ,P 〉 0.05 ）. Univariate analysis showed that early marriage, multiple sex partners, early sexual life and delivery could influenced the accuracy of high-risk HPV DNA testing, while age, multiple sex partners, early sexual life influenced the accuracy of cytological examination. But positive resection margin and high-risk HPV infection before procedure didn＇ t influence the accuracy of two methods. Conclusion The relapse rate of GIN （Ⅱ/ Ⅲ） after LEEP is comparatively higher, and the accuracy of high-risk HPV DNA testing and cytological examination in follow-up is high. But patients＇ age, marriageable age, multiple sex partners, early sexual life and delivery should be considered to make a comprehensive judgment.