宫颈薄层液基细胞学检查结合高危型人乳头瘤病毒检查筛查宫颈上皮内瘤变及宫颈癌效果分析

Cfinical effect of thin-prep cell test and high-risk human papillomavirus in the diagnosis of cervical intraepithelial neoplasma and cervical carcinoma

目的探讨薄层液基细胞学检查（TCT）结合高危型人乳头瘤病毒（HPV）检查在宫颈上皮内瘤变（CIN）及宫颈癌防治过程中的作用。方法763例接受宫颈癌筛查患者分别进行高危型HPV检查、TCT及多点活组织病理学检查。比较三种检查方法阳性病例与病理检查结果符合率。结果高危型HPV阳性287例，占37．61％（287/763），病理学检查阳性82例，阳性符合率为28．57％（82/87）；TCT阳性78例，占10．22％（78/763），病理学检查阳性50例，阳性符合率为64．10％（50／78）；TCT和高危型HPV均阳性59例，病理学检查阳性47例，阳性符合率为79．66％（47/59）。三种方法阳性符合率比较差异有统计学意义（P〈0．05）。高危型HPV在不同宫颈病变中的阳性率分别为CINI32．26％（10／31）、CINⅡ41．38％（12／29）、CINⅢ93．55％（29/31）、宫颈癌96．88％（31/32）。结论随着宫颈病变级别的升高，高危型HPV阳性率显著上升；高危型HPV联合TCT可提高CIN及宫颈癌的检出率，为宫颈癌的早期诊断提供参考。

Objective To study the clinical application value of screening cervical precancerous lesions of high risk human papillomavirus （HPV） testing combined with thin-prep cell test （TCT） in prevention of cervical intraepithelial neoplasma （CIN） and cervical carcinoma. Methods Seven hundred and sixty-three women were screened by high risk HPV test, TCT and pathology test of biopsy more. The positive coincident rate with the pathology test positive rate during the three technologies was compared. Results High risk HPV positive was 287 cases, the rate of infection was 37.61% （287/763）, and pathology test positive was 82 cases, the coincident rate of which was 28.57% （82/287）; TCT positive was 78 cases, the rate of infection was 10.22% （78/763）, and pathology test positive was 50 cases, the coincident rate of which was 64.10%（50/78）; TCT ＋ high risk HPV positive was 59 cases,pathology test positive was 47 cases,and the coincident rate of which was 79.66% （47/59）. Among each coincident rate,the differences were statistically significant （P 〈 0.05 ）. The positive rate of high risk HPV infection CIN Ⅰ was 32.26% （ 10/31 ）, CIN Ⅱ 41.38% （12/29）, CIN Ⅲ 93.55% （29/31）, squamous carcinoma of the cervix 96.88% （31/32）, respectively. Conclusions The positive rate of high risk HPV increases significantly with the grade of cervical precancerous lesions. It is of great significance to screen in the population for HPV and TCT in a regular time span, since it could not only decrease HPV infection rate and the incidence of cervical lesions, but also prevent the cervical cancer.