液基细胞学、HPV检测及hTERC基因检测在宫颈癌筛查中的应用价值

The Application Value of ThinPrep Cytology Test,Human Papillomavirus DNA,Human Telomerase RNA Component Gene Detection in Cervical Cancer Screening

目的:研究液基细胞学、人乳头瘤病毒(HPV)检测及人类染色体端粒酶(hTERC)基因检测在宫颈癌筛查中的应用价值。方法:选取2010年12月—2011年3月满足条件的河南省人民医院妇产科就诊者1000例,对其分别进行液基细胞学(TCT)检测、HPV-DNA检测(SPR法)、hTERC基因检测[荧光原位杂交(FISH)技术],对以上3种检测任一结果阳性者行阴道镜下宫颈活检,以病理学为金标准,评价3种方法对宫颈癌筛查的敏感度、特异度、约登指数及符合率。结果:1000例患者中,平均年龄为(41±9)岁,TCT结果异常者119例,占11.9%;HPV阳性者共136例,占13.6%;hTERC基因扩增阳性共58例,占5.8%。229例行阴道镜下宫颈活检,其中宫颈上皮内瘤变(CIN)共36例,其中CINⅠ13例(5.68%),CINⅡ13例(5.68%),CINⅢ8例(3.49%),宫颈鳞状细胞癌(SCC)2例(0.87%)。单独应用一种筛查方案时,TCT的敏感度最高(83.3%)。应用任两种方案联合筛查时,TCT+HPV的敏感度最高(94.4%),但特异度最低(29.6%);TCT或HPV与hTERC基因检测联合都可使敏感度和特异度同时升高。随着病理级别的升高,各筛查方案检出率逐渐升高(P<0.05)。结论:联合筛查方案优于单一筛查方案;HPV检测+hTERC基因检测联合筛查效果最佳,但成本最高。TCT+HPV检测联合筛查不失为一种经济而相对高效的筛查方案,可作为基本筛查进行。应根据经济条件及筛查成本选择适合的筛查方案。

Objective：To evaluate the application of Thin-Prep Cytology test（TCT） 、human papillomavirus（HPV） DNA、human telomerase RNA component（hTERC） gene detection in cervical cancer screening.Methods：From December 2010 to March 2011 in Henan Province People＇s Hospital gynecology clinic 1000 cases,had TCT、HPV（SPR method） 、hTERC detection（fluorescence in situ hybridization FISH technique） respectively,to screen the cervical carcinoma,the above three kinds of detection of any positive result underwent colposcopy and cervical biopsy,based on the histopathology as the gold standard to evaluate three methods of cervical screening sensitivity,specificity,Youden index and the coincidence rate.Results：One thousand cases of patients,average age 41±9,TCT abnormal results were 119 cases,accounting for 11.9%;HPV-positive 136 cases,accounting for 13.6%;hTERC gene amplification in a total of 58 positive cases,accounting for 5.8%.229 routine colposcopy and cervical biopsy were done,in which 36 cases of cervical intraepithelial neoplasia（CIN） ,including 13 CINⅠ（5.68%） ,13 CINⅡ（5.68%） ,8 CINⅢ（3.49%） ,2 squamous cervical carcinoma（SCC） （0.87%） .By single application of a screening program,TCT highest sensitivity（83.3%） .Application of any two programs combined screening,TCT＋HPV highest sensitivity（94.4%） ,but the lowest specificity（29.6%） ;TCT or HPV testing combined with hTERC gene,can make both higher sensitivity and specificity.With the increased CIN level of pathology,the detection rate of the screening program gradually increased（P〈0.05） .Conclusions：In the cervical cancer screening,combined screening is the best way than the single screening,HPV＋hTERC joint screening of genetic testing best,but the highest cost.the TCT＋HPV screening test regarded as a joint cost-effective screening program,can be carried as a basic screening.Screening should be based on economic conditions and cost options for the screening program.