高危型人乳头瘤病毒检测对宫颈上皮内瘤样病变诊断价值的探讨

Value of high-risk human papillomavirus DNA testing to diagnosis of cervical intraepithelial neoplasia

目的:探讨在ASC-H患者中检测HR-HPV DNA预测宫颈上皮内瘤样病变(CIN)和浸润癌的价值,为完善CIN和浸润癌的筛查方案提供依据。方法:研究宫颈薄层液基细胞学诊断为ASC-H的患者68例,均进行HR-HPV DNA检测并在阴道镜下行宫颈组织活检,综合评价HR-HPV预测高级别CIN的价值。结果:在ASC-H中CIN发生率为52.9%(36/68),CINⅡ及以上病变(CINⅡ、CINⅢ及浸润癌)发生率为33.8%(23/68);HR-HPV检测阳性率为70.6%(48/68),HR-HPV阳性组CINⅡ及以上病变发生率为47.9%(23/48),HR-HPV阴性组CINⅡ及以上病变发生率为0(0/20),两组比较差异有统计学意义,χ2=14.797,P=0.001,HR-HPV诊断CINⅡ及以上病变的敏感度和特异度分别为100.0%和44.4%,阳性预测价值和阴性预测价值分别为47.9%和100.0%。结论:初步研究结果提示,HR-HPV阳性ASC-H患者应高度警惕CINⅡ及以上病变发生,建议立即行阴道镜检查;而HR-HPV阴性患者可不进行阴道镜检查。

OBJECTIVE：To investigate the significance of high-risk HPV（HR-HPV） DNA testing in atypical squamous cells,cannot exclude high-grade squamous intraepithelial lesion（ASC-H） to predict cervical intraepithelial neoplasia（CIN）,invasive cancer and guide further treatment.METHODS：A total of 68 patients with ASC-H diagnosed by Thin-Prep-liquid-based cytology were undergone with HR-HPV testing and cervical biopsies.RESULTS：Incidence of CIN and CINⅡ and worse（CINⅡ,CINⅢ,and invasive cancer） in the ASC-H was 52.9%（36/68） and 33.8%（23/68）,respectively.Positive rate of HR-HPV test was 70.6%（48/68） and rate of CINⅡ and worse was 47.9%（23/48） in HR-HPV positive group,but positive rate was 0（0/20） in HR-HPV negative group.There was statistically significant difference（χ2=14.797,P=0.001）.HR-HPV diagnosed CINⅡ and worse in ASC-H with the 100.0% sensitivity and 44.4% specificity,respectively and with 47.9% positive predictive value and 100.0% negative predictive value respectively.CONCLUSIONS：This preliminary study suggestes that immediate colposcopy is essential for patients with HR-HPV positive in ASC-H cytology due to high frequency of CINⅡ and worse,and there is not essential for ASC-H with HR-HPV negative to refer for colposcopy,because a negative HR-HPV DNA testing is a good predictor of the absence of CINⅡ and worse.