人乳头瘤病毒DNA联合液基薄层细胞学检测在宫颈癌筛查诊断中的研究

Study of human papillomavirus dna test combined with thin prep liquid-based cytology test and vaginoscope positioning biopsy in cerical cancer screening and diagnosis

目的分析本地区人乳头瘤病毒(HPV)DNA分型检测、宫颈液基薄层细胞学检查(TCT)和阴道镜活检组织病理学检查对宫颈癌筛查的意义及临床价值。方法选择宫颈癌高危患者1080例,采用PCR技术对所有被检人群宫颈脱落细胞学标本进行23种HPV基因型和采用TCT技术对HPV阳性患者进行细胞学检测,分析HPV感染的主要型别分布特点,并对TCT检查阳性者进行阴道镜活检组织病理学检查。结果 1080例标本中HPV阳性315例,总感染率为29.17%。共检测出20种基因亚型,高危基因组HPV基因亚型感染显著高于低危基因组,高危基因组以HPV16和HPV58感染为主要基因型别,少见的HPV33在本地区感染偏高。HPV阳性年龄主要集中在44岁以下,共253例(80.3%),其中以35～44岁162例(51.4%)最为显著。HPV基因型别单项阳性237例(21.94%),两项阳性57例(5.28%),三项阳性20例(1.85%),四项以上阳性1例(0.09%)。液基细胞学检查发现不典型鳞状上皮细胞(ASC-US)93例,鳞状上皮内低度病变(LSIL)35例,鳞状上皮内高度病变(HSIL)8例,鳞状细胞癌(SCC)2例,不典型腺细胞(AGC-US)8例。所有细胞学阳性病例行阴道镜下定位活检,发现宫颈上皮内瘤变(CIN)35例,癌变5例;所有CIN和癌变患者组织学标本全部HPV感染,并且以HPV16(26例)和HPV58(12例)基因型别为主。结论本地区HPV感染以单项基因为主,感染的基因亚型主要是HPV16和HPV58。发生CIN和癌变者与HPV16、HPV58感染密切相关。HPV阳性年龄主要集中在44岁以下,以35～44岁最为显著。HPV联合TCT筛查,并结合阴道镜下定位活检是早期筛查宫颈癌及癌前病变的有效手段之一。

Objective To study some relation between human papilloma virus（HPV） infection types and cervical cancer occurring,survey HPV infection rates of married women and mainly distributed characteristics of high-risk HPV gene types about cervical cancer, analysis meaning and clinical value of cervical cancer screening by HPV-DNA test,cervical thin prep liquid-based cytology test（TCT）and histopathological examination by vaginoscope in local area. Methods Twenty-three kinds of HPV genotype of 1080 cervix cytologic specimens were tested by the PCR technology and HPV positive cases by TCT,and distribution characteristics of HPV infection main types were analyzed; HPV positive cases by TCT were arranged finishing histopathological examination by vaginoscope. Results Three hundred and fifteen cases were HPV positive, and the total infection rate was 29. 17%;twenty gene subtypes were detected, HPV gene subtypes infection in high-risk group were significantly higher than those in low-risk group, HPV16 and HPV58 were the main genotypes, rare HPV33 was a little bit high in this region. HPV infection was frequently observed in cases with age less than 44 years old（253,80. 3%） ,especially in cases aged from 35 to 44（162, 51.4%）. Single HPV genotypes were positive in 237 cases（21. 940/00）, two HPV genotypes positive in 57 cases（5. 28 %）, three HPV genotype positive in 20 cases （ 1.85 %）, and more four HPV genotype positive in 1 case（0. 09 %）. There were 93 cases with atypical squamous cell of undetermined significance（ASC-US）, 35 cases with low-grade squamous intraepithelial lesion（LSIL）, 8 cases with high-grade squamous intraepithelial lesion（HSIL）, 2 cases with squamous cell carcinoma（SCC）, 8 cases with atypical glandular cells of undetermined significance（AGC-US）by TCT. All cytology positie cases accepted vaginoscope positioning biopsy： 35 cases with cervical intraepithelial neoplasia （CIN）, 5 cases with cancer;histological specimens of all CIN and cancer cases were with HPV infection, main genotypes were HPV16（26 cases）and HPV58（12 cases）. Conclusion Single HPV gene infection is main subtypes, HPV16 and HPV58 gene subtypes are predominant subtypes. CIN and cancer occurring closely relate with HPV16 and HPV58 infection. HPV positive age is mainly less than 44 years old, and 35 to 44 years old are the most significant. HPV combined with TCT screening, and vaginoscope positioning biopsy are effective means of early screening in finding cervical cancer and precancerous.