宫颈上皮内瘤变及宫颈癌检测高危型HPV临床意义

Clinical significance of high-risk HPV detection in cervical carcinoma and cervical intraepithelial neoplasia

目的:探讨宫颈上皮内瘤变(CIN)和宫颈癌患者采用第二代杂交捕获(HC-Ⅱ)检测高危型人乳头瘤病毒(hr-HPV)的临床意义及与病毒载量的关系。方法:对300例宫颈病变患者采用杂交捕获二代技术(HC-Ⅱ)检测宫颈分泌物hr-HPVDNA感染情况,并行液基薄层细胞学检查(TCT)和病理活检。结果:300例受检患者中,HC-Ⅱ检出hr-HPV阳性者59例(19.67%),病理结果阳性符合率62.71%(31/59);TCT检出阳性者41例(13.67%),病理结果阳性符合率73.17%(30/41),两者检测阳性率及与病理结果阳性符合率比较差异均具有统计学意义(P<0.05)。CINⅠ～Ⅲ及SCC组hr-HPV感染率分别为55.56%(5/9)、62.29%(9/14)、78.26%(18/23)和100.00%(5/5),随着病理分级升高,hr-HPV的感染率亦随之增高(χ2=84.637,P=0.000)。病毒载量分布结果显示,hr-HPV载量随病理分级升高而逐渐减少;病变等级与病毒载量无相关性(R=0.061 7,P>0.05)。结论:hr-HPV感染是宫颈癌的重要致病因素,HC-Ⅱ检测在hr-HPV感染中有较高的敏感度。

Objective：To discuss the clinical significance of hybrid capture 2（HC-II）in the detection of high-risk HPV（hr-HPV）for the diagnosis of cervical intraepithelial neoplasia（CIN） and cervical carcinoma and association of DNA load. Methods：Totally 300 outpatients who had received HC-Ⅱ,thinprep cytologic test（TCT） and poathologic biopsy were selected from March 2009 to April 2011. Results：Among 300 cases,59 cases（19.67%）were hr-HPV infection detected by HC-Ⅱ,and the positive coincidence rate was 62.71%（31/59）.TCT found that 41 cases（13.67%） were positive,and its positive coincidence rate was 73.17%（30/41）.There was statistical significance in the positive coincidence rate between HC-Ⅱ and TCT（P〉0.05）.The hr-HPV infection rate of CINⅠ-Ⅲ and SCC group were 55.56%（5/9）,62.29%（9/14）,78.26%（18/23） and 100%（5/5） respectively,and it was increased with the increase of the pathology classification（χ^2=84.637,P=0.000）.Viral load distribution results show that hr-HPV load CIN Ⅰ-cervical cancer gradually reduce.Lesions grade and viral load without correlation（r=0.0617,P0.05）. Conclusion：The hr-HPV infection is an important pathogenic factors of cervical cancer,and HC-Ⅱ is high sensitivity in hr-HPVDNA.