高危型人乳头状瘤病毒16,18型DNA检测在宫颈病变筛查中的应用价值

The detective value of high-risk human papillomavirus genotype 16 and 18 DNA in screening cervical lesions

目的评价高危型人乳头状瘤病毒16,18型(HPV16,18)DNA检测在宫颈病变筛查中的价值。方法收集209例病理组织学结果为癌及癌前病变[宫颈上皮内瘤变(CIN)Ⅰ、CINⅡ、CINⅢ、宫颈浸润癌]和296例病理组织学为良性病变(炎症、息肉等),并同时做了液基细胞学检查、HPV16,18 DNA检测的病例,统计比较HPV16,18 DNA检测与液基细胞学检查对癌及癌前病变的敏感性、特异性及阴性预测值;比较不同病变程度分类患者中HPV16,18的检出率。结果 209例癌及癌前病变患者中HPV16,18阳性158例,液基细胞学阳性[低级别鳞状上皮内病变(LSIL)、不除外高级别鳞状上皮细胞(ASC-H)、高级别鳞状上皮内病变(HSIL)、鳞状细胞癌]128例。296例宫颈良性病变患者HPV16,18阳性43例,液基细胞学阳性2例。HPV16,18 DNA检测对癌及癌前病变的敏感性为75.6%,液基细胞学为61.2%,两者比较差异有统计学意义(χ2=12.69,P<0.01),HPV16,18 DNA对癌及癌前病变的检出率明显高于液基细胞学。HPV16,18 DNA检测特异性为85.5%,阴性预测值为83.2%;液基细胞学特异性为99.3%,阴性预测值为78.4%;CINⅡ病变的HPV阳性检出率明显高于CINⅠ(χ2=6.69,P<0.05)。结论高危型HPV16,18感染与宫颈癌及宫颈癌前病变的发生、发展密切相关,HPV16,18 DNA检测对癌前病变和宫颈癌的敏感性高于液基细胞学、特异性低于液基细胞学,对宫颈炎、息肉等良性病变的阴性预测值高于液基细胞学,检测HPV16,18 DNA有着重要的临床价值。

Objective To evaluate the detective value of high-risk human papillomavirus（HPV） genotype 16 and 18（HPV16,18） in screening cervical lesions.Methods By histological biopsy,209 cases were cancer and percancerous lesions [cervical intraepithelial neoplasia（CIN） Ⅰ,CIN Ⅱ,CIN Ⅲ and invasive cervical cancer],and 296 cases were inflammation,polyp and other benign lesions.HPV16,18 DNA and liquid-based cytology were used to detect the cases with cancer and percancerous lesions by histological biopsy.Comparing the results of the 2 methods,HPV16,18 infectious rates,sensitivity,specificity and negative predictive value were statistically analyzed.Results Of 209 patients with cancer and precancerous lesions,158 cases were positive of HPV16,18,and 128 cases were positive of liquid-based cytology [low-grade squamous intraepithelial lesion（LSIL）,atypical squamous cells,cannot exclude a high-grade squamous intraepithelial lesion（ASC-H）,high-grade squamous intraepithelial lesion（HSIL） and squamous cell carcinoma].Among the 296 patients with benign lesions,43 cases were positive of HPV16,18,and 2 cases were positive of liquid-based cytology.The results of cancer and precancerous lesions showed that the positive rate of HPV16,18 DNA was higher than that of liquid-based cytology（χ2=12.69,P0.01）.The sensitivity,specificity and negative predictive value of HPV16,18 DNA were 75.6%,85.5% and 83.2% respectively,and 61.2%,99.3% and 78.4% of liquid-based cytology.The HPV16,18 positive rate of CIN Ⅱ was obviously higher than that of CINⅠ（χ2=6.69,P0.05）.Conclusions The occurrence of cervical cancer and percancerous lesions is closely related to HPV16,18 infection.Compared with liquid-based cytology,HPV16,18 DNA in cervical cancer and percancerous lesions has a higher sensitivity,lower specificity and higher negative predictive value.HPV16,18 DNA has an important clinical value for screening cervical benign lesions,and it is better than liquid-based cytology.