摘要
目的探讨高危型人乳头状瘤病毒(HR-HPV)检测联合液基细胞学检查(TCT)在宫颈高度病变[≥宫颈上皮内瘤变(CIN)Ⅱ]诊断中的意义。方法对2009年8月至2011年5月在青岛大学医学院附属医院妇科门诊就诊的800例患者进行HPV-DNA的杂交捕获法二代(HPV-HCⅡ)和TCT的检测,280例因细胞学异常[非典型鳞状上皮细胞-不能明确意义(ASC-US)及以上的病变]行阴道镜下多点活检,结合其病理结果进行分析。结果①800例患者HPV总感染率为36.8%(294例),平均年龄(39±9)岁,HPV感染的高峰年龄为35岁。HPV阴性组(506例)平均年龄(38±8)岁,2组比较差异有统计学意义(P<0.05)。②280例患者中以ASC-US为界点,细胞学异常对宫颈高度病变检出率为45.0%(128/280),以低度鳞状上皮内病变(LISL)为界点其检出率为52.2%(109/209),宫颈高度病变检出率随着细胞学级别的升高而升高(P<0.01)。③127例宫颈高度病变中92.9%HR-HPV阳性,HPV阳性在CINⅡ中的检出率为89.2%,在CINⅢ中检出率为93.6%。④在280患者中71例细胞学为ASC-US,其高度病变的检出率为23.9%,HPV2阳性组高度病变检出率明显高于阴性组(P<0.05)。结论 HR-HPV检测联合TCT明显提高宫颈高度病变的检出,具有重要的意义,是宫颈癌筛查的最佳方法。
Objective To evaluate the significance of high-risk human papillomavirus（HR-HPV） DNA tes ting and liquid-based cytology in screening high-grade cervical lesions. Methods A total of 800 cases had liquidbased cytology test and HR-HPV DNA testing by hybrid capture [I in which 280 cases received cervical biopsy because of abnormal cytology. Results OThe overall prevalence of HPV infection was 36.8%. Two hundred and ninety-four patients were HPV positive with the mean age of （39i9） years, while 506 patients were HPV negative and their mean age was （38±8） years; the former was significantly younger than the later （P〈0.05）. ②In the 280 cases, the rate of high-grade cervical lesions were 45.0% （128/280）and 52.2%（109/209）in people with abnormal cervical cytology above ASC-US and LISL, respectively. The rate was increased with aggravation of cervical cytology （P〈0.05） . ③In 127 high-grade cervical lesions the rate of HPV infection was 92.9%. The rare was 89.2% in CIN Ⅱand 93.60,/oo in CINIⅢrespectively. ④Among 71 patients with cervical cytology of ASC-US in the 280 cases, the rate of high-grade cervical lesions was 23.9% and was higher in HPV positive group （P〈 0.05）. Conclusion HR-HPV DNA testing binding with liquid-based cytology test can help improve the screening of high-grade cervical lesions and it has great value. It is the best choice for the screening of cervical cancer.
