HPV检测对非典型鳞状细胞病人临床管理的应用价值

VALUE OF HPV DETECTION ON CLINICAL MANAGEMENT OF PATIENTS WITH ATYPICAL SQUAMOUS CELLS

目的针对宫颈液基细胞学检查结果为不典型鳞状上皮细胞(ASCUS)病人,进一步行高危型人乳头瘤病毒(HR-HPV)检测,探讨其对ASCUS临床处理方式选择的指导价值。方法收集宫颈液基细胞学检查为ASCUS病人362例,应用二代杂交捕获技术(HC2)检测其HR-HPV DNA,并应用阴道镜对宫颈可疑病变部位取材活检,以病理结果为诊断标准。结果 362例ASCUS病人中共有59例(16.30%)发生宫颈病变。HR-HPV阳性者219例,其宫颈病变检出率(23.74%)明显高于HR-HPV阴性组(5.59%),差异有显著性(χ2=22.531,P<0.01)。ASCUS结合HR-HPV DNA检测可使37.57%病人免于不必要的阴道镜下宫颈活检。<30岁年龄段HR-HPV感染率最高(72.92%),随年龄增长,HR-HPV感染率逐渐下降。HR-HPV阳性病人中CINⅡ、CINⅢ及宫颈浸润癌检出率最高的年龄段为30～40岁,占17.44%。结论对于宫颈细胞学检查结果为ASCUS病人,进一步行HR-HPV DNA检测是一种较好的分流管理方式,并且对于年轻病人更应重视HR-HPV检测。

Objective Aiming at atypical squamous cells （ASC） that confirmed by liquid based cytology of cervix, a fur- ther detection of high-risk HPV was conducted to investigate its value in guiding the selection of clinical management for ASC of undetermined significance （ASCUS）. Methods By using hybrid capture Ⅱ （HC2） technique, 362 patients with ASCUS were de tected for their high-risk HPV DNA, and a colposcopic biopsy was done on suspected region to confirm the diagnosis pathologically. Results Of all 362 ASCUS patients, 59 （16.30%） were with cervical intraepithelial neoplasia （CIN）. In 219 with positive high- risk HPV DNA, the detection rate of CIN was higher than those with negative high-risk HPV, being 23.74% versus 5.59% （Х^2 = 22.531 ,P〈0.01）. A combined detection of ASCUS with high risk HPV could exempt 37.57% of them from unwanted colposcopic biopsy. The highest infection rate （72.92%） of high-risk HPV was noted in women of 〈30 years of age, which fell off along with growing old. In those with high-risk HPV, the highest detection rate of CIN Ⅱ , CINⅢ, or ICC was in 30-40-year group, accounting for 17.44%. Conclusion High-risk HPV DNA test would be helpful for women with ASCUS detected cytologically, especially for young ones.