高危HPV检测及随访对宫颈癌预防的临床意义

Clinical significance of the testing and follow up of high risk HPV on the prevention of cervical cancer

目的:采用HC-Ⅱ方法对HR-HPV感染进行检测,联合TCT、阴道镜检查、宫颈活检、宫颈锥切术,对HR-HPV阳性患者随访,分析高危型HPV感染与宫颈癌前病变的关系,从而评估HR-HPV检测对宫颈癌预防的临床意义。方法:选取自愿接受宫颈癌筛查的25～45岁非孕期患者3 842例为研究对象,同时进行TCT及HC-Ⅱ法HR-HPV检测。对单纯HPV阳性患者,予以定期观察;对HPV阳性,细胞学检查为ASCUS、ASC-H、LSIL,予以阴道镜检查,并进行活检;对HPV阳性,细胞学检查为HSIL,则行LEEP术,标本送病理检查,以组织病理结果为诊断的金标准。对783例HPV阳性患者随访3年。用SPSS 13.0软件进行数据处理和统计分析。结果:应用HC-Ⅱ检测HR-HPV的阳性检出率为22.62%,高于TCT细胞学异常的检出率5.62%;随访发现NILM中HR-HPV在6个月内转阴率仅有16.72%,低于CIN治疗后的转阴率(60%以上)。结论:TCT检查的同时进行HR-HPV检测,并积极治疗有症状的HR-HPV感染者,可以更加有效地预防CIN及宫颈癌的发生。

Objective：To test HR-HPV infection by HC-Ⅱ assay,and follow up the positive patients by combination with TCT,colposcopy,cervical biopsy and LEEP.Relationship between HR-HPV infection and cervical precancerous lesions were analyzed and the clinical significance of HR-HPV testing to the prevention of cervical cancer was evaluated.Methods：From the out-patient clinic patients of our hospital during Jan.2008 to Dec.2009,3 842 unpregnancy patients who were 25-45 years and received cervical cancer screening were selected.They were tested for HR-HPV by HC-Ⅱ and TCT.Patients with HPV positive simply were referred for reviewing regularly.Patients with HPV positive,and ASCUS,ASC-H or LSIL in cytology were referred for colposcopy and biopsy.Patients with HPV positive,and HSIL in cytology were referred for LEEP and diagnosed by histopathology result.783 cases of HPV positive patients were followed up for 3 years.SPSS 13.0 software was used for data processing and statistical analysis.Results：The positive rate of HR-HPV infection was 22.62% by HC-Ⅱ,which was higher than the rate of abnormal cytology by TCT which was only 5.62%.During the following up,only 16.72% HR-HPV positive cases turned to negative in the NILM group,however,more than 60% patients who had CIN and received treatment turned to negative.Conclusion：Testing HR-HPV infection during the TCT process,and giving treatment to the symptomatic HR-HPV infected patients is an effective method to prevent CIN and cervical cancer.