HC2 HPV检测在宫颈病变筛查中的临床应用

Clinical Application of HC2 HPV Testing in the Screening of Cervical Lesions

目的:对育龄妇女人乳头瘤病毒(HPV)感染的情况分析及探讨宫颈病变筛查临床路径策略。方法:随机选择体检者2070例,妇科门诊就医的患者1405例,采用杂交捕获2代技术(HC2)高危型HPV DNA检测。从1405例妇科门诊患者中抽取297例同时进行HC2 HPV和液基细胞学检查(TCT)患者分析HPVDNA检测预测情况。结果:①体检组、门诊组HPV总的感染阳性率分别为:12.17%、21.28%,差异有统计学意义(P<0.01)。门诊组30～39岁,40～49岁,≥50岁3组的HPV感染阳性率明显高于体检组(P<0.01);体检组以20～29岁感染率最高(20.00%),门诊组以≥50岁组感染率最高(36.50%)。②门诊组HC2HPV与TCT同时检查,以TCT初诊结果≥LSIL为阳性时,HPV阳性预测值15.87%(30/189),阴性预测值100%(108/108)。结论:妇科门诊患者HPV检查有利于宫颈病变筛查。HC2高危型HPVDNA检测阳性后,再进行第二步细胞学检查可以作为宫颈病变筛查的临床路径思路。

Objective：To analyze situation of human papillomavirus （HPV） infection in women of child- bearing age and to explore a new strategy for screening cervical lesions in clinic. Methods ：2070 physical ex- amination individuals （physical examination group） and 1405 gynecologic outpatients （outpatient group） were selected randomly to test HPV using hybrid capture II assay （HC2） ,297 cases were selected randomly from 1405 outpatients to test HPV both by HC2 and thinprep cytologic test（TCT）. Results：（~）The positive rates of HPV infection in physical examination group （ all cases） and outpatient group （ all cases） are 12. 17% and 21.28% ,the difference between the two groups was significant（ P〈0.01 ）. The positive rates of HPV in- fection in physical examination group were significantly higher than those in outpatient group （ P 〈 0.01 ） when the patients＇ ages were 30 to 39 years old,40 to 49 years old,and older than 50 years old. In physical examination group, the highest infection rate was in the individuals who were aged 20 - 29 years old （20. 00%） ;In outpatient group the highest infection rate was in the individuals who were older than 50 years old （36. 50% ） （2）. The individuals in the outpatient group who were tested by both TCT and HC2 were regarded as positive when their result of TCT was LSIL, or more severe. The positive predictive value and negative pre- dictive value was 15.87% （30/189）, 100% （ 108/108 ） respectively. Conclusions： HPV testing in gynaeco- logical outpatients is good for cervical lesion screening. Secondary cervical cytological examination after the positive result of HC2 HPV test may be a new strategy for screening cervical lesions.