摘要
目的分析宫颈病变患者中高危型人乳头状瘤病毒(high—riskhumanpapillomavirus,HR—HPV)感染情况及特点,探讨HR—HPVDNA用于检测高级别宫颈上皮内瘤变(CIN)价值。方法回顾分析采用液基薄层细胞学(TCT)检查、HR—HPV检测第二代杂交捕获技术(HC-II法)和阴道镜检查并行活检的1130例宫颈病变患者临床资料。结果1130例患者HR.HPV阳性率65.84%(744/1130)。细胞学检测异常862例,不典型鳞状细胞(ASCUS)356例、不能除外高度鳞状上皮内病变的不典型鳞状细胞(ASCH)84例、低度鳞状上皮内病变(LSIL)216例、高度鳞状上皮内损伤(HSIL)184例、癌22例。病理学诊断≥CINI/HPVI682例,HR—HPV阳性率78.59%(536/682)。≥CINII病变TCT方法灵敏度88.94%,特异度32.73%;HC-Ⅱ方法灵敏度90.21%,特异度51.82%;两种方法联合灵敏度97.45%,特异度22.42%,阳性预测值47.22%,阴性预测值92.50%。30—39岁患者除与40-49岁有相近HR—HPV发生率外(,=0.41,P〉0.05),比20~29岁和50~59岁发病率高(x2=3.99和8.15,P〈0.05,〉60岁除外)。HC—II方法检测ASCUS病理≥CINlI灵敏度89.83%,特异性53.78%;HC-II检测LSIL≥CINⅡ病变的灵敏度97.62%,特异性22.72%。结论HR-HPV在各年龄段均有较高感染率,随着宫颈病变程度加深,HR—HPV感染率逐步升高。HC-Ⅱ检测HR-HPVDNA是筛查宫颈上皮内瘤变可选用方法,特别是对高级别CIN有较高的灵敏度、特异度、阳性预测值和阴性预测值。HR-HPVDNA检测是一种有效的ASCUS和LSIL的管理手段,有较高的灵敏度和阴性预测值。
Objective To understand the current status of high-risk human papilioma virus (HR-HPV) infection in women with cervical lesion, and evaluate the significance of HR-HPV detection by hybrid capture Ⅱ ( HC- Ⅱ ) in screening and diagnosing cervical lesion, especially high grade cervical intraepithelial neoplasia (CIN). Methods The retrospective analysis was conducted on the data of 1130 women with cervical lesion diagnosed by cervical cytological examination of thin prep liquid-based cytology test (TCT), HC-Ⅱ for HR-HPV, colposcopy and biopsy under colposcopy between June 2010 and December 2012. Results In 1130 cases, the positive rate of HR-HPV was 65.84% (744/1130), 862 cases had unusual cytology results, 356 cases had ASCUS, 84 cases had ASCH, 216 cases were with LSIL, 184 cases were with HSIL and 22 cases were with cancer. The number of biopsy ≥CIN ⅡHPV I was 682 and the positive rate of HR-HPV was 78.59% ( 536/682 ). In screening ≥ CIN Ⅱ , the sensitivity and specificity of TCT were 88.94% and 32. 73%, the sensitivity and specificity of HR-HPV DNA detection by HC- Ⅱ were 90. 21% and 51.82%. After the combination of two methods, the sensitivity was 97.45%, the specificity was 22.42%, the positive predicting value was 47.22% and the negative predicting value was 92. 50%. There was no significant differences in the incidence rates of HR-HPV between age groups 30 - 39 and 40 - 49 years ( P 〉 0.05 ), the incidence rates in age groups 30 - 39 and 40 - 49 years were higher than in age groups 20 - 29 and 50 - 59 years ( P 〈 0. 05 ). The sensitivity and specificity of HC-Ⅱ in screening ≥ CIN Ⅱ of ASCUS were 89.83% and 53.78% respectively. The sensitivity and specificity of HC- Ⅱin screening ≥ CIN Ⅱ of LSIL were 97.62% and 22. 72%, respectively. Conclusion The infection rate of HR-HPV was high in all age group women and increased with severity of cervical lesion. HR-HPVdetection by HC-I is an important method in screening cervical lesion, test of HR-HPV DNA contributes much to diagnosis of high grade CIN with high sensitivity, specificity, positive predicting value and negative predicting value. HR-HPV detection is a viable option in the management of women with ASCUS and LSIL of TCT, the sensitivity and negative predicting value of the test were high.
出处
《疾病监测》
CAS
2013年第8期680-683,共4页
Disease Surveillance