高危型HPV检测在无颈管/转化区液基标本中的应用

Application of high risk HPV testing in patients without endocervical/transformation components

目的评价HPV检测对无EC/TZS成分、涂片阴性的妇女中进行疾病风险评估的价值。方法我们对2009年1月和2012年1月44192例宫颈液基结果进行回顾性分析。依据年龄和有无EC/TZ成分对低度鳞状上皮内瘤变(LSIL)和高度鳞状上皮内瘤变(HSIL)进行分组,对高危型人乳头状瘤病毒(hrHPV)DNA检出率进行比较。结果共44192份子宫颈涂片标本,有EC/TZ及无EC/TZ所占比例分别为62.87%、37.13%;整体LSIL检出率为0.78%,HSIL检出率为0.32%。在44192份样本中,总体比较,有EC/TZ组LSIL(P<0.001)、HSIL(P<0.001)检出率高于无EC/TZ组,差异显著;在LSIL组,各年龄段间,以及总体比较,有EC/TZ组HPV检出率与无EC/TZ组无显著差异(P=0.125)。在HSIL组,总体比较,有EC/TZ组HPV检出率与无EC/TZ组无显著差异(P=0.438)。即LSILs和HSILs妇女按照EC/TZS进行分组后,hrHPV检出率没有显著的差异。结论 hrHPV DNA检测对有或无EC/TZS妇女可进行客观有效的分层,是对无EC/TZS成分、涂片阴性的妇女进行疾病风险评估的有用的辅助工具。

Objective To assess the value of high risk HPV testing in risk stratification of women with or without EC/TZS. Methods A retrospective study was conducted reviewing the results from 44 192 liquid-based cervical Pap tests performed between January 2009 and January 2012. Women with any Pap result were stratified by 10-year age groups and according to the presence or absence of an EC/TZ sample （EG/TZS）. Women with LSIL and HSIL results with and without an EC/TZS were also compared for results of hrHPV DNA detection. Results Of the total of 44 192 cervical Pap tests, 16 409 （37.13%） lacked an EC/TZS and 62.87% with the presence of EC/TZS. The absence of an EC/TZS was found to be highest in adolescents and in women aged 30 years. The overall detection rate of ISIL was 0.78% and that of HSIL was 0.32%. Both the LSIL and HSIL rates were significantly higher in samples with an EC/TZS compared with samples without an EC/TZS （LSIL：4.51% vs 3.37% and HSIL：0.72% vs 0.29% ）. However,when women with LSILs and HSILs were divided into a group in which EC/TZS was present and a group in which EC/TZS was absent,no significant differences were found with regard to hrHPV DblA rates between the 2 groups. Conclusion Adjunctive hrHPV DNA testing is effective in stratifying the risk of SIL in women with and without an EC/TZS. hrHPV results provide a useful new assistant tool for stratification of disease risk in women with negative Pap tests and no EC/TZS.