高危型人乳头状瘤病毒检测及阴道镜检查在未明确意义的宫颈不典型鳞状上皮细胞中的诊断价值

Diagnostic value of high risk HPV test and colposcopy in diagnosing atypical squamous cells with undetermined significance

目的 探讨对宫颈细胞学诊断为意义不明确的不典型鳞状细胞（ASCUS）病变患者行高危型人乳头瘤检测（HRHPV）及阴道镜活检的意义,并建立临床诊断路径.方法 对诊断为ASCUS的106例住院患者分别进行HR-HPV检测及阴道镜下宫颈活组织检查及宫颈管内膜诊刮术,并探讨ASCUS与年龄的关系.结果 ASCUS患者主要年龄分布段为30～49岁,106例ASCUS中组织病理学检查结果为：炎症70.75％ （75/106）、宫颈上皮内瘤变（CIN,包括CIN Ⅰ、CINⅡ、CINⅢ）29.25％ （31/106）、高级别CIN（包括CINⅡ及CINⅢ）发生率为13.21％（14/106）、浸润癌发生率为0.00％.HR-HPV检测阳性者48例,阳性率为45.28％ （48/106）.HR-HPV阳性组CIN的检出率为58.33％ （28/48）,HR-HPV阴性组CIN的检出率为5.17％ （3/58）,2组比较有差异有统计学意义（P＜0.001）.结论 ASCUS患者尤其是30 ～ 49岁年龄段者,如HR-HPV阳性应行阴道镜检查明确诊断；HR-HPV阴性患者可不进行阴道镜检查,但需定期检查宫颈薄层液基细胞学及人乳头瘤病毒.

Objective To explore the application value of HR-HPV test and colposcopy in diagnosing atypical squamous cells with undetermined significance （ASCUS）, and to build a clinical diagnostic pathway. Methods HR-HPV test, as well as vaginal microscopically cervical biopsy and cervical tube intima curettage, were performed in 106 hospitalized patients who were diagnosed as ASCUS. The relationship between ASCUS and patients＇age was also analyzed. Results Most of ASCUS patients were aged from 30 to 49 years. The histopathological results of 106 ASCUS were as follows： inflammation 70.75% （75/106）, CIN （including CINI, CIN II and CIN]]I ） 29.25% （31/106）, high grade CIN （including CIN ]l and CIN I]] ） 13.21% （ 14/106） and invasive cancer 0% （0/106）. Forty-eight patients 45.28% （48/106） were positive for HR-HPV. The detection rate of CIN was 58.33% （28/48） in HR-HPV-positive group. However, only 5.17% （3/58） pa- tients were diagnosed as CIN in HR-HPV negative group. There was significant difference between the two groups （P 〈 0. 001）. Conclusion Colposeopy is suggested in ASCUS patients with HR- HPV positive, especially aged for 30 to 49 years. HR-HPV-negative patients are not necessary to receive colposcopy, but thinprep cytology test （TCT） and HR-HPV test should be done regularly.