高危型人乳头状瘤病毒检测在宫颈癌筛查中的应用价值

Value of detection of high-risk human papillomavirus in screening of cervical cancer

目的评价高危型人乳头状瘤病毒(HPV)检测,在发现宫颈病变及分流管理细胞学结果为无明确诊断意义的非典型鳞状细胞(ASCUS)人群中的应用价值。方法对161例液基细胞学检测(TCT)阳性的患者,行HPV检测及阴道镜下宫颈活检病理检查,结合病理结果进行分析。结果 161例TCT结果异常标本中,病理证实正常/炎症为43例,宫颈上皮内瘤变(CIN)Ⅰ34例,CINⅡ25例,CINⅢ/原位癌38例,腺癌(AC)21例;TCT结果为ASCUS+非典型腺上皮细胞(AGC)、非典型鳞状细胞不除外高度鳞状上皮内病变(ASC-H)、鳞状上皮内低度病变(LSIL)、鳞状上皮内高度病变(HSIL)、鳞癌(SCC)+腺癌(AC)中HPV阳性率分别为53.66%、54.55%、77.27%、87.88%、95.24%;各病理组HPV阳性率分别为炎症60.47%、CINⅠ67.65%、CINⅡ88.00%、CINⅢ/原位癌89.47%、AC 95.24%;在41例ASCUS病例中,HPV阴性组无高级别宫颈病变检出,HPV阳性组高级别宫颈病变检出率为40.91%,差异有统计学意义(P<0.05)。结论持续的HPV感染与宫颈病变的演进有关,高危型HPV检测是宫颈癌机会性筛查的有效辅助手段,对TCT结果为ASCUS人群有分流处理的作用。

OBJECTIVE To evaluate the value of detection of high-risk human papillomavirus （HPV） in screening of cervical cancer and shunt management cytology without definite diagnostic significance among the atypical squamous cells （ASCUS） population. METHODS Totally 161 cases of liquid-based cytology-positive patients were enrolled in the study, then the detection of high-risk HPV and vaginal microscopic cervical biopsy were performed, and the pathological results were analyzed. RESULTS Of 161 cases with abnormal TCT results, the pathological testing result showed that there were 43 cases of normal or inflammation, 34 cases of cervical intraepithelial neoplasia （CIN） I , 25 cases of CIN II , 38 cases of CIN Ill or carcinoma in situ, and 21 cases of AC. The result of TCT indicated that the positive rate of HPV in the ASCUS ＋ AGC was 53. 66%, 54. 55% in the ASC-H, 77.27% in the LSIL, 87.88% in the HSIL, and 95. 24% in the SCC＋AC. Among the pathological groups, the positive rate of HPV was 60.47% in the cases of inflammation, 67.55% in the cases of CIN I , 88.00% in the cases of CINII , and 89.47% in the cases of CINIII or carcinoma in situ. No case of high level cervical lesion has been detected among the HPV-negative cases of ASCUS （41 cases ）, while the detection rate of the high level cervical lesion was 40.91% among the HPV-positive cases, the difference was statistically significant （P〈0.05）. CONCLUSION Continuous HPV infection is related to the evolution of cervical lesion, and the detection of high-risk HPV can serve as an effective auxiliary method for the opportunistic screening of cervical cancer, and the result of TCT has effect of shunting the ASCUS population.