不明确意义非典型鳞状上皮细胞患者人乳头瘤病毒分型检测的临床意义

Clinical significance of human papillomavirus genotyping in patients with atypical squamous cells of undetermined significance

目的:分析宫颈脱落细胞学检查结果为不明确意义非典型鳞状上皮细胞(ASCUS)患者,在不同亚型人乳头瘤病毒(HPV)感染情况下的组织病理学结果,为ASCUS患者临床处理方法的选择提供依据。方法:大连市相关宫颈癌筛查项目中,宫颈脱落细胞学检查结果为ASCUS,并同意接受HPV分型检测及阴道镜检查的448例女性为研究对象,分析ASCUS患者的HPV感染亚型与组织病理学结果之间的相关性。结果:448例ASCUS患者中HPV阳性251例,阳性率为56.03%,HPV阳性组的宫颈癌及其癌前病变患病率(29.08%)高于HPV阴性组(4.06%);组织病理学诊断为宫颈上皮内瘤变(CIN)者80例,宫颈浸润癌(SCC)1例,检出率为18.08%。高危HPV16、58、52、33、31和18型感染者宫颈癌及癌前病变的检出率依次为:57.14%(28/49)、34.78%(8/23)、31.82%(7/22)、18.75%(3/16)、44.44%(4/9)、42.86%(3/7)。结论:应通过HPV分型检测对ASCUS患者群进行分流管理,以提高宫颈癌及其癌前病变的诊断率。

Objective： To analyze the histopathological results of the patients with different subtypes of human papillomavirus （HPV） diagnosed as atypical squamous ceils of undetermined significance （ASCUS） after cervical exfoliocytological examination, provide a basis for choosing clinical treatment of ASCUS. Methods： A total of 440 women diagnosed as ASCUS after cervical exfoliocytological exami- nation and receiving HPV genotyping and colposcopy in Dalian cervical cancer screening project were selected as study objects, the correla- tion between HPV subtypes of ASCUS patients with HPV infection and histopathological results was analyzed. Results ： Among 448 ASCUS patients, 251 patients were found with positive HPV, the positive rate of HPV was 56.03%, the incidence rate of cervical cancer and cervi- cal precancerous lesion in positive HPV group was 29. 08%, which was higher than that in negative HPV group （4. 06% ） ; 80 patients were diagnosed as cervical intraepithelial neoplasia （CIN） by histopathological examination, one patient was diagnosed as invasive cervical cancer, the detection rate was 18.08% ; the detection rates of high risk HPV16, 58, 52, 33, 31, 18 were 57.14% （28/49）, 34. 78% （8/ 23）, 31.82% （7/22）, 18.75% （3/16）, 44.44% （4/9）, and 42. 86% （3/7）, respectively. Conclusion： ASCUS patients can be separated and managed through HPV genotyping to improve the diagnostic rates of cervical cancer and cervical precancerous lesion.