宫颈TCT异常患者行HPV检测在宫颈病变诊断中的临床价值

Clinical value of HPV testing in women with atypical squamous cells of cervical lesions

目的:探讨薄层液基细胞学检查(TCT)异常的患者行人乳头状瘤病毒(HPV)检测在宫颈癌及癌前病变诊断中的临床价值。方法:2010年3月至2012年3月在汉川市人民医院妇科门诊就诊的患者共计2389例行液基细胞学检查,结果异常的有526例患者,同时进行HPV DNA检测和阴道镜下宫颈活检,以组织病理学结果作为诊断的金标准。结果:宫颈活检组织病理学诊断结果:526例患者中宫颈炎及CINⅠ456例,占86.69%,CINⅡ34例,占6.46%,CINⅢ32例,占6.08%,宫颈浸润癌4例,占0.76%。HPV DNA检测阳性者共有226例,阳性率随病变严重程度的增加而增加。CINⅡ级及其以上病变检出率在HPV DNA检测阳性组中明显高于阴性组中,两组比较有显著性差异(P<0.05)。结论:细胞学检查结果异常的患者,病理组织学检查结果相差较大,可以从宫颈炎症到宫颈癌。HPV DNA检测可以减少单纯应用薄层液基细胞学而造成的宫颈病变漏诊率,并对细胞学结果有进一步的分流作用。

Objective： To analyze the clinical value of HPV testing for the diagnosis of cervical cancer and precan- cerous lesions in women with abnormal liquid - based cytology. Methods ： A retrospective study was carried out on pa- tients whose liquid - based cytology were abnormal in 526 cases all subjects were examined by HPV DNA testing and Colposcopy - directed biopsy. Results： In 526 cases patients with abnormal TCT, cervicitis and CIN I was 456 cases, accounting for 86.69% , CIN was 34 cases,accounting for 6.46% ,32 cases of CIN Ill ,6.08% , cervical carcinoma was 4 cases,accounting for 0.76%. 226 cases was HPV positive, the positive rate was increased with the severity of disease. CIN 1] level and above lesion detection rate was significantly higher in HPV positive group than that of nega- tive group in HPV detection, there were significant differences between two groups （ P 〈 O. 05 ）. Conclusion ： Patients with abnormal cytology results could be with different histopathologieal results, from cervicitis to cervical cancer. HPV - DNA detection can reduce the rate of misdiagnosis in simple application of liquid - based cytology on cervical le- sions, and there was further Shunt function for cytology results.