4种人乳头状瘤病毒DNA检测方法在宫颈病变诊断中的比较研究

A comparative study on four methods of detection of DNA of human papillomavirus in diagnosis of cervical lesions

目的评价实时荧光定量PCR法(RT-PCR)、PCR-反向点杂交法和杂交捕获Ⅱ代(HC-Ⅱ)法对高危型人乳头状瘤病毒(HR-HPV)DNA检测及宫颈高度病变的诊断价值。方法选取宫颈薄层液基细胞学检查(TCT)异常并行阴道镜病理活检的218名妇女为研究对象,用HC-Ⅱ、实时荧光定量PCR法8个型(RT-PCR-8)、实时荧光定量PCR法13个型(RT-PCR-13)和PCR-反向点杂交法分别检测其宫颈细胞HR-HPV DNA;以病理组织学检测结果为金标准,比较4种检测方法对宫颈上皮内瘤变(CIN)Ⅱ及以上病变的诊断效果;采用SPSS 13.0软件进行统计分析,计数资料采用χ2检验。结果 HC-Ⅱ、RT-PCR-8、RT-PCR-13和PCR-反向点杂交法对218例HR-HPV DNA阳性检出率分别为72.48%、70.18%、75.23%和69.27%,差异无统计学意义;4种方法在宫颈炎性反应、CINⅠ、CINⅡ、CINⅢ和宫颈鳞状细胞癌(CSCC)5个不同等级宫颈病变中的HR-HPV阳性率检测差异无统计学意义;在诊断CINⅡ及以上病变的敏感度、特异度、Yoden指数、阳性预测值和阴性预测值等方面比较差异无统计学意义。结论对组织病理学诊断结果为CINⅡ及以上的宫颈病变,实时荧光定量PCR法(8个型或13个型)、PCR-反向点杂交法和杂交捕获Ⅱ代(HC-Ⅱ)法诊断效果相近,满足临床需求。

OBJECTIVE To explore the detection of human papillomavirus（HPV）DNA with real-time PCR（RTPCR）,PCR reverse dot blot hybridization,and hybrid capture generationⅡ（HC-Ⅱ）method and evaluate the diagnostic value of high-grade cervical lesions.METHODS Totally 218women who presented with abnormal liquidbased cytological test of cervical thin layer and underwent the colposcopy and biopsy were enrolled in the study, then the HR-HPV DNA was detected respectively by using HC-Ⅱ,RT-PCR-8,RT-PCR-13,and PCR reverse dot blot hybridization method,the result of histopathological test was defined as the golden standard,the effect of diagnosis of cervical intraepithelial neoplasia（CIN）Ⅱand more severe cervical lesions was compared between the four detection methods,the statistical analysis was performed with the use of SPSS13.0software,and the count data were analyzed by using chi-square test.RESULTS Among the 218subjects,the positive rate of detection of HR-HPV DNA was 72.48% by HC-Ⅱ,70.18% by RT-PCR-8,75.23% by RT-PCR-13,69.27% by PCR reverse dot blot hybridization method,the difference was not significant.The difference in the positive rate of HRHPV in the five grades of cervical lesions between the four detection methods,including cervicitis,CINⅠ,CIN Ⅱ,CIN Ⅲ,and cervical squamous cell carcinoma（CSCC）,was not significant.The difference in the sensitivity, specificity,Yoden index,positive predictive value,or negative predictive value of diagnosis of CINⅡ or more severe lesions was not significant.CONCLUSIONFor the histopathologically diagnosed CINⅡand more severe cervical lesions,the HC-Ⅱ,RT-PCR-8,RT-PCR-13,and PCR reverse dot blot hybridization method have the similar diagnosis effect and meet the clinical requirements.