阴道镜联合人乳头瘤病毒检查在非典型鳞状上皮细胞病变中的临床应用

Clinical application of colposcopy combined with Human papilloma virus testing in detecting atypical squamous cells of undetermined significance

目的分析阴道镜联合人乳头瘤病毒(human papilloma virus,HPV)检查在非典型鳞状上皮细胞(atypical squamous cells of undetermined significance,ASCUS)中的应用价值。方法选择连续纳入2013年1—12月经液基薄层细胞检测(thinprep celltest,TCT)并诊断为ASCUS的患者102例,均做阴道镜检查及HPV-DNA检测,并在阴道镜下活检,以病理诊断结果为金标准。计数资料采用百分率表示,采用卡方检验,P<0.05为差异有统计学意义;一致性采用Kappa检验,Kappa>0.75为一致性较好。结果 102例患者中HPV-DNA检测阳性占49.02%,其中低危型占42.00%,高危型占58.00%。阴道镜检查结果阴性占56.86%,宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅰ占25.49%,CINⅡ占9.80%,CINⅢ占7.84%。宫颈活检病理结果发现1例原位癌。HPV-DNA检测结果与宫颈活检病理结果的比较,灵敏度为82.00%,特异度为85.25%。以HPV-DNA检测结果是否为阳性及病理结果是否为炎症,根据Kappa一致性检验,可得Kappa=0.765,一致性较好。阴道镜Reid评分结果与宫颈活检病理结果比较,灵敏度为97.62%,特异度为95.08%。根据Kappa一致性检验,可得Kappa=0.813,一致性较好。结论阴道镜联合HPV检查能够快速高效地对宫颈ASCUS患者进行管理并进一步诊断,与病理结果一致性好,对社区宫颈病变早期筛查、诊断及宫颈癌的防治工作具有重要意义。

Objective To evaluate the clinical value of colposcopy combined with HPV testing for atypical squamous cells of undetermined significance（ASCUS）.Methods 102 consecutive cases who underwent CT and were diagnosed as ASCUS from January to December in 2013 were selected for HPV-DNA testing and colposcopy.Colposcopy with biopsy was conducted and the pathologic diagnosis was as the gold standard.Percentage was used to for count data, chi-square test for the ratio of count data,the result of P〈0.05 was considered statistically significant;testing of Kappa was used for consistency cheek,Kappa〉0.75 was considered to be in good agreement.Results Of 102 cases,49.02% were positive for HPV testing,with 42.00% of low-risk and 58.00% of high-risk;56.86% were negative for vaginoseopy,with 25.49% of CIN Ⅰ ,9.80% of CIN Ⅱ and 7.84% of CIN Ⅲ .Cervical biopsy found one case of carcinoma in situ（CIS）.The results of HPV-DNA testing and cervical biopsy were compared,showing the sensitivity was 82.00% and specificity was 85.25%.The results of HPV-DNA testing and cervical biopsy were used to determine the positive nature of results and inflammation respectively.According to Kappa test,the result of Kappa=0.765 showed that there was well consistency.The results of Reid colposcopic scores and cervical biopsy were compared,showing the sensitivity was 97.62% and specificity was 95.08%.According to Kappa test, the result of Kappa=0.813 showed that there was well consistency.Conclusion Colposeopy combined with HPV testing can quickly and efficiently manage the patients with ASCUS and make further diagnosis,which has a good consistency with pathological result.Therefore,it is of significance in the early screening, diagnosis,pre- vention and control of cervical carcinoma in community.