HPVL1壳蛋白检测、宫颈液基薄层细胞学检查、HPV分型检测在宫颈病变筛查中的临床意义

Clinical significance of HPVL1 shell protein detection,cervical Thinprep cytology test,and HPV genotyping in screening of cervical lesions

目的探讨HPVL1壳蛋白检测、宫颈液基薄层细胞学(TCT)检查、HPV分型检测在宫颈病变筛查的临床意义,为临床宫颈病变筛查提供参考依据。方法选取2017年1月-2018年1月在四川省第四人民医院行HPV筛查的患者424例为研究对象,对其临床资料及宫颈脱落细胞标本进行回顾性分析,所有患者均经HPVL1壳蛋白检测、TCT检查、HPV分型检测,以病理学检查结果作为标准,对3种检测方法的临床应用价值进行分析比较。结果TCT阳性检测率与HPV分型检测阳性率分别为30.3%、93.8%,其中低危亚型(LR-HPV)主要见于非典型鳞状上皮细胞(ASCUS)与低度鳞状上皮内病变(LSIL)等低度病变细胞中,随着TCT检测病变级别升高,高危亚型(HR-HPV)检测阳性呈现逐渐增加的趋势。病理学检测阳性率为38.2%,以病理学检查结果作为标准,HPV分型检测阳性诊断符合率明显高于HPVL1壳蛋白检测和TCT检测,且HPVL1壳蛋白检测阳性诊断符合率高于TCT检测,差异均有统计学意义(P<0.05);随着宫颈病变等级的升高,HPVL1壳蛋白检测诊断的阳性符合率呈现逐渐下降趋势。与HPVL1壳蛋白检测、TCT检查、HPV分型检测单独应用相比,三者联合诊断CINⅡ以上病变的灵敏度、特异度及阳性预测值等均明显提高,差异有统计学意义(P<0.05)。结论在宫颈癌筛查中,TCT与HPV分型检测是重要指标,HPVL1壳蛋白检测能够对宫颈病变风险进行一定程度评估,三者联合检测在宫颈病变筛查方面具有重要价值。

Objective To explore the clinical significance of HPVL1 shell protein detection,cervical Thinprep cytology test( TCT),and HPV genotyping in screening of cervical lesions,provide a reference basis for screening of cervical lesions. Methods A total of 424 patients receiving human papillomavirus( HPV) screening in the Fourth People’s Hospital of Sichuan from January 2017 to January 2018 were selected,the clinical data and cervical exfoliated cell specimens were retrospectively analyzed. HPVL1 shell protein detection,cervical TCT,and HPV genotyping were conducted among all the patients. The clinical application value of the three detection methods were analyzed and compared taking pathological examination result as the standard. Results The positive rates of TCT and HPV genotyping were 30. 3% and93. 8%,respectively. low-risk HPV subtype was mainly observed in atypical squamous epithelial cells( ASCUS) and low-grade squamous intraepithelial lesions. The positive rate of high-risk HPV subtype increased gradually with the increase of severity of cevical lesions detected by TCT. The positive rate of pathological examination was 38. 2%. The coincidence rate of positive diagnosis of HPV genotyping was statistically significantly higher than those of HPVL1 shell protein detection and TCT using pathological examination result as the standard,and the coincidence rate of positive diagnosis of HPVL1 shell protein detection was statistically significantly higher than that of TCT( P<0. 05). The coincidence rate of positive diagnosis of HPVL1 shell protein detection decreased significantly with the increase of grade of cervical lesions.Compared with single detection of the three methods,the sensitivity,specificity,and positive predictive value of joint detection of three methods for cervical intraepithelial neoplasia Ⅱ and above lesions increased significantly( P< 0. 05). Conclusion In cervical cancer screening,TCT and HPV genotyping are important indicators. HPVL1 shell protein detection can assess the risk of cervical lesions to a certain extent. Joint detection of the three methods has important value in screening of cervical lesions.