高危型人乳头瘤病毒检测作为宫颈癌前病变首筛项目的研究

Detection of High-Risk Human Papillomavirus as the First Screening Project for Cervical Precancerous Lesions

目的探讨高危型人乳头瘤病毒(HPV)检测作为宫颈癌前病变首筛项目的应用价值。方法对1 013例慢性宫颈炎或疑似宫颈病变患者采用液基细胞学(LCT)检查及第二代杂交捕获技术(HC2)高危型HPV检测进行宫颈癌筛查,并与组织病理学比较。LCT检查以LCT≥非典型鳞状细胞(ASCUS)/非典型腺细胞(AGUS)为阳性,HC2检测以HC2≥1.0ng·L-1为阳性,任一项结果阳性者行阴道镜下取活检,并以宫颈活检病理结果为确诊金标准。结果 LCT检查对宫颈癌前病变敏感度、特异度、阳性预测值、阴性预测值分别为:89.61%、97.08%、27.27%、94.32%,HC2检测对宫颈癌前病变敏感度、特异度、阳性预测值、阴性预测值分别为:96.10%、70.03%、43.79%、98.67%;HC2检测的敏感度、阳性预测值及阴性预测值均显著高于LCT检查(P<0.05),但特异度显著低于LCT检查(P<0.05)。LCT联合HC2检测(LCT、HC2任一阳性)阳性符合率为19.54%,HC2检测阳性符合率(阳性预测值)明显高于LCT联合HC2检测(P<0.05)。结论在进行宫颈癌前病变筛查的流程中,将高危型HPV检测作为筛查流程的首筛项目,有助于降低宫颈癌前病变的漏诊率;高危型HPV检测阳性的患者再循流程行LCT,可提高宫颈癌前病变筛查的特异性;高危型HPV检测阴性的患者不必行进一步检查,有助于降低检查成本,避免不必要的浪费。

Objective To investigate the value of the detection of high-risk human papillomavirus（HPV）as the first screening project for cervical precancerous lesions.Methods A total of1 013patients with chronic cervicitis or suspected cervical lesions underwent liquid based cytology（LCT）and second-generation hybrid capture（HC2）test for cervical cancer screening.LCT≥atypical squamous cells of undetermined significance（ASCUS）/atypical glandular cells of undetermined significance（AGUS）and HC2≥1.0ng·L-1 were considered positive.Biopsies were taken under colposcopic guidance and pathologic examination was used as the gold standard.ResultsCompared with LCT test,the sensitivity,positive predictive value and negative predictive value increased（96.10%vs 89.61%,43.79% vs 27.27%and 98.67% vs 94.32%,respectively）but the specificity decreased（70.03% vs 97.08%）for predicting cervical precancerous lesions by HC2test（P〈0.05）.The positive coincidence rate determined by combined LCT and HC2test was19.54%,which was significantly lower than that determined by HC2test alone（P〈0.05）.Conclusion The detection of high-risk HPV as the first screening project can help to reduce the missed diagnosis rate in the screening for cervical precancerous lesions.Furthermore,LCT test can improve the specificity of cervical cancer lesion screening in HPV-positive patients.However,further examination is unnecessary in HPV-negative patients for reducing examination costs and avoiding unnecessary waste.