高危型HPV检测在宫颈病变漏诊中的应用

Application of high risk HPV detection in missed diagnosis of cervical intraepithelial neoplasia

目的：探讨高危型人乳头瘤病毒（HPV）检测对降低宫颈病变漏诊率的意义。方法对443例经高危型 HPV检测、阴道镜下活检及实施宫颈环形电切术（LEEP）患者的临床资料进行回顾性分析。结果以LEEP术后病理诊断为准，阴道镜下宫颈活检诊断不足者111例，占25．06％。高危型HPV阳性患者302例，其中，诊断不足者96例，占31．79％；HPV阴性141例，诊断不足者15例，占10．64％，两组比较差异有统计学意义（ P＜0．05）。按年龄分段，阳性组中诊断不足率呈现2个低谷的“N”型分布，≤30岁段与41～45岁年龄段较低，31～35年龄段与大于或等于51岁段者较高；阴性组中诊断不足率呈现2个高峰，≤30岁段较高，41～45岁呈一小高峰，其他年龄段较低；阳性组与阴性组比较，≤30岁年龄段阳性组低于阴性组，41～45岁年龄段两组比较差异无统计学意义（P＞0．05），其他年龄段阳性组均明显高于阴性组（P＜0．05）。以不同的HPV载量进行分组，随着病毒载量的增大，诊断不足率逐渐增加，1≤ HPV≤10组与10＜ HPV≤100组比较差异无统计学意义（P＞0．05），＞100组与其他两组比较差异有统计学意义（P＜0．05）。结论高危型 HPV检测可降低宫颈病变漏诊率；并且与年龄和病毒载量有关。

Objective To explore the application of high risk human papillomavirus（HPV） detection in missed diagnosis of cervical intraepithelial neoplasia（CIN） .Methods 443 patients were analyzed retrospectively ,who were experienced HPV detection , colposcopic biopsy and LEEP treatment .Results Based on the pathological diagnosis after LEEP ,111 patients were under diag-nosed by biopsy ,which were 25 .06% .In the 302 positive HPV patients and 141 negative HPV ones ,the rates of under diagnosis were respectively 31 .79% and 10 .64% .The difference was significant between the two groups .According to the age section ,the under diagnosed rates of HPV positive group had two lows .The lows were women under 30 years and 41-45 years old ,while the highs were 31-35 years old or above 51 years old .For the negative group ,the highs were under 30 years old and 41-45 years old ,and the other age sections were low .The difference of rates between the two groups was changed by age .For the women under 30 years old ,the rate of positive group was lower than the negative one .For the women among 41-45 ,the two groups had no significant difference .For the other women ,the rate of positive group was significant higher than the negative one .All the subjects were divid-ed by HPV virus load .The rate of under diagnosis was increased with increasing virus load .The rates were similar between the groups of 1≤ HPV≤10 and 10〈 HPV≤100 .The rate of 〈100 group was significant higher than the other ones .Conclusion The high-risk HPV detection could reduce the rate of missed diagnosis ,which is affected by age of patients and is related to virus load .