TCT、DNA定量分析及HPV检测在宫颈癌及癌前病变筛查中的应用研究

The Study of TCT,DNA Imaging Cytometry and Human Papillomavirus Test in Cervical Intraepithelial Neoplasia and Cervical Cancer Screening

目的:研究液基薄层细胞学检查(TCT)、DNA定量分析、HPV检测在宫颈癌及癌前病变筛查中的应用价值。方法:将2012年1月—2013年1月在我院妇科体检、门诊及住院的2 572例妇女的宫颈脱落细胞分别行TCT、Feulgen染色后DNA定量分析和HPV分型检测。共筛查出可疑宫颈癌及癌前病变253例,并经宫颈活检后组织病理诊断。以组织学诊断为标准,分析筛查方法的敏感性和特异性。结果:1TCT、DNA定量分析、高危型HPV(HR-HPV)检测对高级别宫颈上皮内瘤变(CINⅡ/Ⅲ)及浸润性宫颈鳞癌(ISCC)的敏感性分别为64.5%、90.3%、54.8%,特异性分别为97.3%、93.2%、94.1%;2TCT结合DNA定量分析、TCT结合HR-HPV检测对CINⅡ/Ⅲ及ISCC敏感性分别为96.2%、88.2%,特异性分别为94.9%、98.9%;DNA定量分析较TCT和HR-HPV检测的敏感性高,差异有统计学意义(P<0.05);TCT结合HR-HPV检测的特异性高,差异有统计学意义(P<0.05)。结论:TCT结合DNA定量分析或HR-HPV检测均可提高敏感性,但TCT结合HR-HPV检测特异性最高,因其经济、准确,利于开展,更适应于青海高原地区的宫颈癌和癌前病变的筛查。

Objective： To explore the play of Thinperp Cytology Test（TCT） technique,DNA imaging cytometry and human papillomavirus（HPV） in cervical intraepithelial neoplasia and Cervical Carcinoma screening.Method：A total of 2 572 woman involved in this study in hospital from January 2012 to January 2013.The samples of cervical exfoliate cell of all patients were taken for TCT,DNA imaging cytometry after Feulgen DNA specific stain and HPV test by Polymerase Chain Reaction（PCR）.In this study 253 woman were underwent cervical biopsy directly.The histodiagnosis was perform to evaluate the sensitive and specificity of these detection methods when used alone or combined each other,including TCT inspection,DNA imaging cytometry and HPV test.Results： The Sensitiving rates of TCT,DNA imaging cytometry,HPV,TCT ＋ DNA imaging cytometry,and TCT ＋ HR-HPV were64.5%,90.3% 、54.8% 、96.2% 、88.2%,and the specificity rates were,97.3% 、93.2% 、94.1% 、94.9% 、98.9% respectively.We found that DNA imaging cytometry is more sensitive than HR-HPV test and TCT inspection and TCT with HR-HPV are more specific than the other methods.Conclusion： TCT with DNA imaging cytometry and TCT with HR-HPV are most sensitive,while TCT with HR-HPV is most specific.The latter maybe is more useful for Cervical Carcinoma screening in the area of Qing Hai,because of the efficiency,accuracy and practice.