人乳头状瘤病毒基因分型联合薄层液基细胞学检测在宫颈病变筛查中的应用

Application of human papillomavirus genotype combined with thinprep cytologic test in diagnosis of cervical lesion

目的探讨人乳头状瘤病毒(HPV)基因分型联合薄层液基细胞学(TCT)检测在宫颈病变筛查中的应用价值。方法采用导流杂交基因芯片法检测473例宫颈疾病患者HPV基因型别,TCT做细胞学筛查,同时行阴道镜活检,以组织学为金标准,对结果进行分析。结果 473例患者共检出HPV阳性169例,总感染率为35.7%;473例患者高危型HPV(HR-HPV)感染率为32.1%,TCT检测阳性率为26.6%,对宫颈病变筛查的灵敏度、特异度、漏诊率、阳性预测值和阴性预测值差异无统计学意义(χ2=3.444,P=0.063);HR-HPV与TCT联合检测对宫颈病变筛查的灵敏度、特异度、漏诊率、阳性预测值、阴性预测值分别为95.8%、77.7%、4.2%、52.3%和98.7%,灵敏度和阴性预测值均较单独HR-HPV及TCT检测明显提高,漏诊率明显降低,差异有统计学意义(P<0.05)。结论 HPV基因分型联合TCT检测能明显提高宫颈病变筛查的灵敏度和阴性预测值,降低漏诊率,更加有效地筛查宫颈病变。

Objective To investigate the clinical significance of human papillomavirus（HPV ）genotype combined with thinprep cytologic test（TCT ）in the diagnosis of cervical lesion .Methods A total of 473 patients were checked for 21 subtypes of HPV by diversion hybrid gene chip technology ,TCT and colposcope biopsy were also detected at the same time .The histology was selected as a gold standard to analyze the tested results .Results The over all positive rate of HPV in 473 patients was 35 .7% .The positive rate of high risk HPV（HR‐HPV） was 32 .1% ,the positive rate of TCT was 26 .6% ,the sensibility ,specificity ,false negative rate , positive predictive value and negative predictive value between HR‐HPV detection and TCT detection were no statistical signifi‐cance（χ2 = 3 .444 ,P= 0 .063） .The sensibility ,specificity ,false negative rate ,positive predictive value and negative predictive value of combining test were 95 .8% ,77 .7% ,4 .2% ,52 .3% and 98 .7% ,the sensibility and negative predictive value improved notably , and the omission diagnose rate decreased significantly（P〈 0 .05） .Conclusion HPV genotype combined with TCT detection could significantly improve sensibility and negative predictive value and decrease omission diagnose rate in diagnosis of cervical lesion .