HPV检测在妇产科临床中的应用

Clinical Applications of HPV Testing in Obstetrics and Gynecology

女性生殖道人乳头状瘤病毒(HPV)感染临床常见,而持续性高危型HPV感染是发生宫颈癌的主要原因。目前临床上常用的几种HPV检测方法,其主要目的是确定是否存在高级别宫颈上皮内瘤样变(CIN),而不是诊断有无病毒感染。美国食品和药物管理局(FDA)批准的HPV检测方法包括杂交捕获2代HPV(HC2-HPV)、Cervista HPV、Cobas HPV和Aptima HPV检测。这4种HPV检测方法诊断高级别CIN的敏感度和特异度非常接近。目前HPV检测在妇产科临床中的应用主要包括:与细胞学联合筛查或单独筛查宫颈癌及其癌前病变、细胞学筛查异常的分流及治疗后或筛查异常的随访。HPV初筛方案与联合筛查效能相似、需要的检测次数更少,但HPV初筛诊断高级别CIN的特异度较低,也可能更易漏诊宫颈癌。如何最佳地将HPV检测应用于宫颈癌防治仍需继续完善。

The infection with human papillomavirus （HPV） in women genital tract is common, and the persistent infection of high-risk type HPV is the major cause of cervical cancer. The main purpose of HPV testing is to determine whether there is a high-grade cervical intraepithelial neoplasia （CIN） or cancer, rather than an infection itself,though various methods are available for HPV testing. The four HPV assays approved by the Food and Drug Administration （FDA） for cervical cancer screening are hybrid capture 2 HPV （HC2-HPV）, Cervista HPV, Cobas HPV and Aptima HPV. Above assays were demonstrated to have similar sensitivity and specificity for the detection of high-grade CIN. The current clinical applications of HPV testing in obstetrics and gynecology were included： ①to screen cervical cancer and precursors by sole HPV testing or the HPV testing combined with cytopathology; ②to triage cervical lesions for women with cytopathological abnormalities; ③to follow-up visit for women after treatment or women with abnormal screening results. The HPV primary screening is as effective as the combined screening, and that the testing times are less when compared with the combined screening. However, the HPV primary screening has lower specificity than the cervical cytopathology. Moreover, some women with cervical cancer may be misdiagnosed by an HPV-only screening. It is necessary to explore how to apply the HPV testing to the best advantage in the prevention and treatment of cervical cancer.