宫颈细胞学阴性HPV阳性妇女的HPV分型检测

HPV genotyping detection of HPV positive women with negative cervical cytology

目的探讨宫颈细胞学阴性人乳头瘤病毒(HPV)阳性妇女接受HPV分型检测的临床意义。方法宫颈细胞学阴性HPV阳性的妇女200例,对其进行HPV分型检测并转诊阴道镜及组织病理学检查,分析感染HPV型别与宫颈上皮内瘤变(CIN)Ⅱ+的关系,并在受检1 a后对病理检查结果为CINⅠ及宫颈炎症的患者进行随访,随访方法为宫颈新柏氏液基细胞学检查及HPV分型检测。结果 200例受检者中检出CINⅡ+患者37例(18.6%),HPV16型感染者发生CINⅡ+的风险是不伴HPV16型感染者的2.608倍(OR值为2.608,P<0.05)。151例完成随访的CINⅠ及宫颈炎症患者中,同型HPV感染者的宫颈上皮内瘤变患病率显著高于非同型感染者(P<0.01),且同型感染者发生病理高级别进展的风险是非同型感染患者的14.89倍。结论 HPV分型检测对宫颈细胞学阴性HPV阳性妇女有重要的临床意义。宫颈细胞学阴性HPV16型感染者应立即转诊阴道镜检查。HPV分型检测用于细胞学阴性HPV阳性妇女的随访,随访中发现同型HPV阳性的患者应转诊阴道镜检查,尤其HPV16型感染患者。

Objective To investigate the clinical significance of HPV genotyping detection in patients with negative cervical cytology and positive human papilloma virus（ HPV）. Methods A total of 200 women with negative cervical cytology and positive HPV received the HPV genotyping detection and were referred to colposcopy and histopathological examination. The correlation between different HPV subtype infection and cervical intraepithelial neoplasia（ CINⅡ）＋was analyzed. The women whose pathological diagnosis were CINⅠand cervicitis were followed up for one year by the method of TCT and HPV genotyping detection. Results Of 200 women,37 patients were CINⅡ^＋（ 18.6%）. The risk of patients with HPV16 infection to develop CINⅡ^＋was 2. 608 times higher than that of patients without HPV16 infection（ OR = 2. 608,P〈0. 05）. Of 151 patients with CINⅠand cervicitis who finished the follow-up,the prevalence of cervical intraepithelial neoplasia in patient with homotype HPV infection was higher than that in patients with heterotype HPV infection（ P〈0. 01）. And the risk of higher pathological progression in patients with homotype infection was 14. 89 times higher than that in patients with heterotype HPV infection. Conclusions HPV genotyping detection has important clinical significance for cervical cytology negative and HPV positive women. It is recommend that cervical cytology negative and HPV16 positive women should be referred to colposcopy immediately. HPV genotyping detection can be used for the follow-up of cervical cytology negative and HPV positive women,and patients with positive homotype HPV infection should be referred to colposcopy,especially those with HPV16 infection.