高危型人乳头瘤病毒检查对异常子宫颈细胞学的评价作用

The application of high risk human papilloma virus testing in abnormal cervical cytology

目的:评价异常细胞学联合高危型人乳头瘤病毒(HR-HPV)检查对预测子宫颈上皮内瘤变(CIN)Ⅱ+和子宫颈癌的作用。方法:对206例细胞学异常、HR-HPV阳性/阴性的妇女进行阴道镜检查和子宫颈活组织病理检查并进行分析。结果:206例中HR-HPV阳性率45.15%(93/206),CINⅡ+15.53%(32/206)。ASCUS、LSIL和HSIL+的HR-HPV阳性率分别为40.52%(62/153),54.76%(23/42),72.73%(8/11),差异有统计学意义(χ2=6.1800,P<0.05)。HRHPV阳性患者中,CINⅡ+为30.11%(28/93),CINⅢ+6.45%(6/93)。HR-HPV检查对其子宫颈活检病理结果为CINⅡ+的总体预测值为敏感性87.50%,特异性56.90%,阳性预测值27.18%,阴性预测值96.12%;对CINⅢ+的总体预测值为敏感性100%,特异性51.50%,阳性预测值5.83%,阴性预测值100%。结论:HR-HPV检查对子宫颈异常细胞学结果可起到风险评估、指导分流作用,对于CINⅡ+和CINⅢ+有极高的敏感性和阴性预测价值。

Objective：To evaluate the role of high risk human papilloma virus（HR HPV）testing combined with abnormal cervical cytology in predicting cervical intraepithelial neoplasia（CIN）Ⅱor worse and cervical cancer.Methods：A total of 206 women with abnormal cervical cytology were recruited,whose HR HPV testing was positive or negative.Colposcope examination and cervical tissue pathological examination were carried out in all women,and the outcomes were further analyzed.Results：Among the206 patients,the rate of HR HP positive was 45.15%（93/206）,the proportion of patients with CINⅡor worse was15.53%（32/206）.The rate of HPV positivity in patients with ASCUS,LSIL,and HSIL or worse was 40.52%（62/153）,43.5%,and 72.73%（8/11）,respectively,and there was significant difference（χ^2=6.1800,P〈0.05）.In patients whose HR HPV was positive,the proportion of CINⅡor worse and CINⅢ or worse was 30.11%（28/93）and 6.45%（6/93）,respectively.As for HR HPV testing predicting CINⅡor worse,the sensitivity,specificity,positive predictive value（PPV）and negative predictive value（NPV）was 87.50%,56.90%,27.18% and 96.12%,respectively.As for HR HPV testing predicting CINⅢ ＋ or worse,the sensitivity,specificity,PPV and NPV was 100%,51.50%,5.83% and 100%,respectively.Conclusion：HR HPV testing has a role in assessing high risk and can guide triage of women with abnormal cervical cytology,and it also has high sensitivity and NPV for diagnosis of CINⅡor worse and CINⅢor worse.