宫颈细胞学阴性患者人乳头状瘤病毒分型检测的临床意义

Clinical value of human papillomavirus typing in the diagnosis of cervical lesions in women with negative cervical cytology

目的探讨宫颈细胞学阴性人乳头状瘤病毒(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而HPV阳性的妇女198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HPV分型与宫颈组织病理结果的关系。结果 198例受检妇女中,其中单一型感染141例,各型HPV多重感染59例,其中二重感染24例,三重感染9例。检出CINⅠ级20例,CINⅡ/Ⅲ级30例。85例HPV16型阳性妇女中CINⅡ/Ⅲ级检出率为22.4%,113例HPV16阴性妇女检出率为5.3%,二者检出率差异有统计学意义(P<0.05)。按各型别是否检出CINⅡ/Ⅲ级进行单因素Logistic回归分析,发现感染HPV16者发生CINⅡ/Ⅲ级病变的风险是未感染HPV16者的3.127倍(P<0.05)。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,尤其是宫颈细胞学阴性而HPV16型感染者应立即转诊阴道镜检查。

Objective To investigate the clinical significance of HPV genotyping detection in patients with negative cervical cytology and positive human papillomavirus（ HPV）. Methods A total of 198 women with negative cervical cytology and positive HPV received the HPV genotyping detection,and were referred to colposcopy and histopathological examination. The relationship between HPV typing and pathological examination was analyzed. Results Among 198 patients,141 cases were with simple infection and 59 cases were with various HPV multiple infection,including 24 cases of double infection and 9 cases of triple infection. 20 patients were detected as CIN Ⅰ,and 30 patients were detected as CIN Ⅱ / Ⅲ. Among 85 women with positive HPV16,22. 4% cases were detected as CINⅡ / Ⅲ. Among 113 women with negative HPV16,5. 3% cases were detected as CINⅡ / Ⅲ,and the difference of detection rate was statistically significant（ P〈0. 05）. Logistic regression analysis on single factor showed that the risk of CINⅡ / Ⅲ lesion infected with HPV16 was 3. 127 times that of non HPV16 infection,according to whether CINⅡ / Ⅲ was detected（ P〈0. 05）. Conclusion HPV genotyping detection has important clinical significance for women with negative cervical cytology and positive HPV. In particular,women with negative cervical cytology and HPV16 infection should be immediately referred to the vaginal examination.