不明确意义非典型鳞状上皮细胞患者的HPV分型检测

Typing detection of HPV in patients with atypical squamous cells of undetermined significance

目的探讨人乳头瘤病毒(HPV)分型检测对宫颈癌筛查细胞学为不明确意义非典型宫颈鳞状细胞(ASCUS)人群的临床应用价值。方法对957例宫颈癌筛查细胞学为ASCUS的患者进行HPV分型检测。其中,高危型HPV阳性者行阴道镜检查,并对结果异常者取组织活检;阴道镜未发现异常者进行HPV分型,随访2年。分析HPV型别与病理结果的相关性。结果 957例患者中,检出高危型HPV感染233例(24.35%)。HPV感染前6位为HPV16者71例,HPV33者32例,HPV58者31例,HPV56者24例,HPV18者23例,HPV31者18例。随访2年中,共有182例患者经阴道镜下取活检,检出宫颈炎66例,宫颈上皮内瘤变(CIN)106例(58.24%),宫颈癌10例(5.49%)。CIN中72例为混合感染。在116例宫颈癌及癌前病变中检出HPV16者46例、HPV33者19例、HPV58者15例、HPV18者17例,高于其他型别。HPV分型随访发现,高危HPV持续感染及混合感染的持续感染,在宫颈病变中的检出率高。结论建议对宫颈癌筛查细胞学结果为ASCUS人群行HPV分型检测。若结果为HPV16、18、33、58型,尤其是同时具有混合感染的患者以及在后期的随访中,高危HPV的持续感染以及高危混合感染的持续感染,建议行阴道镜检查。

Objective To explore the clinical value of HPV typing detection in cervical cancer screening cytology in the women with atypical squamous cells of undetermined significance（ASCUS）. Methods The HPV detection and genotyping were performed in 957 women with ASCUS diagnosed cytologically by cervical cancer screening. Colposcopy and biopsy were carried out in the cases with high risk HPV positive and those with colposcopically negative result were followed up for 2 years. The correlation between biopsy results and HPV genotyping was analyzed. Results Of 957 women with ASCUS,233 cases（24. 35%） were detected with high risk HPV infection. The first six specific types of HPV were HPV16 in 71 cases, HPV33 in 32 cases, HPV58 in 31 cases, HPV56 in 24 cases, HPV18 in 23 cases, and HPV31 in 18 cases. During two years follow up, biopsy under colposcopy was performed in 182 cases, of whom, cervicitis was diagnosed in 66 cases （36.26%）, cervical intraepithelial neoplasia（CIN） in 106 cases （58. 24%） , and cervical cancer in 10 cases（5.49%）. The mixture HPV infection in CIN cases was found in 72 cases（67.92%）. Of 116 cases with cervical cancer or precancerous lesions, the infection rate was 39.66% for HPV16, 16.38% for HPV33, 12.93% for HPV58,and 14. 66%for HPV18,which were higher than other types of HPV infection. The follow-up of HPV typing detection showed that persistent infection of high-risk HPV and mixture HPV accounted for the high rate of cervical lesions. Conclusion It is suggested that cervical cytology results of ASCUS should have HPV genotyping test. The colposeopy is recommended in ASCUS patients with the infections of HPV16, HPV18, HPV33, HPV58, especially in those with mixture HPV infection and persistent infection of high risk HPV in the late follow-up.