高危型人乳头瘤病毒感染联合液基薄层细胞检测对宫颈癌及宫颈癌前病变筛查与随访的临床意义

Clinical significance of detection of high-risk human papillomavirus infection combined with liquid-based thin-layer cytology test in screening,follow-up of cervical cancer and cervical precancerous lesions

目的通过对患者筛查及随访中高危型人乳头瘤病毒(HPV)及液基薄层细胞检测(TCT),比较单一检测及联合使用的优缺点,探讨高危型HPV感染检测联合TCT在宫颈癌及癌前病变防治中的作用,为宫颈癌及癌前病变的筛查、随访提供参考依据。方法选取2011年3月-2015年3月浙江省湖州市妇幼保健院和浙江省湖州市菱湖人民医院门诊筛查宫颈有病变者604例,采用TCT技术检查患者细胞学形态,HC-Ⅱ方法检测患者的HPV-DNA,同时做病理学活检,以病理诊断为最终诊断;分析HPV、TCT与CINⅡ~Ⅲ的诊断以及预后的关系;CIN治疗后第6、12、18个月进行随访,复测HPV感染情况及TCT结果。结果纳入CIN者342例,25~34岁、35~44岁、45~54岁、55~70岁分别占21.64%、51.17%、16.37%、10.82%;其中35~44岁比例最高,与其他各组比较差异有统计学意义(P<0.01);HPV-DNA、TCT单一检测以及联合检测时,灵敏度分别为67.25%(230/342)、63.16%(216/342)、92.11%(315/342),特异度分别为70.23%(184/262)、75.57%(198/262)、90.08%(236/262),阳性预测值分别为74.68%(230/308)、77.14%(216/280)、92.38%(315/341),阴性预测值分别为62.16%(184/296)、61.11%(198/324)、89.73%(236/263);3组间比较,联合检测高于单一HPVDNA或者TCT检测,差异均有统计学意义(P<0.05);CINⅡ~Ⅲ者随访至术后第18个月,有极少部分复发或残留,CINⅡ~Ⅲ复发残留率随着病理级别增高而升高,分别为7.69%、10.26%,3组间比较,差异有统计学意义(P<0.05)。结论高危型HPV-DNA和TCT检测在宫颈癌及宫颈癌前病变的筛查及随访中不可或缺,二者联合检测是一种客观性高、可重复性强的检测方法,操作相对简单,能对宫颈疾病的防治起到很好的指导作用。

OBJECTIVE To investigate the advantages and disadvantages of single detection and combined detection of high-risk human papillomavirus （HPV） infection and liquid-based thin-layer cytology test （TCT） in screening and follow-up of patients and explore the value of detection of high-risk human papillomavirus infection combined with liquid-based thin-layer cytology test in prevention and treatment of cervical cancer and cervical precancerous lesions so as to provide guidance for the screening,follow-up of the cervical cancer and precancerous lesions.METHODS A total of 604 patients who were screened to have cervical lesions in outpatient departments of Huzhou Maternal and Child Health-Care Center and Huzhou Linghu People＆#39;s Hospital from Mar 2011 to Mar 2015 were enrolled in the study.The cytological morphology of the patients was examined by using TCT,the HPV-DNA was detected by HC-Ⅱ method,the pathological biopsy was carried out at the same time,the pathological diagnosis was the ultimate diagnosis.The relationship between the HPV,TCT and the diagnosis and prognosis of CIN Ⅱ-Ⅲ was analyzed.The follow-up was conducted after the CIN was treated fro 6,12,and 18 months;the prevalence of HPV infection was reexamined,and the result of TCT was analyzed.RESULTS Of 342 CIN patients who were included in the study,21.64% were aged between 25 and 34 years old,51.17% between 35 and 44 years old,16.37% between 45 and 54 years old,10.82% between 55 and 70 years old.The sensitivity,specificity,positive predictive value,and negative predictive value of the single detection of HPV-DNA were 67.25% （230/342）,70.23 % （184/262）,74.68 % （230/308）,and 62.16 % （184/296）,respectively;the sensitivity,specificity,positive predictive value,and negative predictive value of the single TCT were 63.16% （216/342）,75.57% （198/262）,77.14% （216/280）,and 61.11% （198/324）,respectively;the sensitivity,specificity,positive predictive value,and negative predictive value of the combined detection of HPV-DNA and TCT were 92.11% （315/342）,90.08% （236/262）,92.38% （315/341）,and 89.73% （236/263）,respectively;the sensitivity,specificity,positive predictive value,and negative predictive value of the combined detection were significantly higher than those of the single detection of HPV-DNA or TCT,with statistical significance （P〈0.05）.Only few of the CIN Ⅱ-Ⅲ patients had the relapse or remained after the follow-up for 18 months;the recurrence and residual rates of CIN Ⅱ-Ⅲ were increased with the elevation of pathological grade,which were 7.69%,and 10.26%,respectively;there was significant difference among the three groups （P〈0.05）.CONCLUSION It is absolutely necessary to carry out the detection of HPV-DNA and TCT in screening and follow-up of the cervical cancer and cervical precancerous lesions.The combined detection of the HPV-DNA and TCT is highly objective and repeatable,with the operation simple,and it may play a guiding role in prevention and treatment of cervical diseases.