高危HPV检测联合液基细胞学检查在妊娠期妇女宫颈疾病筛查中的价值

Value of high risk HPV combined liquid-based cytology testing in screening cervical disease in pregnancy women

目的通过高危HPV检测联合液基细胞学检查结果的分析,探讨对妊娠期常规进行宫颈疾病筛查的必要性。方法选择2013年1月~2015年12月在上海市同仁医院产科门诊首次产前检查时采用高危型人乳头状瘤病毒检查和液基细胞学检查进行联合筛查的孕妇7316例,对高危HPV阳性或TCT检查结果异常的孕妇做阴道镜评估,异常者行镜下组织学活检。结果 7316例孕妇中,高危HPV检测阳性者584例,占7.98%,液基细胞学检查异常者180例,占2.46%。高危HPV检测对宫颈病变的敏感性、特异性、阳性预测值、阴性预测值分别为91.40%、93.09%、14.55%、99.88%;液基细胞学检查分别为86.02%、98.62%、44.44%、99.82%,高危HPV检测联合液基细胞学检查分别为100.00%、92.55%、14.74%、100.00%。HPV负荷量与宫颈病变严重程度无关(P>0.05)。结论在妊娠期妇女宫颈疾病筛查中,高危HPV检测联合液基细胞学检查方法相较于单独进行HPV检测和单独进行TCT检查,具有更高的敏感性及阴性预测值,能够及时发现宫颈病变,便于早期发现,早期治疗。

Objective To investigate the necessity of routine screening of cervical diseases during pregnancy through the high-risk HPV detection combined with TCT examination. Methods From January 2013 to December 2015, in outpatinet of Obstetrics, Shanghai Tongren Hospital, 7316 pregnant women received the high-risk HPV detection and TCT examination in the first prenatal examination were selected. Pregnant women with high-risk HPV positive or abnormal TCT results received the colposcopy assessment, and those abnormal women further received the microscopic histological biopsy. Results In 7316 pregnant women, there were 584 high-risk HPV positive pregnant women, accounting for7.98%, and 180 pregnant women with abnormal TCT examination, accounting for 2.46%. The sensitivity, specificity,positive predictive value and negative predictive value of high-risk HPV detection for cervical lesions was 91.40%,93.09%, 14.55% and 99.88%, respectively, those of TCT examination was 86.02%, 98.62%, 44.44% and 99.82%, respectively, and those of high-risk HPV detection combined with TCT examination was 100.00%, 92.55%, 14.74% and100.00%, respectively. There was no significant correlation between HPV load and severity of cervical lesions（P〉0.05）.Conclusion In terms of cervical disease screening for pregnant women, the high-risk HPV detection combined with TCT examination has a higher sensitivity and negative predictive value than that of single application of HPV detection and TCT examination, which can find the cervical lesions timely, so that the disease can be detected and treated early.