液基细胞学与HPV分型联合检测对早期宫颈癌的筛查意义

Significance of Liquid Based Cytology and HPV Typing in the Screening of Early Cervical Cancer

目的探讨液基细胞学(TCT)联合人乳头瘤病毒(HPV)分型检测对早期宫颈癌筛查的临床意义。方法选择慢性宫颈炎患者714例。TCT采用离心甩片法,HPV-DNA检测采用PCR-反向点杂交法,对TCT和HPV-DNA任一检测阳性或二者均阳性者进行阴道镜取活检检查。结果在HPV感染的各年龄组中,20~30岁组和51~60岁组的感染率较高,分别为36.7%和39.7%,各年龄组感染率差异有统计学意义(χ~2=14.974,P=0.039)。TCT检测的阳性率为25.8%,HPV-DNA检测的阳性率为29.7%,略高于TCT检测,但差异无统计学意义(P<0.05)。HPV-DNA高危型感染者中病理诊断为宫颈癌5例,占6.5%,高于HPV-DNA低危型感染者宫颈癌的发生率(0.7%),差异有统计学意义(P<0.05)。TCT联合HPV-DNA分型检测诊断宫颈癌的敏感度高于TCT和HPV-DNA单独检测,特异度高于HPV-DNA单独检测,假阳性率低于HPV-DNA单独检测,假阴性率低于TCT和HPV-DNA单独检测,差异有统计学意义(P<0.05)。结论TCT联合HPV-DNA分型检测可以提高诊断宫颈癌的敏感性和特异性,对宫颈癌的早发现、早治疗有重要临床意义。

Objective To investigate the clinical significance of liquid based cytology combined with typing of human papilloma virus in the screening of early stage cervical cancer. Methods 714 cases of chronic cervicitis with abnormal vaginal bleeding and drainage were selected. TCT used the centrifugal throw slice method, HPV-DNA detection used PCR-reverse dot blot hybridization, then TCT and HPV-DNA any test positive or 2 were positive were given biopsy examination. Results In HPV in- fection in all age groups,20 -30 years old group and 51 -60 years old group infection rate were higher,36.7% and 39.7% ,re- spectively, the infection rates in each age group had no statistical significance （ X2 = 14.974, P = 0. 039）. The positive rate of the HPV-DNA was 29.7%, slightly higher than that of TCT（ 25.8% ）, but the difference was not statistically significant （ P 〈 0.05）. The pathological diagnosis of 5 cases of high-risk type of infection in patients with cervical cancer, accounting for 6.5% , higher than the incidence of cervical cancer in low-risk type HPV-DNA infection （0.7%） ,the difference was statistically significant （P 〈 0.05）. TCT and HPV DNA detection in the diagnosis of cervical carcinoma has a higher sensitivity than TCT and HPV DNA detection alone,the specificity was higher than that of HPV-DNA testing alone, the false positive rate was lower than HPV-DNA testing alone,false negative rate was lower than the TCT and HPV DNA detection alone, the difference was statistically significant （ P 〈 0.05）. Conclusion TCT combined with HPV-DNA typing detection can improve the sensitivity and specificity of the diag- nosis of cervical cancer, it has important clinical significance.