高危型人乳头状瘤病毒检测在细胞学低度鳞状上皮内病变中的价值

Significance of high-risk human papillomavirus detection in management of low-grade squamous intraepithelial lesions in cervical cytology

目的探讨高危型人乳头状瘤病毒(hr HPV)检测在宫颈细胞学为低度鳞状上皮内病变(LSIL)和低度鳞状上皮内病变不除外高度鳞状上皮内病变(LSIL-H)患者管理中的价值。方法回顾性分析366例宫颈细胞学为LSIL和LSIL-H,同时行阴道镜下宫颈活检患者的资料。宫颈细胞学检查采用液基薄层细胞学检查(TCT),高危型HPV检测采用杂交捕获二代(HCⅡ)。结果细胞学LSIL患者中,高级别鳞状上皮内病变及以上病变(简称CINⅡ+病变)的检出率在hr HPV阳性组和hr HPV阴性组分别为15.2%和3.2%,差异无统计学意义(P>0.05);CINⅡ+的检出率在hr HPV阳性组和hr HPV未检查组分别为15.2%和21.5%,差异无统计学意义(P>0.05)。LSIL者CINⅡ+的检出率为17.8%,LSIL-H者CINⅡ+的检出率为64.3%,差异有统计学意义(P<0.05)。HSIL者CINⅡ+的检出率为82.4%,与LSIL-H者相比差异无统计学意义(P>0.05)。结论高危型HPV检测对细胞学LSIL和LSIL-H的分流价值小。LSIL-H需与LSIL区别对待,管理上可参照HSIL。

Objective To investigate the significance of high-risk human papillomavirus（ hr HPV） detection in the management of women with low-grade squamous intraepithelial lesion（ LSIL） and low-grade squamous intraepithelial lesion/cannot exclude high-grade squamous intraepithelial lesion（ LSIL-H） in cervical cytology. Methods Clinical date of 366 patients with LSIL and LSIL-H in cervical cytology were retrospectively analyzed. All of the patients had taken cerbix biopsy undergoing colposcopic. Cervical cytology detection was performed by thinrep cytologic test（ TCT）,and hr HPV was detected by hybrid captuer Ⅱ（ HC-Ⅱ）. Results In patients with LSIL in cervical cytology,the histopathologic detection rates of high-grade squamous intraepithelial or worse lesions（ CINⅡ＋lesions） were 15. 2% and 3. 2% in hr HPV-positive group and hr HPV-negative group,respectively,and the differences were not statistically significant（ P 0. 05）. The histopathologic detection rates of CINⅡ＋lesions were15. 2% and 21. 5% in hr HPV-positive group and hr HPV-unchecked group,respectively. The differences were not statistically significant（ P 〉 0. 05）. The detection rate of CINⅡ＋lesions in LSIL patients was 17. 8%,while that was 64. 3% in LSIL-H patients,and the differences were statistically significant（ P 〉 0. 05）. The detection rate of CINⅡ＋lesions in HSIL patients was82. 4%,compared to the rate in LSIL-H,the difference was not statistically significant（ P 〈 0. 05）. Conclusion The split value of hr HPV detection in LSIL patients was limited. The management of LSIL-H should be distinct with LSIL,and could be based on the current guidelines of HSIL.