高危型HPV检测在农村妇女宫颈癌筛查中的应用

Application of HR-HPV Detection in Screening of Cervical Cancer in Rural Women

目的分析利用高危型HPV检测作为宫颈癌初筛的筛查效果。方法自2015年5月—2017年9月利津县农村妇女宫颈癌免费筛查共63 750例,全部采用高危型HPV检测,阳性率为7.3%(4 637/63 750),高危型HPV检测阳性患者再进行液基细胞学检测(TCT),宫颈活检取材652例,检查结果以病理诊断为金标准。结果共筛查出宫颈上皮内瘤变和宫颈癌328例,其中宫颈癌20例。在病理诊断为CIN2及以上病变中:高危型HPV阳性而TCT为NILM患者有9例,其中1例为宫颈鳞状细胞癌;35~39岁、40~44岁、45~49岁、50~54岁、55~59岁年龄段人数分别占有16.67%、18.18%、35.86%、14.64%、8.08%、6.57%;HPV16、HPV18、HPV其他、HPV混合感染阳性患者分别占有45.96%、10.61%、25.76%、17.68%。HPV16阳性患者相对于HPV18阳性和HPV其他阳性患者发生宫颈上皮内瘤变和宫颈癌的发病率更高,差异有统计学意义(P<0.05)。结论高危型HPV阳性而TCT阴性的患者,仍需要建议阴道镜检查,并决定是否需要宫颈活检,在大型宫颈癌筛查中可以单独使用高危型HPV检测作为初筛。宫颈活检病理诊断为CIN2及以上病变中,45~49岁年龄段的人数最多,应对这一年龄段人群提高警惕。HPV16的致病力最强,对HPV16阳性患者应该加强随访并定期复查。

Objective To analyze the effect of HR-HPV test in initial screening on Cervical Cancer. Methods From May 2015 to September 2017, free Cervical Cancer screening test was provided to 63 750 ruralwomen in Lijin county, all by HR-HPV. 7.3% of the results were positive（4 637/63 750）, TCT test was performed further on the positive,652 women were taken biopsy sample and the result was regarded as final.Results 328 women were diagnosed CIN or Cervical Cancer, among those20 got cervical cancer. Those who got CIN2 or above, 9 of them were HPV positive with TCT NILM, 1 got cervical carcinomas. The proportion of those aged 35 ~ 39, 40 ~ 44, 45 ~ 49, 50 ~ 54, 55 ~ 50 were respectively16.67%, 18.18%, 35.86%, 14.64%, 8.08%, 6.57%, HPV16, HPV18,HPV other, and mixed infection positive patients were 45.96%, 10.61%,25.76%, 17.68%. HPV 16 positive patients were more likely to get CIN or Cervical Cancer compared with HPV 18 positive and HPV other positive,the difference was statistically significant（P 〈 0.05）. Conclusion For those who got HPV positive and TCT negative, colposcopy is suggested to further decide if biopsy sample is necessary. HPV can be used independently for initial screening for mass cervical cancer screening. For those who got CIN2 or above, the most possible age is 45 ~ 49, so such age group should be highly alerted. HPV16 showed the highest virulence, the patients with HPV16 should get repeated visits and retests on timely manner.