人乳头瘤病毒检测及宫颈细胞液基检测对宫颈癌前病变早期诊断的影响分析

Effect of HPV detection and cervical cell basis detection on early diagnosis of cervical precancerous lesions

目的分析人乳头瘤病毒（HPV）检测及宫颈细胞液基检测对宫颈癌前病变早期诊断影响。方法选取2016年1月至2017年1月在永康市妇幼保健院妇科进行宫颈癌癌前病变筛查的患者223例，患者进入门诊筛查范畴后均予宫颈液基细胞学（TCT）检查和HPV检测，检测结果双阳性患者共6l例进行阴道镜宫颈活检组织病理学检查，最终确诊49例患者为上皮细胞改变。比较不同检测方法的准确性及敏感性。结果223例患者中，宫颈炎、CINI、CINII-CINIII及宫颈癌的患者中高危型HPV感染检出率分别为16．22％、39．29％、71．43％、100％。合计三种不同分型的阳性检出率得出，TCT检测的总阳性率为28．57％，HPV组检测的总阳性率为44．44％，联合检测的总阳性率为75．51％，联合检测的阳性率高于TCT检测（X2=21．63，P=0．000）与HPV检测（x2=25．51，P=0．000），差异有统计学意义。ASC分型患者TCT、HPV及联合检测的敏感性分别为57．14％、64．29％、85．71％，准确性分别为64．29％、71．43％、92．86％，联合检测组的敏感性与TCT（X1=2．13，P=0．140）及HPV（X2=1．25，P=0．260）检测相似，准确性与TCT（X2=2．33，P=0．130）及HPV（X2=1．39，P=0．240）相似；LISIL分型患者TCT、HPV及联合检测的敏感性分别为56．25％、62．50％、87．50％，准确性分别为68．75％、75．00％、93．75％，联合检测组的敏感性高于TCT（X2=3．86，P=0．049）及HPV（X2=4．57，P=0．033）检测，准确性高于TCT（X2=3．902，P=0．048）及HPV（X2=4．13，P=0．034）检测；HISIL分型患者TCT、HPV及联合检测的敏感性分别为57．89％、63．16％、89．43％，准确性分别为73．68％、78．95％、94．74％，联合检测组的敏感性高于TCT（X2=4．89，P=0．027）及HPV（X2=3．99，P=0．047）检测，准确性高于TCT（X2=3．99，P：0．048）及HPV（X2=5．34，P=0．027）检测。结论高危型HPV检测及TCT联合使用对官颈癌前病变进行筛查简便高效，兼顾准确性与敏感性，降低漏诊率，对于宫颈癌的预防及控制具有积极的作用。

Objective To analyze the effect of human papillomavirus （HPV） detection and cervical cell basal fluid on the early diagnosis of cervical precancerous lesions. Methods From January 2016 to January 2017, 223 patients in the Maternal and Child Health Care Hospital of Yongkang who received gynecological cervical cancer precancerous lesions screening were selected. All patients into the outpatient screening categories were given cervical liquid- based cytology （TCT） examination and HPV detection, 61 patients with test results of double positive received colposcopy cervical biopsy histopathological examination, the final diagnosis of 49 patients with epithelial cell changes. The accuracy and sensitivity of different detection methods were compared. Results The detection rates of high risk HPV infection in cervicitis,CIN Ⅰ , CIN Ⅱ -CINⅢ and cervical cancer patients were 16.22% ,39.29%, 71.43% and 100.00% in 223 cases of this study. The total positive rate of TCT was 28.57%. The total positive rate was 44.44% in HPV group and 75.51% in combination test. The positive rate of combined detection was higher than TCT （X2 =21.63 ,P =0. 000） and HPV （X2 = 25.51 ,P = 0. 000）,the difference was statistically significant. For ASC patients, the sensitivity of TCT, HPV and combined detection was 57.14% ,64.29% and 85.71%, respectively. The accuracy of TCT, HPV and combined detection was 64.29% ,71.43 % and 92.86%, respectively. The sensitivity of combined detection was similar to TCT （ X2 = 2.13 ,P = 0. 140） and HPV （ X2 = 1.25, P = 0. 260）. The accuracy of combined detection was similar to TCT （ X2 = 2.33, P = 0. 130） and HPV （ X2 = 1.39, P = 0. 240）. For LISIL patients,the sensitivity of TCT, HPV and combined detection was 56.25% ,62.50% and 87.50% , respectively, the accuracy was 68.75% ,75.00% and 93.75% ,respectively. The sensitivity of the combined test group was higher than that of TCT （ X2 = 3.86, P = 0. 049 ） and HPV （ X2 = 4.57,P = 0. 033 ） , and the accuracy of combined test was higher than that of TCT （ X2 = 3. 902 ,P = 0. 048） and that of HPV （ X2 = 4.13, P = 0. 034 ）. For HISIL typing patients, the sensitivity of TCT,HPV and combined detection was 57.89% ,63.16% and 89.43% ,respectively, and the accuracy was 73.68% ,78.95% and 94.74% ,respectively. The sensitivity of the combined test group was higher than that of TCT （ X2 = 4.89, P = O. 027 ） and that of HPV （ X2 = 3.99,P = 0. 047 ） , and the accuracy of combined test was higher than that of TCT （ X2 = 3.99,P = 0.048） and that of HPV （ X2 = 5.34,P = 0.027）. Conclusion High - risk HPV detection combined with TCT in the screen of cervical cancer precancerous lesions is simple and efficient, taking into account the accuracy and sensitivity, it can reduce the rate of missed diagnosis, has a positive effect on prevention and control of cervical cancer.