高危型HPV联合TCT在宫颈上皮内瘤变诊断中的应用价值

Application value of high-risk HPV combined with TCT in the diagnosis of cervical intraepithelial neoplasia

目的探讨高危型人乳头瘤病毒(HR-HPV)联合液基细胞学(TCT)检查在宫颈病变筛查中的应用价值。方法收集2017年7月至2018年12月在陕西省第四人民医院行宫颈病变筛查的患者1 200例,均接受TCT检查及HR-HPV检测,TCT阳性(ASCUS以上)者及高危型HPV感染者经阴道镜下宫颈活检获得病理组织学诊断。结果TCT分级为无上皮内病变(NILM)、未确定诊断意义的不典型鳞状上皮细胞(ASCUS)、低度鳞状上皮病变(LSIL)、未除外高度病变的鳞状上皮细胞(ASC-H)、高度鳞状上皮病变(HSIL)和鳞状细胞癌(SCC)者中,HR-HPV阳性率分别为31.8%、40.1%、60.0%、77.4%、89.7%、100.0%,随着TCT分级提高,HR-HRV感染率逐渐增高,差异有统计学意义(P<0.05);≥CINⅡ组HR-HPV阳性率为95.6%,明显高于<CINⅡ组的46.7%,差异有统计学意义(P<0.05);在TCT分级为ASCUS、ASC-H、LSIL、HSIL患者中,HR-HPV阳性者高级别病变发生率分别为24.6%、45.8%、20.0%、90.8%,均分别高于相应的HR-HPV阴性者(0、0、0、60.0%),差异均有统计学意义(P<0.05)。结论高危型HPV联合TCT在宫颈病变筛查中有重要价值,能够提高宫颈高级别病变的检出率。

Objective To explore the application value of high-risk human papillomavirus(HR-HPV)combined with Thinprep cytologic test(TCT)in the screening of cervical lesions.Methods A total of 1 200 patients who underwent cervical lesion screening in the Fourth People's Hospital of Shaanxi from July 2017 to December 2018 were collected.All patients received TCT detection and HR-HPV testing.Specimens were obtained by cervical biopsy under colposcope in TCT positive(above ASCUS)patients,then histopathological diagnosis was performed.Results The HR-HPV positive rates of patients with TCT graded as negative for intraepithelial lesion or malignancy(NILM,31.8%),atypical squamous cells of undetermined significance(ASCUS,40.1%),low-grade squamous intraepithelial lesion(LSIL,60.0%),atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion(ASC-H,77.4%),high-grade squamous intraepithelial lesion(HSIL,89.7%)and squamous cell carcinoma(SCC,100.0%)increased gradually with the increase of TCT grade(P<0.05).The HR-HPV positive rate in≥CINⅡgroup was 95.6%,which was significantly higher than 46.7%in<CINⅡgroup(P<0.05).The incidence rates of high-grade lesions in patients with TCT grades of ATCUS(4.6%vs 0),ASC-H(45.8%vs 0),LSIL(20.0%vs 0)and HSIL(90.8%vs 60.0%)were higher in HR-HPV-positive patients than in HR-HPV-negative patients(P<0.05).Conclusion The application of high-risk HPV combined with TCT has important value in the screening of cervical lesions,which can improve the detection rate of high-grade cervical lesions.