高危HPV/TCT检测在宫颈上皮内瘤变筛查中应用

Application of high-risk HPV/TCT in screening for cervical intraepithelial neoplasia

目的高危型人乳头瘤病毒(human papillomavirus,HPV)感染是发生宫颈鳞状上皮内瘤变的必要不充分条件,敏感性高但特异性低。本研究探讨高危型HPV/液基细胞学(liquid-based cytology,TCT)检测在宫颈上皮内瘤变筛查中临床价值,为宫颈癌早期筛查提供参考。方法收集2018-03-09-2018-05-21青岛大学医学院附属医院162例患者临床资料,活检前宫颈高危HPV阳性并TCT阴性,分析其病毒类型、上皮内瘤变分级及年龄分布特征。结果162例患者中,高危HPV阳性率为98.57%(160/162),TCT阳性率为74.90%(121/162),χ^2=40.78,P<0.001。HPV敏感度为90.74%(147/162),特异度为85.18%(138/162),假阴性率为6.79%(11/162)。单一型高危病毒感染共22例,其中HPV1618例(43.90%),HPV184例(9.75%),多种高危病毒感染14例(34.14%),高危和低危混合感染5例(12.19%)。病理结果均为宫颈上皮内瘤样变,其中CINⅠ20例,CINⅡ20例,CINⅢ1例,CINⅡ并累及腺体3例,其中<30岁11例,所占比例最高(55%)。结论宫颈或阴道炎症、HPV病毒感染均会引起宫颈细胞学异常,对于TCT检查异常患者进行HPV病毒检测可提高宫颈上皮内瘤变准确率,且要重视年龄较小的患者。

OBJECTIVE High-risk human papillomavirus(HPV)infection is a necessary and insufficient condition for cervical squamous intraepithelial neoplasia.It has high sensitivity but low specificity.This study explores the clinical value of high-risk HPV/liquid-based cytology(TCT)in screening cervical intraepithelial neoplasia,and provides reference for early screening of cervical cancer.METHODS A total of 162patients in the Affiliated Hospital of Medical College of Qingdao University from March 09,2018to May 21,2018were collected.HPV was positive and TCT was negative before biopsy.The viral type,grade of intraepithelial neoplasia and age distribution were analyzed.RESULTS Among the 162patients,the high-risk HPV positive rate was 98.57%(160/162),the cytology positive rate was 74.90%(121/162),χ^2=40.78,P<0.001.The HPV sensitivity was 90.74%(147/162),the specificity was 85.18%(138/162),and the false negative rate was 6.79%(11/162).There were 22cases of single-type high-risk virus infection,including 18cases(43.90%)of HPV16,4cases(9.75%)of HPV18,14cases(34.14%)of high-risk virus infection,and 5cases(12.19%)of high-risk and low-risk mixed infection.Pathological results showed that all were cervical intraepithelial neoplasia,including 20cases of CINⅠ,20cases of CINⅡ,1case of CINⅢ,3cases of CINⅡinvolving glands,of which 11cases were<30years old with the highest proportion(52.38%).CONCLUSIONS Cervical or vaginal inflammation,HPV virus infection can cause cervical cytology abnormalities.HPV virus detection in patients with abnormal cytology can improve the accuracy of cervical intraepithelial neoplasia,and it should pay attention to younger patients.