影响自取样本与医生取样HPV检测一致性的相关因素分析

Analysis of related factors affecting the HPV consistency of self-sampling and physician-collected samples

目的研究影响自取样本与医生取样HPV检测一致性的相关因素。方法2013年7月至2013年9月对2048例女性通过自取样本及医生取样HPV检测进行宫颈癌筛查,同时检测阴道局部雌激素水平及微生态改变。结果1920例女性数据完整,自取样本与医生取样的总体一致率为95.1%(95%CI:94.0%~96.0%),Kappa值为0.74。自取样本对CIN2+的敏感度与医生取样相当(90.9%vs 100%),特异度略低于医生取样(88.8%vs 91.4%,P=0.00)。自取样本阳性/医生取样阴性71例,自取样本阴性/医生取样阳性24例,自取样本阳性/医生取样阴性出现的机率高于自取样本阴性/医生取样阳性(χ^2=23.84,P=0.00)。自取样本阳性/医生取样阴性的危险因素为雌激素高度低落(OR:3.34,P=0.02),不同雌激素水平及阴道微生态改变情况下均未明显增加自取样本阴性/医生取样阳性的机率(P均>0.05)。结论对于雌激素高度低落女性,自取样本HPV检测不失为一项可以替代或弥补医生取样的筛查方法。

Objective To investigate the factors that affecting the consistency of self-collected and physician collected samples for HPV detection.Method From July to September 2013,2048 women were screened for cervical cancer using both self-and physician-collected samples HPV testing,and detecting local estrogen levels and microecological changes in their vaginas.Results 1920 women had complete data.The overall consistency of HPV results for self-collected and physician-collected samples was 95.1%(95%CI:94.0%~96.0%),with a Kappa value of 0.74.The sensitivity of the self-sampled for CIN2^+was comparable to that of the doctors sampled(90.9%vs 100%),and the specificity was slightly lower than the doctors sampled(88.8%vs 91.4%,P=0.00).71 women were HPV positive for self-collected samples only and 24 women were physician-collected samples positive only.Selfpositive-only women were more frequent than physician-positive-only ones(χ^2=23.84,P=0.00).The risk factor for selfpositive-only discordance was high estrogen depression(OR:3.34,P=0.02).There was no significant increase in the probability of physician-positive-only under different estrogen levels and changes in vaginal microecology(all P>0.05).Conclusion For women with high estrogen depression,self-collected samples HPV detection is a replace or supplement method for the physician collected screening.