成都市女性HPV和宫颈细胞学筛查宫颈病变分析

HPV and cervical cytology testing in cervical lesions of women in Chengdu

目的了解成都市女性健康体检者宫颈病变情况,探讨人乳头瘤病毒(HPV)检查和液基薄层细胞学检查(TCT)与宫颈病变的关系。方法对2018年1月—2020年1月在成都医学院第二附属医院核工业四一六医院体检中心接受宫颈病变筛查的女性,采用HPV和TCT检查,对TCT异常者增补阴道镜病理学检查。分析TCT和HPV对宫颈病变的筛查价值。结果 10 395例女性健康体检者中HPV感染率8.89%(924/10 395),共检出HPV亚型数1 052个(高危型859个、低危型193个)。高危HPV型以HPV 16型(1.68%)、HPV 58型(1.33%)、HPV 18型(1.28%)常见,低危HPV型以HPV 6型(0.67%)、HPV Cp8304型(0.38%)、HPV 11型(0.59%)常见。单一HPV亚型感染820例(占88.74%),二重感染85例(9.20%)、三重感染14例(1.52%)、四重感染5例(0.43%);TCT检查,异常765例(7.36%),765例TCT异常患者经阴道镜活检病理组织学明确异常率67.32%(515/765);HPV筛查宫颈病变的灵敏度、特异度、准确率、假阳性率、阳性预测值、阴性预测值分别为93.98%(484/515)、48.00%(120/250)、78.95%(604/765)、21.17%(130/614)、78.83%(484/614)、79.47%(120/151);TCT筛查宫颈病变的灵敏度、假阳性率和阳性预测值分别为100.0%(515/515)、32.68%(250/765)和67.32%(515/765)。单一TCT以宫颈病变的765例体检者中,6例为宫颈癌。联合HPV阳性614例体检者中,13例为宫颈癌,宫颈癌筛查发现率分别为0.78%(6/765)和2.12%(13/614),差异有统计学意义(P<0.05),显示联合TCT+HPV筛查宫颈癌变更敏感。结论成都市女性健康体检者采用TCT或HPV筛查宫颈病变均可获得可靠的筛查效能,TCT筛查宫颈病变的假阳性率过高和阳性预测值过低。临床应尽可能联合筛查效能更好。

Objective To analyze the prevalence of cervical cancer in women receiving health check-ups in Chengdu,and we discuss the relationship of Human papilloma virus (HPV) testing and liquid-based Thinprep Cytology Test (TCT) with cervical cancer.Methods Women receiving cervical cancer screening in the physical examination center of The Second Affiliated Hospital of Chengdu Medical College,The Nuclear Industry 416 Hospital from January 2018 to January 2020 were selected as study subjects.All of them received HPV testing and TCT,and those positive for HPV and TCT were subjected to colposcopy.The value of TCT,HPV testing in screening cervical lesions was analyzed.ResultsIn this study,the HPV infection rate was 8.89%(924/10 395).A total of 1 052 HPV subtypes (859 high-risk types and 193 low-risk types) were detected.HPV 16 (1.68%),HPV 58 (1.33%),and HPV 18 (1.28%) were common high-risk HPV types.HPV 6 (0.67%),HPV Cp8304 (0.38%),and HPV 11 (0.59%) were common low-risk HPV types.There were 820 cases(88.74%) with single HPV subtype infection,85 cases (9.20%) with double infection,14 cases (1.52%) with triple infection,5 cases (0.43%) with quadruple infection;765 cases (7.36%) had abnormal TCT results,and further colposcopy biopsy confirmed that the abnormal rate was 67.32%(515/765).The sensitivity,specificity,accuracy,false positive rate,positive predictive value and negative predictive value of high-risk HPV subtype in screening cervical lesions were 93.98%(484/515),48.00%(120/250),78.95%(604/765),21.17%(130/614),78.83%(484/614),79.47%(120/151),respectively.The sensitivity,false positive rate,positive predictive value of TCT in screening cervical lesions were 100.0%(515/515),32.68%(250/765)and 67.32%(515/765),respectively.Of the 765 cases with cervical lesions by TCT alone,6 cases were cervical cancer.Among 614 patients with combined HPV positive,13 cases were cervical cancer,and the detection rate of cervical cancer screening was 0.78%(6/765)and 2.12%(13/614),respectively,the difference was statistically significant (P<0.05),indicating that cervical cancer screening with combined TCT+HPV was sensitive.Conclusion Both TCT and HPV testing can be used to screen cervical lesions in healthy females in Chengdu,the false positive rate of TCT screening for cervical lesions is too high and the positive predictive value is too low,and the performance of combined screening is better.