高危型人乳头瘤病毒对早期宫颈癌的筛查效果研究

Screening for cervical cancer with high risk human papillomavirus testing

目的探讨高危型人乳头瘤病毒(HR-HPV)对宫颈癌妇女的早期筛查效果和诊断价值。方法选取2016年7月至2019年6月间北京和美妇儿医院收治的338例宫颈癌筛查HR-HPV阳性患者,行阴道镜检查及活检后,分为宫颈癌早期患者82例为宫颈癌组、宫颈癌前病变患者102例为宫颈癌前病变组及慢性宫颈炎患者154例为慢性宫颈炎组。比较三组患者HR-HPV阳性表达率和不同HR-HPV分型在三组患者中的表达情况,检测HR-HPV及其分型对宫颈病变的预测价值和筛查效果。结果宫颈癌组患者HR-HPV阳性表达率为96.3%,高于宫颈癌前病变组的32.4%和慢性宫颈炎组的7.1%,差异均有统计学意义(均P<0.05)。HPV16在三组患者中阳性率最高,在宫颈癌组患者中阳性表达率为92.7%,其次为HPV18,差异均有统计学意义(均P<0.05)。HR-HPV对宫颈癌早期筛查总灵敏度为93.8%,特异度为85.6%,阳性预测值为5.7%,阴性预测值为99.9%。不同分型中,HPV16和HPV18对宫颈癌早期筛查具有较高的灵敏度和特异度(P<0.05)。结论高危型人乳头瘤病毒对宫颈癌早期筛查有很好的临床效果,其中HPV16和HPV18两种分型临床筛查效果最好。

Objective To explore screening for cervical cancer with high risk human papillomavirus(HR-HPV)testing and the diagnostic value.Methods From July 2016 to June 2019,338 patients with positive HR-HPV were included at Beijing Hemei Women and Children Hospital.Colposcopy and biopsy were performed.Amomg them,82 patients were included in an early stage cervical cancer group,102 patients were included in a cervical precancerous lesion group and 154 patients were included in a chronic cervitis group.Positive rate of HR-HPV expression was compared among the three groups and patients of different HR-HPV types.Predictive value and efficacy of screening were evaluated.Results The positivity rate of HR-HPV expression was 96.3%in the cervical cancer group which was higher than 32.4%of cervical precancerous lesion group and 7.1%of the chronic cervicitis group(all P<0.05).The positivity rate of HPV16 expression was 87.8%which was the highest among the three groups followed by HPV18(P<0.05).The overall sensitivity,specificity,positive predictive value and negative predictive value of HRHPV for early screening of cervical cancer was 93.8%,85.6%,5.7%and 99.9%,respectively.HPV16 and HPV18 had high sensitivity and specificity for early screening of cervical cancer(all P<0.05).Conclusion High risk human papillomavirus testing shows good clinical efficacy for the early screening of cervical cancer,among which HPV16 and HPV18 genotyping shows the best efficacy.