贵州省三都水族自取样HPV检测宫颈癌筛查及分流模式

Study on cervical cancer screening and triage of self-sampling HPV detection in Sandu Shui nationality of Guizhou Province

目的探讨一种适用于我国偏远少数民族地区的宫颈癌筛查方式。方法 2018年11月至2019年2月对贵州省黔南布依族苗族自治州三都水族自治县1 874例21~65岁女性进行阴道自取样高危型人乳头瘤病毒(HR-HPV)检测、医取样宫颈液基细胞学检测(TCT)及宫颈细胞学p16免疫化学染色。HPV阳性和(或)TCT异常(ASC-US及以上)和(或)p16阳性者行阴道镜检查及活检,分析检出宫颈鳞状上皮内病变(squamous intraepithelial lesion, SIL)的价值。结果 1 874例女性中,HR-HPV阳性率为15.69%。其中HPV52型最常见,其次依次为HPV16、HPV39、HPV58和HPV56型。249例阴道镜下活检患者中,检出宫颈高级别及以上病变(HSIL+)23例(9.24%);宫颈HSIL+、低级别病变(LSIL)和宫颈炎中p16阳性率分别是73.91%、34.57%和10.34%,三组比较,差异有统计学意义(P <0.001)。自取样HPV检测检出HSIL+的敏感性为100%,HPV阳性、p16检测检出HSIL+的ROC曲线下面积分别为0.577(P>0.05)和0.774(P <0.05)。结论自取样HPV对HSIL的检出具体高敏感度;以阴道自取样HPV宫颈癌筛查作为初筛,结合p16染色分流,可作为贵州省偏远地区筛查选择方式之一,可提高筛查的覆盖率。

Objective To explore a cervical cancer screening strategy suitable for remote minority areas in China. Methods A total of 1 874 cases of Shui minority women aged 21 ~ 65 years in Sandu were randomly sampled self-sampling HPV test, TCT test and P16 cytological immunohistochemical test. The patients with HPV positive, TCT abnormality(ASC-US) and P16 + underwent colposcopy and biopsy, and squamous intraepithelial lesion(SIL) was detected. Results The positive rate of HR-HPV was 15.69% in 1 874 women. HPV52 was the most common type, followed by HPV16, HPV39, HPV58 and HPV56. Among 249 patients with colposcopy biopsy,23 cases(9.24%) were detected with HSIL or above lesions.The positive rates of p16 in HSIL and above cervical lesions, LSIL and cervicitis were 73.91%, 34.57% and 10.34%(P < 0.001).The sensitivity of self-sampled HPV test to HSIL + was 100%, and the area under ROC curve for HSIL + detected by HPV-positive test and p16 test was 0.577(P > 0.05) and 0.774(P < 0.05), respectively. Conclusion Self-sampled HPV was highly sensitive to HSIL. Using self-sampling HPV detection as primary screening, combined with p16 staining triage, can be used as a screening strategy in remote areas of Guizhou province to improve the coverage of screening.