高危型人乳头瘤病毒载量在宫颈癌中的表现特点及筛查应用分析

Features and screening application of high-risk human papillomavirus load in cervical cancer

目的探讨高危型人乳头瘤病毒(HR-HPV)载量在宫颈癌中的表现特点及筛查应用效果。方法以2019年4月至2021年2月平顶山市中医医院门诊行宫颈癌筛查的435例患者作为研究对象,收集患者高危型HPV检测和液基薄层细胞学(TCT)检查结果,以阴道镜病理组织活检为诊断金标准,比较高危型HPV、TCT阳性分布特点,计算高危型HPV病毒载量的诊断价值,并比较以不同高危型HPV病毒载量为阳性判断标准联合TCT在宫颈癌诊断中的准确性。结果经阴道镜活检后显示,435例患者中慢性宫颈炎或CIN1患者253例,CIN2患者85例,CIN3患者97例,发生率分别为58.16%、19.54%和22.30%。不同CIN分级的患者的总HPV、HPV16/18以及其余12型HPV病毒载量差异均有统计学意义(P<0.001)。通过绘制ROC曲线图,当总HPV≥4.89、HPV16/18≥3.56以及其余12型HPV≥3.18时,CIN2~3的诊断价值最高,曲线下面积分别为0.604、0.676和0.601,两两比较差异无统计学意义(P>0.05)。以不同高危型HPV病毒载量为阳性诊断标准进行诊断准确性比较,与HPV≥1相比,当选取HPV≥4.89为阳性诊断标准时,CIN≥2的总符合率显著提高(45.7%vs.66.0%)(χ^(2)=36.666,P<0.001),与TCT相比差异无统计学意义(χ^(2)=1.339,P=0.247)。联合诊断显示,TCT+HPV≥4.89诊断CIN≥2的总符合率最高,可达87.2%,明显高于TCT+HPV≥1(χ^(2)=7.564,P=0.006)。结论提高高危型HPV病毒载量阳性判断标准有助于提升高危型HPV联合TCT对宫颈癌的诊断准确性。

【Objective】To investigate the characteristics of high risk human papillomavirus(HR-HPV)load in cervical cancer and the effect of screening application.【Methods】A total of 435 patients who underwent cervical cancer screening in outpatient department of our hospital from April 2019 to February 2021 were selected as the research subjects.The results of high-risk HPV detection and liquid-based thin-layer cytology(TCT)were collected,and colposcopy pathological biopsy was used as the gold diagnostic standard.The positive distribution characteristics of high-risk HPV and TCT were compared.The diagnostic value of viral load of high-risk HPV types was calculated,and the accuracy of combined TCT in the diagnosis of cervical cancer with viral load of different high-risk HPV types as positive criteria was compared.【Results】Among the 435 patients,253 had chronic cervicitis or CIN 1,85 had CIN 2,and 97 had CIN 3.The incidence rates were 58.16%,19.54%,and 22.30%,respectively.Patients with different CIN grades had statistically significant differences in total HPV,HPV 16/18 and viral load of the other 12 HPV types(P<0.001).By drawing ROC curves,when total HPV≥4.89,HPV 16/18≥3.56 and other 12 types of HPV≥3.18,the diagnostic value of CIN 2~3 was the highest,and the area under the curve was 0.604,0.676 and 0.601,respectively,without statistical significance(P>0.05).Compared with HPV≥1,when HPV≥4.89 was selected as the positive diagnostic criteria,the overall coincidence rate of CIN≥2 was significantly increased(45.7%vs.66.0%),the difference was statistically significant(χ^(2)=36.666,P<0.001).The difference was not statistically significant compared with TCT(χ^(2)=1.339,P=0.247).Combined diagnosis showed that the overall coincidence rate of TCT+HPV≥4.89 in CIN≥2 was the highest,up to 87.2%,significantly higher than TCT+HPV≥1(χ^(2)=7.564,P=0.006).【Conclusion】It is helpful to improve the diagnostic accuracy of high-risk HPV combined with TCT in the diagnosis of cervical cancer by improving the criteria of positive viral load of high-risk HPV.