FH联合hrHPV检测在宫颈癌筛查中的意义

Significance of FH Combined with hrHPV Detection in Cervical Cancer Screening

目的:探讨子宫上皮细胞游离亚铁原卟啉(FH)与高危型人乳头瘤病毒(hrHPV)联合检测在宫颈癌筛查中的意义。方法:选取当地3所三级甲等医院进行宫颈癌门诊筛查的505例女性。或对已有病理活检结果再进行FH检测与hrHPV检测;或进行常规妇科检查后采集宫颈标本,进行FH检测与hrHPV检测,检测结果异常的女性转诊阴道镜,阴道镜结果异常者再进行病理活检。以病理诊断为金标准,计算FH检测、hrHPV检测及两者联合筛查的灵敏度、特异度、阴性预测值、阳性预测值、符合率及ROC曲线下面积等指标,评估不同方法的筛查效能。结果:以≥CINⅠ(宫颈上皮内瘤变Ⅰ级)为结局事件时,FH、hrHPV及2种方法串联和并联策略的灵敏度分别为60.43%、66.19%、45.32%、81.29%,特异度分别为69.13%、81.15%、95.08%、55.19%,阳性预测值分别为42.64%、57.14%、77.78%、40.79%,阴性预测值分别为82.14%、86.34%、82.08%、88.60%,符合率分别为66.73%、77.03%、81.39%、62.38%,ROC曲线下面积分别为0.648、0.737、0.702、0.682。以≥CINⅡ(宫颈上皮内瘤变Ⅱ级)为结局事件时,FH、hrHPV及2种方法串联和并联策略的灵敏度分别为65.55%、77.31%、52.94%、89.92%,特异度分别为69.17%、82.12%、95.34%、55.96%,阳性预测值分别为39.59%、57.14%、77.78%、38.63%,阴性预测值分别为86.69%、92.15%、86.79%、94.74%,符合率分别为68.32%、80.99%、85.35%、63.96%,ROC曲线下面积分别为0.674、0.797、0.741、0.729。结论:FH联合hrHPV的筛查可降低漏诊率和误诊率,提高筛查效果。

Objective:To investigate the significance of combined detection of free ferrous protoporphyrin(FH)in uterine epithelial cells and high-risk human papillomavirus(hrHPV)in cervical cancer screening.Methods:505 women from three local class III class A hospitals were selected for outpatient screening of cervical cancer.They may have pathological biopsy results,and then conduct FH detection and hrHPV detection,or collect cervical samples after routine gynecological examination for FH detection and hrHPV detection.Women with abnormal test results were referred to colposcopy,and those with abnormal colposcopy results were subject to pathological biopsy.Taking pathological diagnosis as the gold standard,the sensitivity,specificity,negative predictive value,positive predictive value,accuracy and area under ROC curve of FH test,hrHPV test and their combined screening were calculated to evaluate their screening efficiency.Results:In the outcome of≥CINⅠ,the sensitivity of FH,hrHPV detection,series and parallel strategies of the two methods were 60.43%,66.19%,45.32%and 81.29%respectively,and the specificity were 69.13%,81.15%,95.08%and 55.19%respectively.The positive predictive values were 42.64%,57.14%,77.78%and 40.79%respectively,and the negative predictive values were 82.14%,86.34%,82.08%and 88.60%respectively.The coincidence rates were 66.73%and 77.03%,81.39%and 62.38%,and the areas under ROC curve were 0.648,0.737,0.702 and 0.682 respectively.In the outcome of≥CINⅡ,the sensitivity of FH,hrHPV detection,series and parallel strategies of the two methods were 65.55%,77.31%,52.94%and 89.92%respectively,and the specificity were 69.17%,82.12%,95.34%and 55.96%respectively.The positive predictive values were 39.59%,57.14%,77.78%and 38.63%respectively,and the negative predictive values were 86.69%,92.15%,86.79%and 94.74%respectively.The coincidence rates were 68.32%,80.99%,85.35%and 63.96%respectively,and the areas under the ROC curve were 0.674,0.797,0.741 and 0.729 respectively.Conclusion:FH combined with hrHPV detection can reduce the missed diagnosis rate or misdiagnosis rate and improve the screening effect.