HPV检测、液基细胞学检测及DNA倍体分析在宫颈筛查中的应用

Application of HPV Detection,Liquid Based Cytology and DNA Ploidy Analysis in Cervical Screening

目的探讨人乳头瘤病毒(human papillomavirus,HPV)检测、液基薄层细胞学检测(liquid-based thin-layer cytology testing,TCT)及DNA倍体分析在宫颈筛查中的应用价值。方法对锦州医科大学附属第一医院妇产科门诊宫颈活检的265名患者回顾分析,以病理学检测为诊断的金标准,分别计算HPV、TCT、DNA倍体分析3种筛查方式的灵敏度、特异度、阳性预测值、阴性预测值,并绘制受试者工作特征曲线ROC曲线,比较曲线下面积(the area under the curve,AUC)值,采用χ^(2)检验进行统计分析,比较3种筛查方式在宫颈病变中的诊断价值。结果265例患者中,病理结果为正常或炎症72例,低度鳞状上皮内病变(low grade squamous intraepithelial lesions,LSIL)85例,高度鳞状上皮内病变(high grade squamous intraepithelial lesions,HSIL)92例,宫颈癌16例。HPV、TCT、DNA倍体分析单独应用筛查,对LSIL及以上病变诊断的灵敏度分别为89.6%、64.8%、85.5%,特异度分别为:59.7%、79.2%、69.4%。HPV与TCT灵敏度、特异度差异均有统计学意义,TCT与DNA倍体分析灵敏度差异、特异度差异均有统计学意义,HPV与DNA倍体分析灵敏度、特异度差异均无统计学意义。阳性预测值分别为:85.6%、89.3%、88.2%,阴性预测值:68.3%、45.6%、64.1%。HPV、TCT、DNA倍体分析曲线下面积AUC值分别为0.747、0.720、0.775,以DNA倍体分析曲线下面积最大。HPV联合TCT、HPV联合DNA倍体分析、TCT联合DNA倍体分析曲线下面积AUC值分别为0.878、0.840、0.895,以TCT联合DNA倍体分析曲线下面积最大。经Z检验比较曲线下面积,在联合筛查中,HPV联合TCT与HPV联合DNA倍体分析差异有统计学意义(P<0.05),HPV联合DNA倍体分析与TCT联合DNA倍体分析差异有统计学意义(P<0.05),HPV联合TCT与TCT联合DNA倍体分析差异无统计学意义(P>0.05)。结论DNA倍体分析在宫颈早期筛查中有较高的检出率,值得临床推广。

Objective To investigate the value of human papillomavirus(HPV)testing,liquid-based thin-layer cytology testing(TCT)and DNA ploidy analysis in cervical screening.Methods A retrospective analysis of 265 patients with outpatient cervical biopsies from the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Jinzhou Medical University was performed,and the sensitivity,specificity,positive predictive value and negative predictive value of HPV,TCT and DNA ploidy analysis were calculated respectively using pathological testing as the gold standard for diagnosis.ROC curve was drawn to compare the area under the curve(AUC),χ^(2) test was used for statistical analysis,and the diagnostic value of the three screening methods in cervical lesions was compared.Results Among the 265 patients,72 had normal or inflammatory pathologic findings,85 had low-grade squamous intraepithelial lesions,92 had high-grade squamous intraepithelial lesions,and 16 had cervical cancer.The sensitivity of HPV,TCT and DNA ploidy analysis for the diagnosis of LSIL or above was 89.6%,64.8%and 85.5%,and the specificity was 59.7%,79.2%and 69.4%,respectively.There were statistically significant differences in sensitivity and specificity between HPV and TCT.There were statistically significant differences in sensitivity and specificity between TCT and DNA ploidy analysis.There were no statistically significant differences in sensitivity and specificity between HPV and DNA ploidy analysis.Positive predictive values were 85.6%,89.3%and 88.2%,while negative predictive values were 68.3%,45.6%and 64.1%,respectively.The AUC values of HPV,TCT and DNA ploidy analysis were 0.747,0.720 and 0.775,respectively.The AUC values of DNA ploidy analysis were the largest.The AUC values of HPV combined with TCT,HPV combined with DNA ploidy analysis and TCT combined with DNA ploidy analysis were 0.878,0.840 and 0.895,respectively.The AUC values of TCT combined with DNA ploidy analysis were the largest.The area under the curve was compared by Z test.In combined screening,there was statistically significant difference between HPV combined TCT and HPV combined DNA ploidy analysis(P<0.05),and there was statistically significant difference between HPV combined DNA ploidy analysis and TCT combined DNA ploidy analysis(P<0.05).There was no significant difference between HPV combined with TCT and TCT combined with DNA ploidy analysis(P>0.05).Conclusion DNA ploidy analysis has a high detection rate in early cervical screening and is worthy of clinical promotion.