高危型HPV分型宫颈癌初筛检测及联合细胞学/病毒载量的二次筛查措施的作用分析

Primary Screening Detection of High-risk HPV Typing Cervical Cancer and the Role of Secondary Screening Measures Combined with Cytology/Viral Load

目的研究高危型HPV分型宫颈癌初筛检测及联合细胞学/病毒载量的二次筛查措施的作用。方法选择医院妇科2019年2月-2022年2月收治的疑似宫颈病变的62例患者。对所有受试者均开展高危型HPV检测,检测方式为实时荧光聚合酶链式反应(PCR)技术,共可检测HPV16、18、31、33、35、39、45、51、52、56、58、59、66、68以及82型15种高危型HPV亚型。同时对所有受试者均进行细胞学/病毒载量检测。分析基于高危型HPV分型(HPV 16/18型阳性;HPV 16/18/58型阳性;HPV 16/18/58/31/33型阳性;HPV 16/18/58/31/33/52型阳性;所有15种高危HPV亚型任一亚型阳性)及其联合细胞学/病毒载量的二次筛查效果,即对子宫颈上皮内瘤变(CIN)Ⅱ及以上病变(CINⅡ+)以及CINⅢ及以上病变(CINⅢ+)。结果方案1d、1e的CINⅡ+、CINⅢ+检出率均高于方案1a,且方案1d、1e的CINⅡ+检出率高于方案1b,方案1e的CINⅡ+检出率高于方案1c(均P<0.05)。方案2a、2b、2c、2d、2e的CINⅡ+检出率分别为85.48%、91.94%、91.94%、90.32%、87.10%;CINⅢ+检出率分别为46.77%、48.39%、60.00%、51.61%、43.55%,不同筛查方案检出结果对比均不明显(均P>0.05)。方案3a、3b、3c、3d的CINⅡ+检出率分别为91.94%、93.55%、87.10%、90.32%;CINⅢ+检出率分别为48.39%、60.00%、51.61%、53.23%,不同筛查方案检出结果对比均不明显(P>0.05)。结论高危型HPV分型宫颈癌初筛检测及联合细胞学/病毒载量的二次筛查措施具有一定的临床应用效果,可能有效提高对CINⅡ+及CINⅢ+的检出率。

Objective To study the role of primary screening detection of high-risk HPV typing cervical cancer and secondary screening measures combined with cytology/viral load.Methods 62 patients with suspected cervical lesions were selected from February 2019 to February 2022.All subjects were tested for high-risk HPV by real-time fluorescent polymerase chain reaction(PCR),which can detect 15 high-risk HPV subtypes of HPV16,18,31,33,35,39,45,51,52,56,58,59,66,68 and 82.At the same time,cytology/viral load was detected in all subjects.Analyze the secondary screening effect based on high-risk HPV typing(HPV 16/18 positive;HPV 16/18/58 positive;HPV 16/18/58/31/33 positive;HPV 16/18/58/31/33/52 positive;any subtype of all 15 high-risk HPV subtypes positive)and its combined cytology/viral load,that is,cervical intraepithelial neoplasia(CIN)Ⅱand above lesions(CINⅡ+)and CINⅢand above lesions(CINⅢ+).Results The detection rates of CINⅡ+and CINⅢ+in scheme 1D and 1E were higher than those in scheme 1a,and the detection rates of CINⅡ+in scheme 1D and 1E were higher than those in scheme 1b,and the detection rates of CINⅡ+in scheme 1E were higher than those in scheme 1C(all P<0.05).The detection rates of CINⅡ+in schemes 2a,2b,2C,2D and 2E were 85.48%,91.94%,91.94%,90.32%and 87.10%respectively;The detection rates of CINⅢ+were 46.77%,48.39%,60.00%,51.61%and 43.55%respectively.The comparison of detection results of different screening schemes was not obvious(all P>0.05).The detection rates of CINⅡ+in schemes 3a,3b,3C and 3D were 91.94%,93.55%,87.10%and 90.32%respectively;The detection rates of CINⅢ+were 48.39%,60.00%,51.61%and 53.23%respectively.The comparison of detection results of different screening schemes was not obvious(all P>0.05).Conclusion The primary screening test of high-risk HPV typing cervical cancer and the secondary screening measures combined with cytology/viral load have a certain clinical effect,which may effectively improve the detection rate of CINⅡ+and CINⅢ+.