高危型人乳头瘤病毒-DNA检测联合液基薄层细胞学检查宫颈病变的临床应用

Clinical significance of high-risk HPV-DNA detection combined with TCT in screening and followup of cervical lesions

【目的】探究宫颈病变筛查、随访高危型人乳头瘤病毒脱氧核糖核酸(HPV-DNA)检测联合液基薄层细胞学检查(TCT)的应用价值。【方法】选取2019年2月—2021年2月转诊至妇幼保健计划生育服务中心进行宫颈病变复查的患者共计241例,其中80例为宫颈上皮内瘤变(CIN)患者。利用TCT技术对患者宫颈细胞学形态进行检查,利用华大医学自主研发的二代高通量测序技术及飞行时间质谱技术对患者进行HPV-DNA分型的筛查,同时进行病理活检检查,以病理诊断结论作为最终诊断结果。对80例患者分别进行TCT、HPVDNA与TCT、HPV-DNA联合检测。对比TCT、HPV-DNA与TCT、HPV-DNA联合检测对于CINⅡ、CINⅢ诊断和预后的关系;对21例CINⅡ和18例CINⅢ经过治疗后的第6个月、12个月以及18个月分别进行随访,再次对HPV感染情况和TCT检查结果进行复测。【结果】80例宫颈上皮内瘤变患者中,年龄35~44岁区间有41例(51.25%),相比于其他年龄组差异有统计学意义(P<0.001);TCT、HPVDNA和TCT联合HPV-DNA检测相比,联合检测在灵敏度、特异性、阳性预测值以及阴性预测值方面优势更加明显(P<0.05);CINⅡ和CINⅢ患者在治疗后18个月随访的复发率分别为9.52%和16.67%。【结论】TCT检测在宫颈癌前筛查中有着积极作用,通过将高危型HPV-DNA分型和TCT联合检测,灵敏度、特异度等检测值明显更高,进一步说明高危型HPV-DNA检测的使用能够提升宫颈病变筛查准确性,对后续随访工作的开展具有重要意义。

[Objective]To explore the application value of high-risk HPV-DNA detection combined with TCT in cervical lesion screening and follow-up.[Methods]This study was conducted from February 2019 to February 2021.During this period,241 subjects who were the patients referred from the primary community hospitals to the center for re-examination of cervical lesions.Of which 80 were patients with cervical intraepithelial neoplasia.Liquid-based cytology(TCT)technology was used to examine the cervical cytological morphology.The secondgeneration high-throughput sequencing technology and time-of-flight mass spectrometry technology,independently developed by BGI,were used to screen for HPV-DNA typing.At the same time,biopsy sampling was carried out,and the final pathological diagnosis was made.TCT detection and combined HPV-DNA detection were performed on 80 patients to compare the relationship between TCT alone and TCT/HPV-DNA combined test for the diagnosis and prognosis of CINⅡand CINⅢ.Follow-up was conducted,and the HPV infection and TCT were re-tested.[Results]Among the 80 cases of cervical intraepithelial neoplasia,41 cases(51.25%)were between 35 and 44 years old,higher than the other age groups(P<0.001).Compared with either TCT or HPV-DNA,TCT combined with HPV-DNA had obvious advantages in sensitivity,specificity,positive predictive value,and negative predictive value(P<0.05).The recurrence rate in CINⅡand CINⅢgroups was 9.52%and 16.67%respectively after 18 months of the follow-up.[Conclusion]TCT detection plays a positive role in cervical pre-cancer screening.By combining high-risk HPV-DNA typing and TCT detection,the detection values of sensitivity and specificity are significantly higher,which can improve the accuracy of cervical lesion screening and is of great significance for the follow-up work.