宫颈病变患者HPV基因分型检测及其临床意义分析

Analysis of Genotyping Detection of HPV in Patients with Cervical Lesions and Its Clinical Significance

目的:分析宫颈病变患者人乳头瘤病毒(HPV)基因分型检测及临床意义。方法:回顾性分析2021年5月—2023年5月泰兴市人民医院收治的125例宫颈病变患者的临床资料,均进行HPV基因分型检测。统计125例宫颈病变患者HPV感染阳性率、HPV基因分型情况(多重感染重复计算)。比较不同程度宫颈病变患者中HPV感染阳性率、高危型HPV感染阳性率。以病理检查为“金标准”,分析并比较液基薄层细胞学检查(TCT)单独诊断、TCT联合HPV基因分型诊断子宫颈癌的准确度、敏感度、特异度。结果:125例宫颈病变患者中,HPV感染阳性率为51.20%(64/125),HPV感染阳性患者中HPV基因型总数为92株,其中高危型HPV为63.04%(58/92),低危型HPV为36.96%(34/92)。高危型HPV感染阳性率最高的前5位基因型分别为HPV16(16.30%)、HPV18(11.96%)、HPV58(8.70%)、HPV53(6.52%)、HPV51(4.35%);低危型HPV感染阳性率最高的前3位基因型分别为HPV6(8.70%)、HPV11(7.61%)、HPV40(4.35%)。不同级别宫颈病变患者HPV感染阳性率、高危型HPV感染阳性率比较,差异有统计学意义(P<0.05)。TCT单独诊断子宫颈癌的准确度为78.40%(98/125),敏感度为66.67%(18/27),特异度为81.63%(80/98),阳性预测值为50.00%(18/36),阴性预测值为89.89%(80/89),Kappa值为0.431;TCT联合HPV基因分型诊断子宫颈癌的准确度为88.00%(110/125),敏感度为59.26%(16/27),特异度为95.92%(94/98),阳性预测值为80.00%(16/20),阴性预测值为89.52%(94/105),Kappa值为0.609;TCT联合HPV基因分型诊断子宫颈癌的准确度、特异度均显著高于TCT单独诊断,差异有统计学意义(P<0.05);TCT联合HPV基因分型诊断子宫颈癌的敏感度低于TCT单独诊断,但差异无统计学意义(P>0.05)。结论:宫颈病变类型与HPV基因分型密切相关,且不同宫颈病变恶性程度患者HPV感染阳性率、高危型HPV感染阳性率存在显著差异,因此HPV基因分型用于辅助子子宫颈癌筛查具有重要意义。

Objective:To analyze the genotyping detection of HPV in patients with cervical lesions and its clinical significance.Method:The clinical data of 125 patients with cervical lesions who admitted to Taixing People's Hospital from May 2021 to May 2023 were retrospectively analyzed,and HPV genotyping was performed in all of them.The positive rate of HPV infection and HPV genotyping of 125 patients with cervical lesions were analyzed(multiple infection repeated counting).The positive rate of HPV infection and high-risk HPV infection in patients with different degree of cervical lesions were compared.Using pathological examination as the"gold standard",the accuracy,sensitivity and specificity of liquid based thin layer cytology(TCT)alone and TCT combined with HPV genotyping in the diagnosis of cervical cancer were analyzed and compared.Result:Among 125 patients with cervical lesions,the positive rate of HPV infection was 51.20%(64/125),and the total number of HPV genotypes in HPV positive patients was 92,of which 63.04%(58/92)were high-risk HPV and 36.96%(34/92)were low-risk HPV.The top 5 genotypes with the highest positive rate of high-risk HPV infection were HPV16(16.30%),HPV18(11.96%),HPV58(8.70%),HPV53(6.52%),HPV51(4.35%);the top 3 genotypes with the highest positive rate of low-risk HPV infection were HPV6(8.70%),HPV11(7.61%)and HPV40(4.35%),respectively.There were significant differences in the positive rates of HPV infection and high-risk HPV infection in patients with different levels of cervical lesions(P<0.05).The accuracy of TCT alone was 78.40%(98/125),the sensitivity was 66.67%(18/27),the specificity was 81.63%(80/98),the positive predictive value was 50.00%(18/36),the negative predictive value was 89.89%(80/89),and the Kappa value was 0.431;the accuracy of TCT combined with HPV genotyping was 88.00%(110/125),the sensitivity was 59.26%(16/27),the specificity was 95.92%(94/98),the positive predictive value was 80.00%(16/20),and the negative predictive value was 89.52%(94/105),the Kappa value was 0.609.The accuracy and specificity of TCT combined with HPV genotyping in the diagnosis of cervical cancer were significantly higher than those of TCT alone,the differences were statistically significant(P<0.05);the sensitivity of TCT combined with HPV genotyping in the diagnosis of cervical cancer was lower than that of TCT alone,but the difference was not statistically significant(P>0.05).Conclusion:The types of cervical lesions are closely related to HPV genotypes,and there are significant differences in the positive rate of HPV infection and highrisk HPV infection in patients with different malignant degrees of cervical lesions,therefore,HPV genotyping is of great significance in assisting cervical cancer screening.