DH3初筛阳性在宫颈高危病变中的临床意义

Clinical Significance of DH3 Positive Screening in High-risk Cervical Lesions

目的:探讨DH3(人乳头瘤病毒杂交捕获—化学发光法核酸检测试剂盒)初筛阳性在宫颈高危病变中的临床意义。方法:回顾性统计我院2017年6月—2018年8月门诊或体检行DH3筛查的患者,其中175例DH3阳性的患者作为研究对象,以病理活检为金标准,统计DH3阳性结果的病变分布情况。结合TCT的检查结果,探讨细胞学在DH3阳性结果的分流作用,同时运用统计学分析年龄、病毒负荷量与宫颈高危病变的关系。结果:DH3阳性率15.95%,病理学示175例DH3阳性患者中,炎症63例(36.00%),LSIL42例(24.00%),HSIL44例(25.14%),宫颈癌(鳞癌及腺癌)26例(14.86%),宫颈高危病变(≥HSIL)率40.00%,DH3阳性预测值64.00%;宫颈高危病变率在年龄组20～30岁、30～40岁、40～50岁、50～60岁、>60岁中分别为12.50%、25.58%、45.61%、53.13%、68.42%,宫颈高危病变随年龄增加而增高,组间差异有统计学意义(χ~2=22.863,P<0.05);宫颈高危病变率在HPV负荷量分组≤10、10～30、30～60、60～100、>100中分别为14.89%,28.57%、47.62%58.35%、55.41%,宫颈高危病变随高危病毒感染量增加而增高,组间差异有统计学意义(χ~2=22.026,P<0.05);157例DH3阳性患者同时行TCT及病理活检,TCT阳性病变(≥ASC-US)83例,阳性率52.87%,组织学阳性病变(≥LSIL)97例,阳性率61.78%,TCT与组织学一致率为74.52%(117/157)。结论:DH3是宫颈高危病变筛查的可行方法,随着年龄及感染病毒负荷量的增加,宫颈高危病变发生率增加,TCT对DH3阳性患者分流有重要指导意义,但同时也需关注患者年龄及病毒负荷量对宫颈高危病变的影响。

Objective:To investigate the clinical significance of DH3(human papillomavirus hybridization capture-chemiluminescence nucleic acid detection kit) positive screening in cervical high-risk lesions.Methods:A retrospective study was conducted on 175 DH3 positive patients in our hospital from June 2017 to August 2018. Pathological biopsy was used as the gold standard to calculate the distribution of DH3 positive results. Combined with the results of TCT, the shunting effect of cytology on DH3 positive results was discussed.Meanwhile, the relationship between age, viral load and cervical high-risk lesions was analyzed by statistics.Results:The positive rate of DH3 was 15.95%. Pathological examination showed that 63 cases(36.00%) were inflammation, 42 cases(24.00%) were LSIL, 44 cases(25.14%) were HSIL, 26 cases(14.86%) were cervical cancer(squamous cell carcinoma and adenocarcinoma), 40.00% were cervical high-risk lesions(>HSIL), 64.00% were DH3 positive predictive value;the high-risk lesion rate of cervix was 12.50%,25.58%,45.61%,53.13%,68.42%,respectively in age groups:20 to 30 years old, 30 to 40 years old, 40 to 50 years old,50 to 60 years old and over 60 years old, The high-risk cervical lesions increased with age(χ~2=22.863,P<0.05), and the high-risk cervical lesions rate was less 14.89%,28.57%,47.62%,58.35%,55.41%, respectively in HPV load groups:less than 10,10 to 30,30 to 60, 60 to 100,more than 100.Cervical high-risk lesions increased with the increase of high-risk virus infection(χ~2=22.026,P<0.05).157 DH3 positive patients underwent both TCT and pathological biopsy, the positive rate was 52.87% in TCT.97 cases were histologically positive(> LSIL), and the positive rate was 61.78%. The coincidence rate between TCT and histology was 74.52%(117/157).Conclusion:DH3 is a feasible method for screening high-risk cervical lesions.With the increase of age and viral load, the incidence of high-risk cervical lesions increases.TCT has improtant guiding significance for shunting of DH3 positive patients,but at the same time,attention should be paid to the influence of age and viral load on high-risk cervical lesions.