高危型人乳头瘤病毒感染作为宫颈癌初筛的价值分析

Value of High-risk Human Papilloma Virus Infection in Preliminary Screening of Cervical Cancer

目的探讨高危型人乳头瘤病毒(HR-HPV)阳性感染在普通人群宫颈病变程度评估中的作用。方法 2013年杭州市拱墅区女性居民,年龄20~60岁女性且一年内未做宫颈癌筛查者行Cervista HR-HPV检测,并对HR-HPV阳性患者进一步行液基细胞学(TCT)检查。结果在879例HR-HPV阳性且行TCT检查的女性居民中,A5/6阳性234例,占26.6%;A7阳性119例,占13.5%;A9阳性336例,占38.2%。HR-HPV型别以A9型最常见,20~30岁、≥30~40岁、≥40~50岁、≥50岁组A9型别占HR-HPV阳性的比例分别为35.2%、42.2%、37.6%和36.7%。对于初筛HPV阳性879例进行细胞学检查,TCT正常者813人,占92.5%。TCT异常者66人,TCT异常率为7.5%。A5/6型234例中TCT异常比例为6.8%;A7型119例中TCT异常比例为5.9%,A9型336例中TCT异常比例为9.8%。结论 HR-HPV检测结果阳性并不等同于宫颈癌及癌前病变。A9型HR-HPV阳性的患者属高危人群,应密切随访。Cervista检测HPV-DNA方法也许能取代宫颈细胞学检查,成为新一代宫颈病变的常规筛查方法。

Objective To investigate the role of high-risk human papilloma virus(HR-HPV) positive infection in evaluating the cervical lesions in general population,as well as the value of HPV infection in early cervical cancer screening.Methods The women aged 20-60 years-old without cervical cancer screening within one year in Gongshu District,Hangzhou City were detected by Cervista HR-HPV testing in 2013,and HR-HPV positive patients further undergone TCT examination and colposcopy.Results In 879 female residents with HR-HPV positive,234(26.6%) cases were A5/6 positive,119(13.5%) cases were A7 positive,336(38.2%) cases were A9 positive.The most common type of HPV was A9 type in all age groups,the proportions of A9 HR-HPV in 20-30,≥30-40,≥40-50 and ≥50 age groups were 35.2%,42.2%,37.6% and 36.7% respectively.In 879 female residents with HR-HPV positive,813(92.5%) residents were found with normal TCT,66(7.5%) residents were with abnormal TCT.TCT abnormal rates were 6.8%,5.9% and 9.8% in A5/6,A7 and A9 HPV groups,respectively.Conclusion Positive HR-HPV is not equal as cervical cancer or precancerous lesions.The person with positive A9 HR-HPV should be closely followed up.Whether Cervista HPV-DNA detection could replace cervical cytology,to be a new generation of routine screening method of cervical lesions,needs to accumulate more clinical research data to confirm the feasibility.