宫颈液基细胞学联合HPV检查在宫颈病变筛查中的评价(1)
[摘要] 目的 研究人乳头瘤病毒(HPV)联合宫颈液基薄层细胞学(TCT)检测在宫颈病变筛检中的应用价值。方法 整群选取2014年1—12月以424例妇科门诊就诊女性为研究对象，分别行HPV、TCT检测及阴道镜下病理活检，以病理学结果为“金标准”，对宫颈HPV及TCT的单独检测，以及二者联合检测对宫颈病变筛查的方法学评价。结果 424例就诊女性患者49.5%为HPV阳性，且随着宫颈疾病病变程度不断进展，HPV阳性率也呈现升高趋势；424例TCT检查结果：宫颈不典型鳞状细胞(ASCUS)以上病变阳性率为49.3%，其中ASC105例，低度鳞状上皮内病变(LSIL)69例，高度鳞状上皮内病变(HSIL)34例，鳞状细胞癌(SCC)1例；两种方法联合对于宫颈上皮内瘤变(CINI)以上病变的筛查相对于单独检查，灵敏度(98.1%)、约登指数(0.78)及阴性预测值(93.6%)均有不同程度的提高。结论 TCT联合HPV检测对宫颈病变的筛检有着重要的临床价值。
[关键词] 人乳头瘤病毒(HPV)；液基薄层细胞学(TCT)；宫颈病变
[中图分类号] R737 [文献标识码] A [文章编号] 1674-0742(2016)05(c)-0055-04
[Abstract] Objective To research the application value of HPV combined with TCT in the screening of cervical lesions. Methods 424 cases of female patients diagnosed in the gynecology clinic of our hospital from January 2014 to December 2014 were selected as the research objects and were given HPV and TCT detection and pathologic biopsy vaginoscopy， and the methodology of screening of cervical lesions was evaluated through the single detection of cervical HPV and TCT and combined detection of the two using the pathological results as “gold standard”. Results Of 424 cases of female patients， 49.5% was HPV positive， and with the continuous progress of the degree of cervical disease， HPV positive rate also showed an increasing trend， TCT examination results of 424 cases： the positive rate of above-ASCUS lesions was 49.3%， ASC occurred to 105 cases， low-grade squamous intraepithelial lesion occurred to 69 cases， high-grade squamous intraepithelial lesion occurred to 34 cases， squamous-cell carcinoma occurred to 1 case， compared with those of the single examination， the sensitivity， Youden index and negative predictive value of the combined examination in the screening of above-CINIwere improved in varying degrees. Conclusion TCT combined with HPV detection is of an important clinical value to the screening of cervical lesions.
[Key words] Human papilloma virus (HPV)； Thinprep cytology test (TCT)； Cervical lesions
子宫颈疾病是女性临床常见疾病，主要包括宫颈炎、宫颈癌等，其中宫颈癌是女性发病率仅次于乳腺癌的第二大肿瘤疾病，其病死率却超过了乳腺癌，因此，宫颈癌的早期诊断和治疗突显得尤为重要，同时也是宫颈癌防治的关键性因素[1]。从巴氏涂片到现在广泛应用于宫颈癌筛查的液基薄层细胞学，使得宫颈癌的发生率呈现逐渐下降趋势，且逐步为宫颈液基细胞学所取代，有研究显示[2-4]：宫颈液基细胞学在宫颈病变检测中的灵敏度和特异度各自可达 74%～93%及 56%～79%，近年来已证实HPV感染与宫颈癌联系密切。将薄层液基细胞学和HPV检测相结合，对能否提高识别子宫颈高度病变的灵敏度、特异度降低漏诊率及广泛的使用推广筛检价值，研究争论颇多。该研究对该院门诊妇科自2014年1—12月因接触性出血、白带异常就诊的424名女性进行HPV、宫颈液基细胞学检测，并行阴道镜下宫颈组织学活检，评价液基细胞学联合HPV检测在对宫颈病变的诊断应用价值，现报道如下。
1 资料与方法
1.1 一般资料
整群抽取该院妇科门诊行宫颈液基细胞学及HPV检测已婚女性共424例为研究对象，每位患者均签署知情同意书，均属自愿检查。受检人群年龄20～76岁，平均年龄(40±10)岁。 (高洁 方法 战英杰)
[关键词] 人乳头瘤病毒(HPV)；液基薄层细胞学(TCT)；宫颈病变
[中图分类号] R737 [文献标识码] A [文章编号] 1674-0742(2016)05(c)-0055-04
[Abstract] Objective To research the application value of HPV combined with TCT in the screening of cervical lesions. Methods 424 cases of female patients diagnosed in the gynecology clinic of our hospital from January 2014 to December 2014 were selected as the research objects and were given HPV and TCT detection and pathologic biopsy vaginoscopy， and the methodology of screening of cervical lesions was evaluated through the single detection of cervical HPV and TCT and combined detection of the two using the pathological results as “gold standard”. Results Of 424 cases of female patients， 49.5% was HPV positive， and with the continuous progress of the degree of cervical disease， HPV positive rate also showed an increasing trend， TCT examination results of 424 cases： the positive rate of above-ASCUS lesions was 49.3%， ASC occurred to 105 cases， low-grade squamous intraepithelial lesion occurred to 69 cases， high-grade squamous intraepithelial lesion occurred to 34 cases， squamous-cell carcinoma occurred to 1 case， compared with those of the single examination， the sensitivity， Youden index and negative predictive value of the combined examination in the screening of above-CINIwere improved in varying degrees. Conclusion TCT combined with HPV detection is of an important clinical value to the screening of cervical lesions.
[Key words] Human papilloma virus (HPV)； Thinprep cytology test (TCT)； Cervical lesions
子宫颈疾病是女性临床常见疾病，主要包括宫颈炎、宫颈癌等，其中宫颈癌是女性发病率仅次于乳腺癌的第二大肿瘤疾病，其病死率却超过了乳腺癌，因此，宫颈癌的早期诊断和治疗突显得尤为重要，同时也是宫颈癌防治的关键性因素[1]。从巴氏涂片到现在广泛应用于宫颈癌筛查的液基薄层细胞学，使得宫颈癌的发生率呈现逐渐下降趋势，且逐步为宫颈液基细胞学所取代，有研究显示[2-4]：宫颈液基细胞学在宫颈病变检测中的灵敏度和特异度各自可达 74%～93%及 56%～79%，近年来已证实HPV感染与宫颈癌联系密切。将薄层液基细胞学和HPV检测相结合，对能否提高识别子宫颈高度病变的灵敏度、特异度降低漏诊率及广泛的使用推广筛检价值，研究争论颇多。该研究对该院门诊妇科自2014年1—12月因接触性出血、白带异常就诊的424名女性进行HPV、宫颈液基细胞学检测，并行阴道镜下宫颈组织学活检，评价液基细胞学联合HPV检测在对宫颈病变的诊断应用价值，现报道如下。
1 资料与方法
1.1 一般资料
整群抽取该院妇科门诊行宫颈液基细胞学及HPV检测已婚女性共424例为研究对象，每位患者均签署知情同意书，均属自愿检查。受检人群年龄20～76岁，平均年龄(40±10)岁。 (高洁 方法 战英杰)