摘要
目的了解湖南地区妇女宫颈病变状况,探索最佳的普查方法。方法回顾分析2012年7月至2013年7月在中南大学湘雅三医院体检中心进行妇科普查的24 817例已婚妇女常规检查,包括宫颈细胞学检查(新柏氏膜式液基薄层细胞学检查法(TCT)或巴氏涂片法)、高危型人乳头状瘤病毒(HPV-DNA)检测、HPV阳性或TCT异常者进行阴道镜病理组织学检查。结果 24 817例体检妇女中发现慢性宫颈炎14 779例,患病率为59.6%;TCT检查组进行早期宫颈癌及癌前病变筛查的敏感性为92.56%,特异性为80.05%,阳性率2.95%,假阴性率为0.18%,巴氏涂片细胞学检查组敏感性为57.35%,特异性为97.33%,阳性率1.45%,假阴性率为1.65%,两组比较差异有统计学意义(均P<0.05)。16.61%的体检者HPV-DNA感染阳性;709例有组织病理结果,其中宫颈上皮内瘤变(CIN)Ⅰ级46例、CINⅡ36例、CINⅢ48例、早期侵袭性宫颈癌10例;以组织病理学结果为诊断标准,TCT异常组的宫颈瘤变率(31.4%),高于TCT正常组瘤变率(4.8%)(P<0.05)。也显著高于HPV-DNA阳性组(19.47%)(P<0.05)。结论 TCT和HPV-DNA联合检查有助于宫颈上皮内瘤变的早期诊断,在宫颈癌早期诊断中优于巴氏涂片细胞学检查+HPV检测,是推荐宫颈病变和早期宫颈癌筛查的最佳方案。
Objective To investigate the health state of the cervical of women in Hunan by gynecological general survey and to explore the best method of gynecological examination. Methods We analysed the result of 24 817 Chinese women from Hunan province who underwent gynecological examination in the examnation center of the third affliated Xiangya Hospital from July 2012 to July 2013. The examination covered physical examination, cervicalcytology （Thinprep cytologic test or Pap smear） and high-risk human papmomavirus（HR-HPV）. Women with HPV- positive or aberrant TCT were advised to get colposcopy and histopathologieal examination. Results In all 24 817 subjects, there were 14 779 cases having chronic cervicitis （incidence ：59.6% ） o The sensitivity 6f TCT for screen- ing cervical precancerous lesion or early cervical cancer was 92. 56% , and specificity is 80. 05%. The thepositive rate was 2. 95% , and the false-negative rate was 0. 18% comparing with the rates in Pap smear as 57.35%, 97.33%, 1.65%, 1.45% ,respectively. There was significant difference between the two groups （P 〈 0. 05 ） o the rate of HR-HPV infection was 17.67%. Totally 709 biopsy specimens were obtained,46 of 709 patients were diag- nosed CIN I , 36 were diagnosed CIN 11,48 were diagnosed CIN In, 10 patients were diagnosed early cervical cancer and 1 was diagnosed invasive cervical cancer Using pathologic histology result as a gold standard, the inci- dence of CIN （31.4%）in populations with aberrant TCT results was higher than that in the normal populations （4. 8% ） （P 〈0. 05 ）,and also was much higher than the population with HPV-DNA positive（ 19.47% ）（P 〈 0. 05）. Condusions The combined test of TCT and PHV support the early diagnosis of CIN, and TCT combined with HPV is an optial choice for screening of early cervical lssion and cervical cancer.
出处
《基础医学与临床》
CSCD
2015年第4期435-438,共4页
Basic and Clinical Medicine
关键词
妇科普查
宫颈癌
HPV
TCT
阴道镜
gynecological general survey
cervical carcinoma
human papillomavirus
thinprep cytologic test
colposcopy
