摘要
目的分析HPV分型检测联合TCT对中老年女性宫颈病变的筛查价值。方法选择2015年1月至2017年12月来北京市朝阳区妇幼保健院就诊的4 628名48～64岁年龄段的女性患者为研究对象,行HPV分型检测联合TCT检查,对细胞学检测阴性且高危HPV检测阳性患者(A组)、高危HPV检测为阴性且TCT检测为ASCUS以上的患者(B组)、高危HPV检测阳性且TCT检测为ASCUS以上的患者(C组)行阴道镜检查,并做组织病理学活检,比较三种检测方法对宫颈病变的筛查价值。结果 4 628筛查对象中高危型HPV阳性1 029人,阳性率为22.23%,其中以单一感染为主(74.93%)。筛查对象中TCT阳性407人,阳性率为8.79%,其中ASCUS为288例(70.76%)、LSIL为73例(17.94%)、HSIL为41例(10.07%)、鳞状细胞癌5例(1.23%)。Fisher确切概率法检验结果显示不同宫颈病变HPV感染率比较有显著性差异(P=0.001),随着宫颈病变的加重,HPV感染率逐渐增加。根据病理检查结果比较三种检测方法的筛查价值,结果显示C组筛查价值最大,灵敏度为97.62%、特异度为79.66%、阳性预测值为69.49%、阴性预测值为98.60%、AUC为0.92、约登指数为0.77。结论高危型HPV与宫颈病变密切相关,高危HPV检测联合TCT对中老年女性宫颈病变有较好的筛查价值。
Objective To analyze the value of human papilloma virus (HPV) typing detection combined with thinprep cytologic test (TCT) in cervical lesions screening in middle-aged and elderly women.Methods Totally 4 628 women aged 48 to 64 in Beijing Chaoyang District Maternity and Child Care Hospital from January 2015 to December 2017 were selected and checked for HPV types and TCT.TCT negative and high-risk HPV test positive patients (group A),high-risk HPV test negative and atypical squamous cells of unknown significance(ASCUS) above patients (group B),high-risk HPV testing positive and ASCUS above patients (group C) received colposcope examination and histopathological biopsy.The screening value was compared among three groups.Results Among 4 628 subjects screened,1 029 were HPV positive for high-risk types,with a positive rate of 22.23%,mainly single infection (74.93%).Among the subjects screened,407 were TCT positive,with a positive rate of 8.79%,including 288 cases (70.76%) of ASCUS,73 cases (17.94%) of low grade squamous intraepithelial neoplasia (LSIL),41 cases (10.07%) of high degree of squamous intraepithelial neoplasia (HSIL),and 5 cases (1.23%) of squamous cell carcinoma.Fisher's exact probability test results showed that there was significant difference in HPV infection rate among different cervical lesions ( P < 0.05 ),and that the HPV infection rate increased gradually with the aggravation of cervical lesions.According to the results of pathological examination,the diagnostic values of three detection methods were compared,and the results showed that group C had the highest diagnostic value,with sensitivity of 97.62%,specificity of 79.66%, positive predictive value of 69.49%,negative predictive value of 98.60%,AUC of 0.92,and a Yoden index of 0.77.Conclusion High-risk HPV is closely related to cervical lesions,and high-risk HPV detection combined with TCT has a good screening value for cervical lesions in middle-aged and elderly women.
作者
郑华
王立聪
ZHENG Hua;WANG Licong(Department of Gyneoclogy and Obstetrics,Beijing Chaoyang Maternal and Child Care Hospital,Beijing 100020,China)
出处
《中国妇幼健康研究》
2019年第3期365-368,共4页
Chinese Journal of Woman and Child Health Research
关键词
人乳头瘤病毒
液基薄层细胞学
宫颈病变
筛查
human papilloma virus (HPV)
thinprep cytologic test (TCT)
cervical lesions
screening
