目的探讨宫颈癌甲基化检测对于非16/18型高危人乳头瘤病毒(high risk human papillomavirus,HR-HPV)感染人群的临床价值。方法方便选取2016年6月—2020年6月就诊于福州市第一医院的267例非16/18型HR-HPV阳性的女性患者,所有研究对象均进...目的探讨宫颈癌甲基化检测对于非16/18型高危人乳头瘤病毒(high risk human papillomavirus,HR-HPV)感染人群的临床价值。方法方便选取2016年6月—2020年6月就诊于福州市第一医院的267例非16/18型HR-HPV阳性的女性患者,所有研究对象均进行PAX1检测、TCT检测,并以病理学检查结果为诊断金标准,分析两种筛查方法的诊断效能、转诊阴道镜检出率。结果PAX1检测的灵敏度为92.50%,特异度为43.90%,阳性预测值为28.99%,阴性预测值为95.92%,差异有统计学意义(Kappa=0.200,P<0.05);TCT检测的灵敏度为96.20%,特异度为14.00%,阳性预测值为21.70%,阴性预测值为93.75%,差异有统计学意义(Kappa=0.045,P<0.05)。两种筛查方法比较TCT的灵敏度高于PAX1检测,PAX1检测的特异度高于TCT检测,PAX1检测与金标准的Kappa值大于TCT与金标准的Kappa值,PAX1检测与金标准的一致性优于TCT与金标准;TCT检测阳性转诊阴道镜检率为88.01%(235/267),PAX1检测阳性转诊阴道镜检率为63.30%(169/267),PAX1检测与TCT检测比较,阴道镜检率减少24.72%。结论对于非16/18型HR-HPV感染人群采用PAX1检测,可以降低长期随访人群的恐慌,避免过度医疗。展开更多
Histological low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 （LSIL/CIN1） preceded by normal or mildly abnormal cytology is recommended for conservative follow-up, with no separat...Histological low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 （LSIL/CIN1） preceded by normal or mildly abnormal cytology is recommended for conservative follow-up, with no separated management. In this study, we assessed the triage value of human papillomavirus （HPV） 16/18 genotyping in 273 patients with LSIL/CINI. HPV16/18 genotyping was performed at baseline and follow-up was at 6-monthly intervals for up to 2 years. At each follow-up, women positive for cytology or high-risk HPV （hrHPV） were referred for colposcopy. Enrollment cytology, HPV16/18 genotyping, and questionnaire-obtained factors were linked to the 2-year cumulative progression rate. Univariate and multivariate analyses were performed taking into account time-to-event with Cox proportional hazard regression. The results showed that 190 cases （69.6%） regressed, 37 （13.6%） persisted, and 46 （16.8%） progressed. HPV16/18 positivity （hazard ratio （HR）, 2.708; 95% confidence interval （CI）, 1.432-5.121; P=-0.002） is significantly associated with higher 2-year cumulative progression rate. Sub-analysis by enrollment cytology and age restricted the positive association among patients preceded by mildly abnormal cytology and aged 30 years or older. Immediate treatment is a rational recommendation for the high-risk subgroup, when good compliance is not assured.展开更多
文摘目的探讨宫颈癌甲基化检测对于非16/18型高危人乳头瘤病毒(high risk human papillomavirus,HR-HPV)感染人群的临床价值。方法方便选取2016年6月—2020年6月就诊于福州市第一医院的267例非16/18型HR-HPV阳性的女性患者,所有研究对象均进行PAX1检测、TCT检测,并以病理学检查结果为诊断金标准,分析两种筛查方法的诊断效能、转诊阴道镜检出率。结果PAX1检测的灵敏度为92.50%,特异度为43.90%,阳性预测值为28.99%,阴性预测值为95.92%,差异有统计学意义(Kappa=0.200,P<0.05);TCT检测的灵敏度为96.20%,特异度为14.00%,阳性预测值为21.70%,阴性预测值为93.75%,差异有统计学意义(Kappa=0.045,P<0.05)。两种筛查方法比较TCT的灵敏度高于PAX1检测,PAX1检测的特异度高于TCT检测,PAX1检测与金标准的Kappa值大于TCT与金标准的Kappa值,PAX1检测与金标准的一致性优于TCT与金标准;TCT检测阳性转诊阴道镜检率为88.01%(235/267),PAX1检测阳性转诊阴道镜检率为63.30%(169/267),PAX1检测与TCT检测比较,阴道镜检率减少24.72%。结论对于非16/18型HR-HPV感染人群采用PAX1检测,可以降低长期随访人群的恐慌,避免过度医疗。
基金Project supported by the Zhejiang Provincial Natural Science Foundation of China(No.LQ14H160007)the National Natural Science Foundation of China(No.81402364)+2 种基金the Zhejiang Provincial Medical & Hygienic Science and Technology Project of China(No.2013KYA104)the Special Fund for Scientific Research in the Public Interest from the National Health and Family Planning Commission of the People’s Republic of China(No.2015SQ00243)the National Key Research and Development Program of China(No.2016YFC1302900)
文摘Histological low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 （LSIL/CIN1） preceded by normal or mildly abnormal cytology is recommended for conservative follow-up, with no separated management. In this study, we assessed the triage value of human papillomavirus （HPV） 16/18 genotyping in 273 patients with LSIL/CINI. HPV16/18 genotyping was performed at baseline and follow-up was at 6-monthly intervals for up to 2 years. At each follow-up, women positive for cytology or high-risk HPV （hrHPV） were referred for colposcopy. Enrollment cytology, HPV16/18 genotyping, and questionnaire-obtained factors were linked to the 2-year cumulative progression rate. Univariate and multivariate analyses were performed taking into account time-to-event with Cox proportional hazard regression. The results showed that 190 cases （69.6%） regressed, 37 （13.6%） persisted, and 46 （16.8%） progressed. HPV16/18 positivity （hazard ratio （HR）, 2.708; 95% confidence interval （CI）, 1.432-5.121; P=-0.002） is significantly associated with higher 2-year cumulative progression rate. Sub-analysis by enrollment cytology and age restricted the positive association among patients preceded by mildly abnormal cytology and aged 30 years or older. Immediate treatment is a rational recommendation for the high-risk subgroup, when good compliance is not assured.
