摘要
目的：探讨商危型人乳头瘤病毒（HPV）DNA检测在宫颈癌筛查中的作用。方法：2005年4月～2006年4月在我院妇科门诊就诊2340名妇女进行宫颈癌前病变筛查，采用第2代杂交捕获试验（HC-Ⅱ）检测高危型HPV DNA联合薄层液基细胞学检查，同时进行阴道镜检查，并以宫颈活检的组织病理学为确诊标准。结果：筛查并经病理诊断为HPV感染365例，宫颈上皮内瘤变（CIN）Ⅰ级71例，CINⅡ48例，CINⅢ55例，宫颈浸润癌31例。以组织病理学为确诊标准，高危型HPV DNA检测CINⅡ、CINⅢ的敏感度是91．33％，特异度是74．51％，阳性预测值是5．21％，阴性预测值是99．79％。宫颈细胞学筛查CINⅡ、CINⅢ，以未明确诊断意义的不典型鳞状上皮细胞（ASCUS）为分界点的敏感度、特异度、阳性预测值、阴性预测值分别是90．80％、80．45％、12．30％、99．50％；以高度鳞状上皮内病变（HSIL）为分界点的敏感度、特异度、阳性预测值、阴性预测值分别是98．90％、73．98％、4．90％、100．00％。高危型HPV DNA在不同宫颈病变中的阳性率分别是：宫颈癌88.57％（31／35），CINⅢ91．67％（66／72），CINⅡ87．50％（56／64），CINⅠ42．00％（21／50）。结论：高危型人乳头瘤病毒DNA检测在宫颈癌前病变的筛查中有很高的敏感度和阴性预测值，高危型HPV DNA联合细胞学检查可使敏感度和阴性预测值有提高，但特异度未能提高。
Objective： To investigate the effect of high - risk human papillomavirus （HPV） DNA test and cytological detection for primary screening on cervical cancer. Methods： From April 2005 to April 2006, a total of 2 340 women were screened by combining high - risk HPV DNA test （hybrid capture Ⅱ, HC - Ⅱ） and cytological test （liquid - based ThinPrep cytology test）, and the abnomal cytological or HPV DNA findings were further biopsied under the celpescope. Results： Final pathological diagnosis was HPV infection in 365 crees, cervical intraepithelial nenplasia （CIN） Ⅰ in 71 cases, CIN Ⅱ in 48 cases, CIN Ⅲ in 55 cases, invasive cervical cancer 31 cases. Baaed on the criteria of histology and pathology, the sensitivity, specificity, positive - predictive and negative - predictive value of high - risk HPV DNA test for detecting all cases of CIN Ⅱ, CIN Ⅲ were 91.33%, 74.51%, 5.21% and 99.79%. In detecting all casns of CIN Ⅱ, Ⅲ by cytological test, for atypical squamous cell of undetermined signification （ASCUS）, the sensitivity, specificity, positive - predictive value and negative - predictive value were 90.80%, 80.45%, 12.30% and 99.50% respectively; for low-grade squamous intraepithelial lesion （LSIL）, the sensitivity, specificity, positive - predictive and negative - predictive value were 69.98%, 90.60%, 11.09% and 99.49% respectively; for high - grade squamons intraepithelial lesion （HSIL）, the sensitivity, specificity, positive - predictive and negative - predictive value were 49.01%, 98.64%, 29.20% and 99.31% respectively. By the combination of high - risk HPV DNA test and cytological test, the sensitivity, specificity, positive - predictive and negative - predictive value for deteciting all cases of CIN Ⅱ, Ⅲ were 98.90%, 73.98%, 4.90% and 100.00% respectively. The infection rate of HPV in cervical cancer was 88.57% （31/35）, in CINⅢ 91.67% （66/72）, in CINⅡ 87.50% （56/64） and in CINⅠ 42.00% （21/50）. Conclusion： High - risk HPV DNA test has high sensitivity and negative - predictive value. The combination of high - risk HPV DNA test and cytological teat increases the sensitivity and negative - predictive value, but it does not increase the specificity. The performance of biopsy under the colposcope can help the diagnosis of cervical dysplasia.
出处
《中国妇幼保健》
CAS
北大核心
2006年第24期3434-3436,共3页
Maternal and Child Health Care of China
