摘要
目的:评价宫颈薄层液基细胞检测(TCT)联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变(CIN)筛查的价值。方法:选取TCT检查结果异常,包括意义不明不典型鳞状细胞(ASCUS)、低度鳞状上皮内瘤变(LSIL)、高度鳞状上皮内瘤变(HSIL)和鳞状上皮癌(SCC)的163例绝经后妇女为研究对象,荧光定量PCR(FQ-PCR)法检测高危型人乳头状瘤病毒(HR-HPV16、18、31、33、45、52、56、58)分型,并以阴道镜下宫颈活检病理学诊断作为诊断金标准进行对比研究。结果:①不同年龄段绝经妇女TCT结果异常的类型构成比,差异无统计学意义(P>0.05)。②HPV分型检测阳性者80例,感染率49.1%,随着TCT检查宫颈病变级别的升高,HR-HPV感染率亦逐步增加,与低级别比,差异有统计学意义(P<0.05)。③163例TCT异常患者中,病理学诊断阳性51例(CINⅠ级24,CINⅡ级9例,CINⅢ级6例,宫颈浸润癌12例),阳性率31.3%(51/163)。随着TCT检查宫颈癌变级别的增高,宫颈组织病理学诊断阳性率逐步增加,差异有统计学意义(P<0.01)。④宫颈炎组中HR-HPV阳性40例,感染率35.71%,宫颈CIN阳性组中HR-HPV阳性29例,感染率74.4%(其中CIN I级70.8%,CIN II级77.8%,CIN III级83.3%),宫颈浸润癌组中HR-HPV阳性11例,感染率91.7%,随着宫颈病变病理级别的升高,HR-HPV感染率呈上升趋势(P<0.01)。⑤TCT联合HPV检测、单独HPV检测对CIN及宫颈癌筛查的敏感度均高于TCT检查,分别为96.1%、78.4%、66.7%(P<0.01)。TCT联合HPV分型检测、单独HPV检测对CIN及宫颈癌筛查的假阴性率低于TCT检测,有显著性统计学差异(P<0.01)。3种筛查方法的特异度、假阳性率比较,无统计学差异(P>0.05)。结论:TCT联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变筛查中具有重要意义。
Objective： To evaluate the sensitivity and specificity of thinprep cytologic test （TCT） co-test high- risk type HPV （HR-HPV） genotyped detection in cervical intraepithelial neoplasia of postmenopausal women. Methods： A total of 163 post-menopausal women with abnormal results of TCT were collected. High-risk type human papilloma virus （HPV16, 18, 31, 33, 45, 52, 56, 58） were detected in all the women by fluorescence quantitative polymerase chain reaction （FQ-PCR）, based on the pathological diagnosis by cervical biopsy under vaginoscope. Results： 1） There was no statistically significant difference among 163 cases of different age stages （48-49, 50-59, 60-69, 70-78 years old） （P〉0.05）. 2） The total infection rate of HR-HPV in post- menopausal women with cervical lesions was 49.1% （80/163）, and with the increase of TCT check level, the infection rate of HR-HPV increased gradually, the difference was statistically significant （X2=24.26, P〈0.005）. 3） Among 163 cases with pathological, 51 cases （31.3%） were positive, with the increase of TCT check level, the proportions of positive cases were gradually increased, the difference was statistically significant （X2=39.6, P〈0.005）. 4） In cervicitis group, 40 cases were HR-HPV positive, infection rate was 35.71%, 29 patients in cervical CIN group were HR-HPV positive, infection rate was 74.4%, 11 cases in cervical cancer group invaded the embellish HR-HPV positive, infection rate was 91.7%. With the cervical lesions degree of aggravating, HR-HPV infection rates had an increased trend, the difference was statistically signifi- cant （X2=26.41, P〈0.005）. 5） The sensitivity of TCT joint HPV detection of cervical cancer screening was higher than HPV or TCT check alone （96.1%, 78.4%, 66.7%）, the difference was statistically significant （P〈0.01）. The false negative rate of TCT joint HPV detection and HPVdetection alone of cervical cancer screening was lower than TCT check alone, the difference was statistically significant （P〈0.01）. There was no statistically significant difference of specificity and false positives among TCT and Hr-HPV and co-test of them. Coaelusion： The co-test method was important in cervical cancer screening of post-menopausal women.
出处
《生殖与避孕》
CAS
CSCD
2012年第6期417-422,共6页
Reproduction and Contraception
