摘要
目的探讨对广东省潮州地区农村妇女采用高危型人乳头状瘤病毒(HPV)感染、液基细胞学(LBC)和传统巴氏涂片(CPS)筛查法进行宫颈癌筛查的效果,为建立适宜农村地区妇女的宫颈癌筛查策略提供依据。方法选择2011年3月至6月,采用分阶段整群抽样法在潮州地区5个乡镇招募的3723例35～59岁符合筛查条件的农村常住妇女为研究对象(子宫颈完整存在)。对其同时采用高危型HPV,LBC和CPS筛查法进行宫颈癌筛查,并对其中HPV呈阳性者进行HPV分型。对宫颈细胞学改变为低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、HPV呈阳性的未明确诊断意义的不典型鳞状上皮细胞(ASC-US)、非典型鳞状细胞、不能排除高级别鳞状上皮内病变(ASC-H)的受试者,进行阴道镜下宫颈组织活检及随访,评价不同筛查法的筛查效果(本研究遵循的程序符合广东省妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与受试者签署临床研究知情同意书)。结果 3723例接受宫颈癌筛查的受试者中,高危型HPV感染率为8.2%,常见HPV亚型为HPV-52,-16,-58,-33及-68;宫颈上皮内瘤变(CIN)Ⅰ～Ⅲ检出率分别为1.05%(39/3723),0.40%(15/3723)和0.54%(20/3723)。若以宫颈组织病理学活检结果≥CINⅡ为标准,则高危型HPV,LBC和CPS筛查法的灵敏度与特异度分别为94.4%(34/36)与46.6%(27/58),97.2%(35/36)与25.9%(15/58)及52.9%(9/17)与38.0%(19/50)。3种宫颈癌筛查方法的灵敏度与特异度比较,差异均有统计学意义(P<0.05)。LBC与CPS对宫颈癌筛查的阳性预测值(PPV)分别为44.9%(35/78)与22.5%(9/40),且差异具有统计学意义(χ2=5.7,P=0.02)。结论在广东省潮州地区农村妇女中开展宫颈癌筛查发现,高危型HPV检测法相对于LBC,具有更高灵敏度和特异度,在成本许可条件下具有一定推广价值;而LBC相对于CPS,具有更高灵敏度、PPV和更好的制片效果。
Objective To evaluate the effectiveness of high-risk human papilloma virus（HPV） strains testing, liquid based cytology （LBC）, and conventional Pap smear （CPS） in rural areas of Chaozhou city, Guangdong Province, China. Methods A stratified, multistage cluster sampling method was used to collect samples from 5 selected villages in rural areas of Chaozhou city from March to June, 2011. Recruitment of 3723 women aged 35-59 （cervical integrated exist） were done vialocat television advertisements and flyers, as well as notifications by the healthcare professionals. All participants accepted variable cervical cancer screening methods at the same time such as high-risk HPV strains testing using PCR kit, LBC, and CPS, and who were found positive for the high-risk HPV types further underwent HPV genotyping, while samples with abnormal cervical cytology such as low-grade intraepithelial lesion （LSIL）, high-grade intraepithelial lesion （HSIL）, atypical squamous cells of undetermined signification （ASC-US） with high- risk HPV positive were further followed up with histological examination and analysis, and finally evaluated the effectiveness of variable cervical cancer screening methods which was the best. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangdong Women and Children Hospital. Informed consent was obtained from all participants. Results Among 3723 women participated in the study, 8.2% of the women were infected by the high-risk HPV. The popular high-risk HPV types in this study wereHPV-52,-16,-58,-33, and-68. CIN Ⅰ～Ⅲ were 1. 05%（39/3723）, 0.40%（15/3723） and 0.54%（20/3723）, respectively. Based on the abnormal standard of cervical pathology with CIN % lesions or above, the sensitivity of high-risk HPV types testing, LBC and CPS were 94.4o/oo （34/36）, 97.2% （35/36） and 52.9%（9/17）, while the specificity were 46. 6% （27/58）, 25.9% （15/58） and 38.0~ （19/50）, respectively, and there had significance difference（P〈0. 05） in sensitivity and specificity among three methods. There had significance difference （X^2 = 5.7, P = 0.02） in positive predictive value （PPV） between LBC and CPS [44.9% （35/78） vs. 22.5% （9/40）], too. Conclusions Cervical cancer screening in rural areas of Chaozhou city,Guangdong Province, high-risk HPV types testing had shown a higher sensitivity and specificity than those of cervical cytology methods, it was worth to practice under a acceptable cost. Compared to CPS and LBC, high-risk HPV types testing had shown a greater sensitivity and PPV, and had a better and clearer slide background.
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2013年第1期30-36,共7页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
广东省医学科研基金资助(C2012010)~~
关键词
宫颈癌筛查
人乳头瘤病毒
液基细胞学
传统巴氏涂片
cervical cancer screening
human papilloma virus
liquid based cytology
conventional Pap smear
