摘要
目的研究人乳头瘤病毒(HPV)、液基薄层细胞学检查(TCT)及阴道镜下活检在宫颈病变筛查中的应用价值。方法选择2015年1月至2016年12月妇科门诊就诊及住院,行宫颈癌初次筛查的248例患者为研究对象展开回顾性分析,入选的248例患者均行HPV-DNA检测、TCT检测,对检测阳性及临床诊断疑似宫颈病变者(170例)行阴道镜下病理组织活检,并以阴道镜下病理组织活检检测结果为金标准,评价HPV-DNA检测、TCT检测及其联合检测在宫颈病变筛查中的应用价值。结果(1)HPV-DNA检测阳性患者161例,均出现1种或1种以上的HPV病毒感染,HPV-DNA检测总阳性率为64.92%(161/248);(2)TCT检测显示正常细胞或良性炎症改变200例(80.65%),阳性患者48例,其中ASCUS 20例(8.06%)、LSIL 15例(6.05%)、HSIL 10例(4.03%)、SCC 3例(1.21%), TCT检测总阳性率为19.35%(48/248);(3)170例患者阴道镜下病理组织活检结果显示正常或慢性宫颈炎症患者107例(62.94%),CINⅠ级以上的患者63例(30.06%),其中CINⅠ13例(7.65%),CINⅡ24例(14.12%),CINⅢ23例(13.53%),SCC 3例(1.76%);(4)HPV+TCT联合检测对严重宫颈病变(CINⅢ以上)的筛查具有较高的检出率;(5)HPV+TCT联合检测的灵敏度最高(100%),所有指标中至少一项为阳性;HPV单独检测灵敏度85.71%,漏诊率14.29%;TCT单独检测灵敏度76.19%,漏诊率23.81%;HPV+TCT联合检测灵敏度显著高于HPV单独检测与TCT单独检测,差异有统计学意义(χ~2=9.692,17.027,P<0.05)。结论采用HPV、TCT及阴道镜下活检对宫颈病变的早期筛查具重要应用价值,是一种高效、可行的筛查,联合检测可显著提高宫颈癌的诊断灵敏度,降低临床漏诊率,指导宫颈癌的早期诊断与治疗。
Objective To investigate the application value of human papilloma virus(HPV),liquid-based cytology(TCT) and colposcopic biopsy in screening cervical lesions.Methods A retrospective analysis was performed on 248 patients who underwent primary screening for cervical cancer in our hospital from January 2015 to December 2016.All the patients underwent detection of HPV-DNA and TCT. The colposcopic biopsy was performed in detection positive patients and the patients with suspected cervical lesions(n=170).Taking the results of colposcopic biopsy of pathological tissues as the gold standard,the application value of HPV-DNA detection,TCT and the combined detection in screening of cervical lesion was evaluated.Results The 161 patients with positive HPV-DNA had one or more HPV infections,and the total positive rate of HPV-DNA detection was 64.92%(161/248). TCT detection showed that there were 200 cases of normal cells or benign inflammatory changes(80.65%),in whom, 48 patients were positive,including 20 cases of ASCUS(8.06%),15 cases of LSIL(6.05%),10 cases of HSIL(4.03%),3 cases of SCC(1.21%),with the total positive rate of TCT being 19.35.%(48/248).The colposcopic biopsy showed that there were 107 cases(62.94%) of normal or chronic cervical inflammation,63 cases(30.06%) of grade Ⅰ or above CIN,including 13 cases of CIN Ⅰ(7.65%),24 cases of CIN Ⅱ(14.12%),23 cases of CIN Ⅲ(13.53%),and 3 cases of SCC(1.76%).The detection rate of HPV+TCT for severe cervical lesions(CIN Ⅲ and above) was higher.The sensitivity of HPV+TCT was the highest(100%),and at least one of the indexes was positive.The sensitivity and rate of missed diagnosis of HPV alone were 85.71% and 14.29%,respectively,however, those of TCT alone were 76.19% and 23.81%,respectively.The sensitivity of HPV+TCT detection was significantly higher than that of HPV or TCT alone(χ~2=9.692,17.027,P<0.05).Conclusion HPV,TCT and colposcopic biopsy are of great value for early screening of cervical lesions,and the combined detection can significantly improve the diagnostic sensitivity of cervical cancer,reduce the rate of clinical missed diagnosis,which can guide early diagnosis and treatment of cervical cancer.
作者
孙斯媛
罗飞
胡义忠
包书平
SUN Siyuan;LUO Fei;HU Yizhong(Department of Clinical Laboratory,People’s Hospital of Chizhou City,Anhui,Chizhou 247000,China)
出处
《河北医药》
CAS
2019年第11期1645-1649,共5页
Hebei Medical Journal
