高危型人乳头瘤病毒DNA检测在宫颈癌筛查中的应用

目的:评价高危型人乳头瘤病毒(HPV)DNA检测在宫颈癌筛查中的应用价值。方法:2004～2006年期间,在连云港市第一人民医院健康体检、无妇科临床症状的已婚妇女1628例进行宫颈癌前病变筛查,采用PCR荧光定量检测高危型HPV(HR-HPV)DNA,以病理组织学诊断结果为金标准,应用约登指数比较HPVDNA和薄层液基细胞学(TCT)筛查效果。结果:受检者平均年龄(35±10.2)岁,经病理学诊断HPV感染51例(3.24%),宫颈上皮内瘤变(CIN)Ⅰ级18例、CINⅡ12例,CINⅢ6例,浸润癌3例,内膜癌1例,湿疣15例;以病理学确诊为金标准,HR-HPVDNA检测CINⅡ、Ⅲ的敏感度94.44%、特异度96.76%,阳性预测值25.0%,阴性预测值99.93%,约登指数0.91;HR-HPVDNA检测+TCT检测敏感度100.0%,特异度96.82%,阳性预测值26.47%,阴性预测值100.0%,约登指数0.97。HR-HPVDNA在健康妇女和不同宫颈病变中的阳性率分别是正常/炎症3.24%(51/1572)、CINⅠ84.21%(16/19)、CINⅡ91.67%(11/12)、CINⅢ100.0%(6/6)、浸润癌100.0%(3/3)、湿疣80%(12/15)、内膜癌1例未检出。结论:HR-HPVDNA检测在宫颈癌的筛查中具有敏感度高、阴性预测值高的特点,TCT与HR-HPVDNA联合检测可提高筛查的敏感度和阴性预测值。

Application of high-risk human papillomavirus DNA test in cervical cancer screening

Objective:To evaluate the application value of high-risk human papillomavirus(HPV)DNA test in cervical cancer screening.Methods:1 628 married women without gynecological symptoms received physical examination in the First People's Hospital of Lianyungang and detected for precancerous lesions of uterine cervix,high-risk HPV DNA of the total women were detected by fluorescence quantitatiye polymerase chain reaction,histopathologic diagnosis was golden standard,HPV DNA and the effect of liquid-based thinprep cytology test(TCT)were compared with Youden index.Results:The average age of the women was(35±10.2)years.51 cases(3.24%),18 cases,12 cases,6 cases,3 cases,1 case and 15 cases were diagnosed as HPV infection,cervical intraepithelial neoplasia(CIN)Ⅰ,CIN Ⅱ,CIN Ⅲ,infiltrating carcinoma,endometrial carcinoma and condyloma,respectively.Based on histopathologic diagnosis,the sensitivity,specificity,positive predictive value and negative predictive value of high-risk HPV DNA test for detecting CIN Ⅱ,CIN Ⅲ were 94.44%,96.76%,25.0% and 99.93%,respectively,the Youden index was 0.91.By the combination of high-risk HPV DNA test and TCT,the sensitivity,specificity,positive predictive value and negative predictive value for detecting CIN Ⅱ,CIN Ⅲ were 100%,96.82%,26.47% and 100.0%,respectively,the Youden index was 0.97.The positive rates of HPV in normal inflammation,CIN Ⅰ,CIN Ⅱ,CIN Ⅲ,infiltrating carcinoma and condyloma were 3.24%(51/1572),84.21%(16/19),91.67%(11/12),100%(6/6),100%(3/3)and 80.0%(12/15),respectively.Conclusion:High-risk HPV DNA test has high sensitivity and negative predictive value.The combination of high-risk HPV DNA test and TCT increases the sensitivity,negative predictive value of cervical cancer screening.