人乳头瘤病毒分型检测在宫颈癌机会性筛查中的应用

目的　探讨门诊女性人乳头瘤病毒(Human Papillomavirus, HPV) 感染的常见基因型；评价导流杂交基因芯片技术（简称HybriMax）在发现宫颈病变中的价值。方法　采用HybriMax技术对9 802例有性生活史的门诊就诊女性进行下生殖道HPV感染分型检测，分析门诊女性HPV感染的常见基因型。其中1061例患者同期行病理组织学诊断，按病理结果分为宫颈炎组489例、宫颈上皮内瘤变（cervical intraepithelial neoplasm, CIN）Ⅰ120例、CINⅡ/Ⅲ369例和宫颈癌83例，以病理诊断为金标准，评价HybriMax在筛查宫颈病变中的价值。结果　9 802例门诊女性中前5种常见的HPV感染型别(按阳性率递减)依次为HPV16 (14.38 %)、HPV58 (6.96 %)、HPV52 (5.26%)、HPV33 (3.59 %)、HPV53(3.29%)。宫颈癌组依次为HPV16、18、58、33和39。HybriMax技术检测CINⅡ、Ⅲ和宫颈癌的敏感度、特异度、阳性预测值、阴性预测值分别为88.50 %、50.01 %、 56.82%、85.43%。结论　门诊女性常见的HPV感染基因型为HPV16、58、52、33和53。HybriMax技术对发现CINⅡ、Ⅲ和宫颈癌有较好的敏感性和特异性，适合于宫颈病变的大规模筛查和临床诊断。

Human papillomavirus genotyping in cervical cancer opportunistic screening

Objective To investigate the distribution of human papillomavirus (HPV) genotypes detected in cervical lesions, and to explore the oncogenesis of various HPV genotypes. To evaluate the clinical value of gene chips technology（HybriMax） in cervical lesions screening Methods 　A total of 1061 patients with cervical lesions were divided into four groups: Chronic cervicitis, CINⅠ, Ⅱ, Ⅲ, and cervical carcinoma group in terms of pathological diagnosis. All patients were detected for 21 HPV DNA genotypes by gene chips technology（HybriMax）. The correlations between HPV genotypes prevalence and cervical lesions grades were analyzed. The predictive value of HybriMax in cervical lesions screening was compared with pathological results, which were used as a golden standard. Results The 5 most common genotypes were (in descending orders) in cervical lesions group were HPV16 (38.83 %)、HPV58 (11.31 %)、HPV33 (7.63%)、HPV52 (6.41 %)、HPV31(6.13%). In cervical cancer HPV16、18、58、33 and 39. The prevalence of HPV16 was associated with the severity of cervical lesions(P＝0.000). The sensitivity, specificity, positive predictive value and negative-predictive value of HybriMax in HSIL and cervical cancer detection are 88.50 %,50.01 %, 56.82% and 85.43% respectively. Conclusions　HPV types 16 、58 、33、31、52、53 were most common in cervical lesions, the most pathogenic genotype was HPV 16. HybriMax has a good sensitivity and specificity for CINⅡand above, it appears to be highly suitable for diagnostic as well as large-scale epidemiology studies.