2种方法学检测对女性宫颈病变诊断的临床价值

目的研究沈阳地区女性宫颈感染高危型人乳头瘤病毒(hrHPV)状况及年龄分布情况,以及与宫颈活检病理诊断的相关性。方法该院491例18~75岁女性行第2代基因杂交捕获技术(hc2HPV DNA)和薄层液基细胞学检查(TCT)2种方法的联合检测,并对有必要进行电子阴道镜检查的患者进行病理活检,且以病理诊断为宫颈病变诊断的金标准。结果 491例女性hrHPV DNA检测阳性率为48.9%,TCT阳性率为61.9%,两者比较差异有统计学意义(P0.01)。TCT异常女性中,浸润性宫颈癌(ICC)组中位年龄(55.6岁)与不典型鳞状上皮细胞(ASC)/未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、低度鳞状上皮细胞内瘤变(LSIL)、高度鳞状上皮细胞内瘤变(HSIL)组中位年龄(43.0、38.6、44.2岁)差异有统计学意义(P0.05),提示该地区ICC的高发年龄为(55.6±12.3)岁。宫颈病变中,39~49岁组(33.6%)与≤29岁组(13.8%)、49岁组(25.6%)患病率比较,差异有统计学意义(P0.05),与29~39组(27.0%)比较差异无统计学意义(P0.05)。宫颈活检病理异常者有70.1%感染hrHPV,其中慢性宫颈炎、宫颈上皮内瘤样变(CIN)Ⅰ、CINⅡ、CINⅢ、ICC患者的hrHPV感染率随着宫颈病变程度的加重而增加,分别为53.0%、77.8%、90.0%、97.6%、100.0%;hrHPV DNA病毒相对荧光值检测(RLU/CO)中位数分别为1.89、10.01、23.81、77.93、216.76,其中CINⅡ、CINⅢ、ICC组的hrHPV病毒相对荧光值与慢性炎性组的病毒相对荧光值比较,差异有统计学意义(均P0.05),与CINⅠ组比较差异无统计学意义(P0.05)。结论 hc2HPV DNA与TCT检测并结合宫颈病理学是筛查宫颈癌及癌前病变的必要手段,具有重要的临床意义。

The diagnostic value of hc2 HPV DNA and TCT detection for women with cervical lesions

Objective To study the status of high risk human papillomavirus(hrHPV) and the age of distribu‐tion of cervical infection of women in Shenyang area ,and the correlation with the pathological diagnosis cervical biop‐sy .Methods 491 cases of women ,aged 18 to 75 ,detected by the second generation of genetic hybrid capture technol‐ogy (hc2 HPV DNA) and a thin layer of liquid based cytology (Thinprep Cytologic Test ,TCT ) ,morever ,the neces‐sary electronic colposcope examination of patients should conduct pathological biopsy ,and take pathological diagnosis as the gold standard of cervical disease diagnosis .Results 491 cases of women′s hrHPV DNA tests positive rate was 48 .9% ,TCT examination abnormal positive rate was 61 .9% ,there were significant difference between them (P <0 .01) .In TCT abnormal women ,the average age of ICC group had significant difference (55 .6 years) with ASC/AS‐CUS group ,LSIL and HSIL group (43 .0 ,43 .0 ,44 .2 years) (P< 0 .05) ,indicating that the high risk of ICC′s field in shenyang area was (55 .6 ± 12 .3) .In cervical lesions group ,> 39 - 49 years old age group (33 .6% ) had significant difference with the group of 29 years old or less (13 .8% ) and the group of over 50 years old (25 .6% ) or higher (P< 0 .05) ,However ,compared with > 29 - 39 group (27 .0% ) ,there was no significant difference between them (P> 0 .05) .70 .1% of women got infected with hrHPV in abnormal cervical biopsy pathologic diagnosis ,chronic cer‐vicitis ,CIN Ⅰ ,CIN Ⅱ ,CIN Ⅲ and ICC hrHPV infections in patients were increased with the degree of cervical le‐sions ,it was respectively 53 .0% ,77 .8% ,90% ,97 .6% ,90% ;hrHPV DNA viral load testing median (RLU /CO ) were 1 .89 ,10 .01 ,23 .81 ,77 .93 ,216 .76 and CIN Ⅱ group ,CIN Ⅲ group and the ICC′s hrHPV viral load had signifi‐cant difference with the viral load of chronic inflammation group (P < 0 .05) ,and had no significant difference with CIN Ⅰ group .Conclusion The combination of hc2 HPV DNA and TCT examination ,cervical pathological examina‐tion is the essential means to screening for cervical cancer and precancerous lesions and have important clinical signifi‐cance .