HPV DNA检测在宫颈病变筛查中的价值

目的 探究人乳头状瘤病毒(HPV) DNA检测对宫颈癌及其癌变前期的筛查效果.方法 对2014年1月至2016年12月到四川省人民医院接受官颈病变筛查的2 852例患者进行HPV DNA检测,同时进行病理活检,并以病理检查结果为金标准.考察不同年龄、区域(农村和城市)和肥胖对HPV DNA阳性检出率的影响,同时比较不同病理分型HPV DNA检测结果,分析HPV DNA检测的灵敏度、特异度、阳性预测值、阴性预测值及漏诊率.结果 18～＜35岁组患者的HPV阳性率明显高于35～＜50岁组和50～58岁组,差异有统计学意义(P＜0.05);35～＜50岁组患者的HPV阳性率与50～58岁组比较,差异无统计学意义(P＞0.05).城市组患者的HPV阳性率明显低于农村组,差异有统计学意义(P＜0.05);正常体质量组和体质量超标组HPV阳性率比较,差异无统计学意义(P＞0.05).HPV DNA筛查阳性患者病理检查癌变前期检出率为28.60％,癌症检出率为1.60％;HPV DNA检测灵敏度为87.79％,特异度为86.98％,阳性预测值为30.20％,阴性预测值为99.11％,漏诊率为12.21％.结论 HPV DNA检测对于宫颈病变筛查具有较高的灵敏度和特异度.

Study on the value of HPV DNA detection in the screening of cervical lesions

Objective To investigate the effect of human papilloma virus (HPV) DNA detection on cervical cancer and its precancerous lesions screening.Methods A total of 2 852 patients participated in cervical screening in Sichuan Provincial People's Hospital from January 2014 to December 2016 were enrolled.The HPV DNA testing and pathological biopsy were conducted in all patients,and the pathological examination results were defined as the gold standard.The influences of age,regions of residence (rural and urban) and obesity on the positive rate of HPV DNA were analysed.The results of HPV DNA testing in different pathological types were compared,and the sensitivity,specificity,positive predictive value,negative predictive value of of HPV DNA testing were analysed,as well.Results The positive rate of HPV DNA in the 18-＜35 age group was significantly higher than that in the 35-＜50 age group and 50-58 age group,the differences were statistically significant (P＜0.05).There was no statistically significant difference in positive rate of HPV DNA between the 35-＜50 age group and 50-58 age group (P＞0.05).The positive rate of HPV DNA of patients in urban areas was significantly lower than that of those patients in rural areas (P＜0.05),while no statistically significant difference was found in the positive rate of HPV DNA between patients with normal weight and patients whose weight exceeded the standard (P＞0.05).Among patients with positive HPV DNA testing results,the detection rate of cervical cancer and its precancerous lesions based on pathological examination was 1.60 ％ and 28.60 ％,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and missed diagnosis rate of HPV DNA testing was 87.79％,86.98 ％,30.20 ％,99.11％ and 12.21％,respectively.Conclusion HPV DNA detection has a high sensitivity and specificity in cervical screening.