液基细胞学和HPV—DNA检测在宫颈病变筛查中的应用研究

目的：探讨液基细胞薄层涂片（TCT）和肿瘤相关人乳头瘤病毒（HPV）检测与阴道镜合用对子宫颈癌及癌前病变筛查的可行性。方法：1376例育龄非孕妇女，采用TCT、HC-Ⅱ（杂交捕获二代）定量检测宫颈HPV—DNA含量。对宫颈细胞学异常和HPV—DNA阳性者行阴道镜下宫颈多点活检和颈管诊刮术，以病理组织学诊断为金标准，比较3种方法阳性检出率，评价TCT、HC-Ⅱ的诊断价值。结果：1376例受检者中，TCT阳性82例（6．0％1，HPV—DNA阳性74例（5．4％1，96例行阴道镜下宫颈多点活检，诊断鳞状上皮内低度病变（LSL）28例、高度病变（HSL）21例、鳞状细胞癌（SCC）2例。阴道镜活检对CIN（宫颈上皮内瘤变1诊断符合率为85．4％，TCT检测率，HPV检测与组织学级别基本一致。结论：本组患病人群符合子宫颈癌及癌前病变的流行病特点：TCT和宫颈HPV—DNA检测可作为子宫颈癌及癌前病变常规筛查的方法，配合阴道镜及病理检验，能明显提高诊断的准确性和早发现癌前病变。

The liquid-based cytology and HPV-DNA test in cervical dysplasia screening application

Objective：To explore the feasibility of screening in cervical cancer and pre-cancerous dysplasia detected by liquid-based thinprep cytologic test （TCT） and human papillomavirus （HPV） DNA test together with colposcope.Metbods： 1 376 on-pregnant women screened from the local genaecology patients, who had sexual life and never had TCT, HPV and colposcope test, were detected the cervical HPV-DNA content by liquid-based thinprep cytologic test（TCT） and hybrid capture Ⅱ（HC-Ⅱ）. The patients with cervical cytologic acnormity and positive human papillomavirus（HPV）infection were further refered to colposcope test taking more directed punch bropsies plus endocervical currettage. Contrast the positive detectable rate of the three methods taking histology as golden standard. Estimating the diagnosis value of TCT and HC-II.Results：l 376 examined women consist of 82 women diagnosed positive in TCT, detected rate being 6.0%; 74 women diagnosed as positive HPV-DNA affection, detected rate being 5.4%. Among the 96 women checked by colposcope for more directed punch biopsies 21 women were diagnosed as human squamous intraepithelial lesion （HSL）,2 women were diagnosed as squamous cell carcinoma （SCC）.The coincidence rate of CIN diagnosed by colposcope was 85.4%, accordant mostly to liquid-based thinprep cytoligic test, HPV and histology standard.Conclusion：This group of patients are in line with the epidemic symptoms of cervical cancer and pre-cancerous dysplasia. TCT and cervical HPV-DNA test are routine methods for srceening cervical cancer and pre-cancerous dysplasia, cooperated with colposcope and pathology test can obviously raise the diag- nose accuracy and detect the pre-cancerous dysplasia as soon as possible.