深圳市社区子宫颈癌筛查结果分析

目的:探讨HPH感染与宫颈癌前病变及宫颈癌的关系,并提出相应的干预措施。方法:2006年4月～2008年4月选取开展妇女健康体格检查较好的深圳市福田区教育系统及尚未很好开展子宫颈癌筛查的深圳市龙岗区居民社区健康妇女为研究对象,对30～60岁妇女进行人类乳头瘤病毒(HPV)检测及阴道镜检查筛查子宫颈癌前病变(子宫颈上皮内瘤变,CIN)和子宫颈癌。结果:筛查深圳市福田区教育系统女性教职工1761例,HPV阳性者208例(11.81%),≥CINⅠ病变34例(1.93%);深圳市龙岗区紫薇社区妇女764例,HPV阳性者122例(16.00%),≥CINⅠ病变34例(4.57%),两者差异有统计学意义(χ2=8.1049,P=0.0044,χ2=12.9075,P=0.0003);HPV阳性者≥CINⅠ病变检出率明显高于HPV阴性者(OR=25.47,95%CI:14.35～45.23);以病理组织学诊断为金标准,评价HPV检测对预测子宫颈上皮内瘤样病变(≥CINⅠ病变)的临床价值,其敏感度:76.47%,特异度:88.69%,阳性预测值:15.75%,阴性预测值:98.46%。结论:HPV感染与子宫颈癌前病变及子宫颈癌密切相关,应将HPV感染者作为高危人群进行监测;健康人群普查能有效预防子宫颈癌前病变及子宫颈癌;应加强健康教育,促进健康人群自觉参与子宫颈癌筛查。

Analysis on the screening results of cervical cancer in community in Shenzhen city

Objective:To study the relationship.between HPH infection and the cervical cancer,and to give out the intervention measure.Methods:From April 2006 to April 2008,the women who aged 30～60 were selected to have human papillomavirus (HPV) and colposcopy testing to detect the cervical cancer and cervical intraepithelial neoplasia (CIN) in the health population of the community of the education system of Futian district of Shenzhen city,these people had advanced medical care,and Ziwei community of Longgang district of Shenzhen city where the cervical cancer screening was not well performed.Results:Of 1 761 cases at the Futian district education system,208 cases were found HPV-positive(11.81%),34 cases were found CIN I or greater lesion (1.93%).Of 764 cases at the Ziwei community in Longgang district,122 cases(16.00%)were found HPV-positive,34 cases were found CIN I or greater (4.57%),there were significant difference (χ2=8.104 9,P=0.004 4,χ2=12.907 5,P=0.000 3);The incidence of CIN I or greater in HPV-positive group was significant higher than the HPV-negative group(OR=25.47,95%CI:14.35～45.23);To evaluate the HPV-test to predict the cervical cancer and CIN with the criterion of histology,the sensitivity was 76.47%,the specificity was 88.69%,the positive predictive value was 15.75% and the negative predictive value was 98.46%.Conclusion:The cervical cancer and CIN have a close relation with HPV infection,so the people with HPV infection should monitor as the high risk ground,and in the healthy people,it would prevent from cervical cancer and CIN with screening.It should strengthen health education and promote people to have cervical cancer screening consciously.