hTERC基因与LCT、HPV检测在宫颈高级别病变筛查中的价值

目的 评价人端粒酶基因（human telomerase RNA component,hTERC）及液基细胞学（liquid-based cytology test,LCT）、HPV检测在宫颈高级别病变（≥CINⅡ）筛查中的价值.方法 收集在厦门市妇幼保健院就诊并接受LCT和HPV检测宫颈病变患者115例,运用FISH技术检测宫颈病变组织hTERC基因扩增情况.以病理结果为标准,评价3种方法不同组合方案在筛查≥CINⅡ病变中的价值.结果 单一方法筛查时,HPV敏感度最高（91.2％）,hTERC基因的特异性（86.5％）和阳性预测值（88.1％）最高;两种方法联合筛查时,LCT＋ HPV的敏感度最高（98.4％）,但特异性最低（37.5％）;任意两种方法联合筛查均能明显提高敏感度和阴性预测值,但不能提高特异性.诊断≥CINⅡ的受试者工作特征（receiver operating characteristic,ROC）曲线下面积以hTERC基因最高（0.85）,筛查效率最高（P＜0.05）;联合筛查则LCT＋ hTERC基因筛查效率最高,但联合筛查方案的筛查效率与单一筛查方案相比差异无统计学意义（P＞0.05）.结论 LCT、HPV与hTERC基因均是筛查≥CINⅡ病变的有效方法,hTERC基因的效率最高,但成本最高,可作为常规筛查的补充;联合筛查能提高敏感度和阴性预测值,提高对≥CINⅡ的检出率,但不能提高筛查效率.LCT＋ HPV联合筛查是一种相对经济和高效的方案,可作为基础筛查进行.

Clinical Evaluation of Human Telomerase RNA Component Gene,Liquid-based Cytology Test and Human Papillomavirus Detection in High-grade Cervical Lesions Screening

Objective To evaluate the application of human telomerase RNA component （hTERC） gene,human papillomavirus （HPV）,liquid-based cytology test（LCT） and their combination plan in high-grade cervical lesions screening.Methods A total of 115 cases were collected,and HPV and LCT were performed.All patients received biopsy and hTERC gene was detected by FISH.The pathology results were the final diagnosis to evaluate each approach for screening cervical lesions.Results By single screening approach,HPV highest sensitivity,but hTERC performed the highest specificity and positive prevalue.Any approache combined screening,LCT ＋ HPV got highest sensitivity but lowest specificity.Any combined screening program could increase the sensitivity and negative prevalue but not specificity.hTERC gene detection showed the highest accuracy and maximum area of under receiver operating characteristic curve,and improved significantly the rate of cervical cancer screening （P ＜ 0.05）,while the program of LCT ＋ hTERC showed the same conclusion in all combined programs,but no significant difference between single approach and any combined program （P ＞ 0.05）.Conclusion LCT,HPV and hTERC gene detection are valuable for screening cervical cancer at present.hTERC gene testing was the best but the highest cost,which make it a useful supplementary to clinical diagnosis.Any combined screening program can increase the sensitivity and negative prevalue,but not improve the rate of cervical cancer screening.The LCT ＋ HPV test was regarded as a joint cost-effective screening program,which can be carried as a basic screening.