宫颈癌早期诊断4种方法的比较和意义

目的 通过比较4种常用方法，以期找到宫颈癌早期筛查的最佳方案。方法 2003年3～4月。选取华中科技大学同济医学院附属同济医院门诊阴道镜室接诊病例50例，以病理检查作为金标准，采用肉眼观测(辅以醋酸和碘试验)、阴道镜检查、液基细胞学检查(TCT)、HC-Ⅱ法HPV DNA检测等4种常用方法，对比其特异性、敏感性、准确性、约登指数及Kappa值。结果 4种检测方法敏感性、特异性、准确性、阳性预测值、阴性预测值、约登指数及Kappa值依次为：肉眼观测辅以醋酸和碘试验(33．33％、74．47％、72．00％、7．69％、94．59％、0．0780、0.0270)，阴道镜检查(33．33％、91．49％、88．00％、20．00％、95．56％、0．2482、0．1892)，液基细胞学检查(66．67％、97．87％、96．00％、66．67％、97．87％、0．8227、0．6454)，HCⅡ法HPV DNA(100％、85．11％、86．00％、30．00％、100．00％、0．8511、0．4067)。结论 肉眼观测辅以醋酸和碘试验诊断价值很低；液基细胞学检测和HC-Ⅱ法HPV DNA检测两者均为宫颈癌早期筛查的可选方法，两种方法联合应用阴性预测值高，阴道镜检测不适用于早期筛查。     

两种引物PCR法检测宫颈刮片中HPV DNA的对比及意义

目的探讨聚合酶链式反应检测宫颈刮片中人乳头瘤病毒的意义及可行性.方法共检测131例宫颈刮片,分为门诊组和宫颈癌组.每例分别使用通用型引物和16型E7引物进行PCR,比较两组间及两对引物检测的阳性率.结果普查组和宫颈癌组阳性率分别为32.99%和73.53%,两组阳性率比较,差异有极其显著性(P＜0.001).普查组中,通用引物和HPV16 E7引物扩增阳性率分别为27.84%和16.49%,差异无显著性(P＞0.05).宫颈癌组中,通用引物和HPV16 E7引物扩增阳性率分别为38.24%和67.65%,差异有显著性(P＜0.05).结论PCR法检测宫颈刮片中的人乳头瘤病毒为一种可行的方法.通用型引物在普通人群中检测的敏感性好,可以作为一种筛查的方法,对高危人群检测高危型HPV DNA更有意义.     

杂交捕获二代法检测高危型人乳头瘤病毒DNA的意义

目的 探索杂交捕获二代（HC-Ⅱ）法检测高危型人乳头瘤病毒（HPV）DNA的意义．方法2003年3—6月在武汉同济医院妇产科采用HC-Ⅱ法检测150例门诊忠者的高危型HPVDNA，以阴道镜辅助活检为金标准，比较该方法的特异性、敏感性、准确性、约登指数及Kappa值。结果高危型HPV阳性率为14．67％，HC—Ⅱ法检测高危型HPVDNA的敏感性、特异性、准确性、阳性预测值、阴性预测值、约登指数及Kappa值依次为：88．89％，91．78％，91．21％，72．73％，97．10％，0．8067，0．7444。假阳性率为6．59％，假阴性率为2．19％。结论HC-Ⅱ法检测高危型HPVDNA阴性预测值高，与金标准有较好的符合率，诊断价值高，为一种很好的早期筛查方法。     

Value and Feasibility of HPV DNA Test in Cervical Scraping Smears

Summary： To investigate the reliability and feasibility of human papillomavirus （HPV） DNA test in cervical scraping smears with polymerase chain reaction （PCR）, 131 cases of cervical scraping specimens were collected, and the positive rates and accuracy of HPV infection were determined in normal subjects and cervical cancer patients. GP5^＋/GP6^＋ and E7 primer pairs designed for detecting HPV L1 and HPV type 16 E7 were tested in this study. Our results showed that positive rates of HPV DNA in normal population and cervical cancer patients were 32.99% and 73.53% respectively and there was significant difference between them （P〈0. 001）. In normal subjects, detection rates of HPV DNA with GP5^＋/GP6^＋ and E7 primer pairs were 27.84 % and 16.49 % respectively, with statistically significant difference between them （P〉0.05）. However the detection rates in cervical cancer patients were 38.24 % and 67.65 % for the two markers, with a significant difference found between them （P〈0.05）. It is concluded that HPV DNA test with PCR for cervical scraping smears was feasible. GP5^＋/GP6^＋ primer pairs may be a useful probe to screen HPV infection in normal population, but they are not sensitive enough in cervical cancer patients. It is suggested that high risk type HPV DNA test was very useful in population with high risk of cervical cancer.