高危型HPV检测在宫颈上皮内瘤变及宫颈癌筛查中的价值

[目的]探讨第二代杂交捕获（HC-Ⅱ）检测高危型HPV病毒用于诊断宫颈上皮内瘤变（CIN）的临床价值.[方法]选择本院妇科2009年2月至2010年2月同时接受了HC-Ⅱ及TCT检测的500例住院患者,阳性者均进行病理检查.比较HC-Ⅱ及TCT检测阳性率及与病理检查结果的阳性符合率;分析病毒载量与不同程度宫颈病变关系.[结果]500例受检患者中, HC-Ⅱ检出高危型HPV感染阳性者169例（33.8%）,病理结果阳性符合率51.48%（87/169）.TCT检出阳性者共93例（18.6%）,病理结果阳性符合率75.26%（70/93）,两者检测阳性率及与病理检查结果的阳性符合率差异均具有统计学意义（P〈0.05）;高危型HPV阳性检出者中病毒载量以100～500 pg/mL等级人数最多, 占感染者29.59%;感染病毒载量在不同程度宫颈病变之间分布无明显差异（P〉0.05）.[结论]HC-Ⅱ具有较高的阳性预测值,但特异性较低,且病毒载量高低无法衡量宫颈病变程度,其作为宫颈病变初筛方法可以浓缩高风险病例,但有引起过度治疗和检查的风险.

Clinical Value of High-risk HPV Detection for Screening Cervical Intraepithelial Neoplasia and Cervical Cancer

[Objective] To explore the clinical value of hybrid capture 2（HC-Ⅱ ） in the detection of high- risk HPV for the diagnosis of cervical intraepithelial neoplasia（CIN） . [Methods] Totally 500 hospitalized patients who had received both HC-Ⅱ and thinprep cytologic test（TCT） were selected from Feb. 2009 to Feb. 2010. The positive patients were examined pathologically. The positive coincidence rate was compared between HC-Ⅱ and TCT. The relationship between virus load and different cervical lesions was analyzed. [Results] Among 500 cases, 169 cases（33.8%） were high-risk HPV infection detected by HC -Ⅱ. The positive coincidence rate of HC-Ⅱ was 51.48% （87/169）. TCT found that 93 eases（18.6%） were positive, and its positive coincidence rate was 75.26% （70/93）. There was statistical significance in the positive coincidence rate between HC-Ⅱand TCT（ P 〈0.05）. The virus load with 100-500 pg/mL was mostly seen in high-risk HPV- positive cases, and the cases with 100-500 pg/mL occupied 29.59% of infectious cases. There was no significant difference in the distribution of virus load in different degrees of cervical lesions（ P〉0.05）. [Conclusion] HC- Ⅱ has higher positive prediction value, but its specificity is lower. The virus load can not judge the degree of cervical lesion. HC-Ⅱ as the preliminary screening method can concentrate the high-risk patients, but it has the risk of excess treatment and examination.