HPV L1壳蛋白检测联合细胞学筛查宫颈变病的临床价值

目的 探讨HPV L1壳蛋白检测联合细胞学在宫颈病变筛查中的临床应用价值.方法 随机收集2014年11月至2016年11月期间温州市中心医院妇科收治的宫颈病变患者的宫颈脱落细胞学标本共420例,采用液基细胞学(TCT)检查宫颈细胞学改变,采用免疫细胞化学法检测HPV L1壳蛋白的表达情况,同时以宫颈活组织病理检查结果作为金标准进行对比研究.结果 420例检测标本中,单纯TCT结果阳性10例(2.38％),单纯HPV L1壳蛋白表达阳性的15例(3.57％);二者检测结果均为阳性的6例(1.43％).对TCT或HPV L1壳蛋白检测为阳性的患者及160例二者检测均为阴性的患者做宫颈活组织病理学检查,并以此检查结果作为标准得出:TCT检查的敏感度为38.89％ (7/18),特异度为97.95％ (143/146);HPV L1壳蛋白检测的敏感度为55.56％ (10/18),特异度为96.58％(141/146);二者联合检测的敏感度为94.44％ (17/18),差异具有统计学意义(P＜0.05);特异度为94.52％ (138/146),差异均无统计学意义(P＞0.05).结论 HPV L1壳蛋白检测联合细胞学能够兼备二者的优势,互补不足,在宫颈病变的临床筛查中具有较高的敏感度和特异度,能够提高宫颈病变诊断的准确率,值得临床推广与应用.

Clinical value of HPV L1 capsid protein detection combined with cytology in screening of cervical lesions

Objective To investigate the clinical value of HPV L1 capsid protein detection combined with cytology in the screening of cervical lesions.Methods Totally 420 cervical exfoliative cytology specimens were collected from November 2014 to November 2016 in Wenzhou Central Hospital.Cytology and expression of HPV L1 capsid protein in these specimens were detected by liquid based cytology test (TCT) and immunocytochemistry,respectively.Furthermore,these results were compared with cervical biopsy which was considered as golden standard.Results In these 420 cases,10 cases (2.38％) were positive for TCT alone,15 cases (3.57％) were positive in HPV L1 capsid protein detection alone.Among them,6 cases (1.43％) were both positive in TCT and HPV L1 capsid protein.Cervical biopsy was performed in patients with positive TCT or HPV L1 capsid protein and 160 patients with both negative detection,and result of biopsy was taken as standard.The sensitivity of TCT was 38.89％ (7/18) and the specificity was 97.95％ (143/146).The sensitivity of HPV L1 protein was 55.56％ (10/18) and the specificity was 96.58％ (141/146).The sensitivity of combined detection of two methods was 94.44％ (17/18),which showed significant difference (P ＜ 0.05),while the specificity was 94.52％ (138/146),which was not statistically different (P ＞ 0.05).Conclusion In the clinical screening of cervical lesions,HPV L1 capsid protein combined with TCT,which showing higher sensitivity and specificity can combine the advantages of these two methods,and complement the insufficiency of each other.They can improve the diagnosis accuracy of cervical lesions,which is worthy of clinical application.