高危型HPV检测及阴道镜检查在意义不明确的不典型鳞状细胞的诊断价值

目的：探讨对宫颈细胞学诊断为意义不明确的不典型鳞状细胞（ASCUS）病变的患者检测高危型人乳头瘤病毒（HR-HPV）及阴道镜活检的意义，并建立临床诊断路径。方法：诊断为ASCUS 320例患者分别进行HR-HPV检测及阴道镜检查，并研究ASCUS与年龄的关系。结果：在ASCUS患者中，主要分布在30～49岁年龄段（49.38%），320例ASCUS中组织病理学检查结果为：炎症73.13%（234/320）、湿疣5.32%（17/320）、宫颈上皮内瘤变（CIN，包括CINⅠ、CINⅡ、CINⅢ）20.61%（66/320）、高级别CIN（包括CINⅡ及CINⅢ）和浸润癌发生率为7.5%（24/320）。HR-HPV检测阳性者144例，阳性率为45%（144/320）。HR-HPV阳性组CIN的检出率为43.75%（63/144），HR-HPV阴性组CIN的检出率为3.41%（6/176），2组间比较差异有统计学意义（P＜0.001）。结论：ASCUS患者尤其是30～49岁年龄者，如HR-HPV阳性应行阴道镜检查明确诊断；HR-HPV阴性患者可不行阴道镜检查，但需定期检查宫颈薄层液基细胞学及人乳头瘤病毒。

Application of the High-risk HPV Testing and Colposcopy in Diagnosing Atypical Squamous Cells of Undetermined Significance

Objective： To evaluate the application value of HR-HPV and colposcopy in CIN and invasive cervical cancer diagnosis，when ASCUS was diagnosed by the cervical cytology，and to build the clinical diagnose pathway. Methods：320 patients who were diagnosed as ASCUS underwent the colposcopy and HR-HPV test. The relationship between ASCUS and patients' age was also analysed. Results：In ASCUS patients，49.38% patients were aged from 30 to 49 years. The histo-pathological results of 320 ASCUS were as follows：inflammation 73.13% （234/320），condyloma 5.32% （17/320），CIN （included CINⅠ，CINⅡ，CINⅢ） 20.61% （66/320），high grade CIN（included CINⅡ，CINⅢ） and invasive cancer 7.5%（24/320）. 144 patients were HR-HPV positive，and the positive rate was 45%（144/320）. In HR-HPV positive group，43.75% patients （63/144） were CIN. In HR-HPV negative group，only 3.41% patients（6/176）were CIN. Ｃｏｎｃｌｕｓｉｏｎs： Those ASCUS patients with HR-HPV positive，especially between 30-year to 49-year，should undergo colposcopy. Those patients with HR-HPV negative might not undergo colposcopy，but they should receive the TCT and HR-HPV test regularly.