高危型人乳头瘤病毒检测在子宫颈细胞学异常者中的应用价值

目的了解子宫颈细胞学异常者中高危型人乳头瘤病毒(HPV)的感染状况,评估高危型HPV检测对细胞学异常者子宫颈高度病变的筛查效力。方法采用第二代杂交捕获实验(hc2)检测949例子宫颈超柏氏薄层液基细胞学(LCT)异常者2001年伯塞斯达系统诊断≥未明确诊断意义的不典型鳞状细胞(ASC-US)]的高危型HPV感染状况,所有患者均同时进行组织病理学检查。结果在949例LCT异常者中,不典型鳞状上皮细胞(ASC)者432例,鳞状上皮内低度病变(LSIL)者310例,鳞状上皮内高度病变(HSIL)者207例,其高危型HPV感染阳性率分别为40.3%、44.8%和89.4%;病理学诊断无上皮内病变或恶性病变(NILM)者335例,子宫颈上皮内瘤变1、2、3级(CIN1、CIN2、CIN3)者分别为388、118和101例,子宫颈鳞状细胞癌(SCC)者7例,其高危型HPV感染阳性率分别为17.3%、66.2%、92.4%、97.0%和100%;在ASC-US组中,子宫颈高度病变在高危型HPV阳性组和阴性组的发生率分别为10.2%和0.8%,差异有显著性(P<0.01);在对子宫颈高度病变的筛查中,细胞学≥不能除外HSIL的ASC(ASC-H)]和细胞学(≥ASC-H)联合高危型HPV检测的敏感性分别为0.925和0.991,特异性分别为0.510和0.748,两组相比差异有显著性(P<0.01);细胞学(≥LSIL)和细胞学(≥LSIL)联合高危型HPV检测的敏感性分别为0.898和0.982,特异性分别为0.567和0.779,差异有显著性(P<0.01)。结论随着子宫颈病变级别及组织病理学级别的升高,高危型HPV感染的阳性率呈上升趋势,对子宫颈细胞学异常者进行高危型HPV检测可提高筛查子宫颈高度病变的效力。

Application of high-risk human papillomavirus testing in women with abnormal cytology

OBJECTIVE: To detect the high-risk human papillomavirus (HPV) infectious condition in women with abnormal cytology and evaluate its values in the screening of high grade squamous intraepithelial lesion. METHODS: We used hybrid capture 2 (hc2) method to examine 949 patients with abnormal cervical cytology results > or =atypical squamous cells of undetermined significance (ASC-US) according to the 2001 The Bethesda System diagnosis criteria]. All subjects also received colposcopy for tissue studies. RESULTS: Among 949 patients with abnormal cytology, the diagnoses of atypical squamous cells (ASC), low grade squamous intraepithelial lesion (LSIL), and high grade squamous intraepithelial lesion (HSIL) were made in 432, 310, and 207 patients, respectively. The high-risk HPV positive rate in ASC, LSIL, and HSIL were 40.3%, 44.8%, and 89.4%, respectively. The numbers of patients with pathologically confirmed results of negative intraepithelial lesion or malignancy (NILM), cervical intraepithelial neoplasia 1, 2, 3 (CIN 1, 2, 3), and squamous cell carcinoma (SCC) were 335, 388, 118, 101, and 7, and the high-risk HPV positive rate was 17.3%, 66.2%, 92.4%, 97.0%, and 100%, respectively. Among patients with atypical squamous cells of undetermined significance (ASC-US), rate of HSIL in high-risk HPV positive group and negative group were 10.2% and 0.8%, respectively (P < 0.01). In screening HSIL, the sensitivities of cytology > or = ASC cannot exclude HSIL (ASC-H)] and cytology ( > or = ASC-H) plus high-risk HPV testing were 0.925 and 0.991, and the specificities were 0.510 and 0.748, respectively (P < 0.01). Sensitivitives of cytology ( > or = LSIL) and cytology (> or = LSIL) plus high risk HPV in detecting HSIL were 0.898 and 0.982, respectively, while the specificitives were 0. 567 and 0.779, respectively (P < 0.01). CONCLUSIONS: The positive rate of high-risk HPV increases with the gravity of cervical lesions. In patients with abnormal cervical cytology, high-risk HPV testing can improve the sensitivity and specificity in the screening of HSIL.