阴道镜检查在HIV感染妇女宫颈高级别病变筛查中的应用价值

目的 比较TCT、HC2-HR-HPV检测及初次阴道镜检查3种筛查方法对HIV感染妇女宫颈高级别病变的筛查效果, 评价阴道镜检查在HIV感染妇女宫颈高级别病变筛查中的应用价值.方法 591例HIV感染妇女均行TCT、HC2-HR-HPV检测及初次阴道镜检查, 对初次阴道镜检查异常患者进行定位活检.对初次阴道镜检查阴性及阴道镜检查不满意者待其TCT及HC2-HR-HPV检测结果回报, 如TCT结果为ACS-H、LSIL、HSIL或TCT为ASC-US合并HR-HPV感染, 再次行阴道镜检查, 对可疑患者进行宫颈多点活检及宫颈管搔刮术.以最终病检结果为金标准, 比较TCT、HC2-HR-HPV检测及初次阴道镜检查对HIV感染妇女宫颈高级别病变 (≥CINⅡ) 的筛查效果.结果 591例HIV感染妇女中HR-HPV感染210例 (35.53%) , CINⅠ62例 (10.49%) , ≥CINⅡ46例 (7.78%) ;初次阴道镜检查对HIV感染妇女宫颈高级别病变筛查的特异度及阳性预测值明显高于TCT、HC2-HR-HPV检测 (P<0.05) ;初次阴道镜检查的漏检率与HC2-HR-HPV检测相似, 明显低于TCT (P<0.05) ;初次阴道镜检查的ROC曲线下面积与TCT相似, 明显大于HC2-HR-HPV检测 (P<0.05) .结论 HIV感染妇女HR-HPV感染率及宫颈高级别病变发生率较高;阴道镜检查特异度高、漏诊率低, 并且具有经济、快速、即诊即治等优点, 对HIV感染妇女进行宫颈高级别病变筛查具有较高的临床应用价值.

Value of Colposcopy in the Screening of High-grade Cervical Lesions in the Women with HIV Infection

Objective To compare the screening effects of TCT, HC2-HR-HPV and colposcopy and to evaluate the value of colposcopy in the screening of high-grade cervical lesions in the women with HIV infection.Me thods A total of 591 HIV-infected women underwent TCT, HC2-HR-HPV testing and colposcopy procedure.Localized biopsy was performed on the patients with positive results in colposcopy.The patients with negative results for the first colposcopy and unsatisfied with colposcopy would undergo colposcopy again only when TCT showed ACS-H, LSIL, HSIL or TCT showed ASC-US with HR-HPV infection, and multiple punch point biopsy and endocervical curettage (ECC) were performed. Results of TCT, HC2-HR-HPV test and the first colposcopy in the diagnosis of high-grade cervical lesions (≥CINII) were compared.Re s ults In the 591 HIV-infected women, 210 patients (35.53%) had HR-HPV infection, 62 patients (10.49%) had CINI, and 46 patients (7.78%) had CINII. The sensitivity, specificity and positive predictive value in the first colposcopy were significantly better than those in TCT and HC2-HR-HPV testing (P<0.05) . Missing rates in the first colposcopy and HC2-HR-HPV testing were similar but were significantly lower than that in TCT testing (P<0.05) . Areas under the ROC curve in the first colposcopy and TCT testing but were significantly larger than that in HC2-HR-HPV testing (P <0.05) .Conclus ions The infection rate of HR-HPV and the incidence of high-grade cervical lesions in HIV-infected women are high. Colposcopy is high in specificity, low in missing rate and with the advantages of low charge, time-saving and immediate diagnosis and treatment, which provides high clinical value in the detection and screening of high-grade cervical lesions in HIV-infected women.