HPV分型检测和TCT检查在宫颈病变筛查中的应用

目的：探讨人乳头瘤病毒（HPV）分型检测和液基细胞学（TCT）检查在筛查宫颈病变中的应用。方法：回顾性分析2012.9~2013.9在我院妇科门诊就诊,同时采用HPV分型和TCT检查的门诊妇女宫颈脱落细胞标本1128例,并最终进行组织病理学检查。结果：1128例标本中HPV阳性率为64.4%（726/1128），共检出21种亚型，高危亚型16种，低危亚型5种，高危型以16,58,52多见，构成比分别为25.0%，12.1%和10.2%。低危型以61,11型多见，构成比分别为3.4%和1.9%。其中单一感染555例，多重感染171例，最多为四重感染。TCT检查≥ASCUS为87.8%（990/1128），在ASCUS、LSIL、HSIL和SCC中HPV的检出率分别为60.3%、71.8%、80.3%和100%。HPV分型检测（H组）的阳性预测值为74.1%，阴性预测值为68.7%，TCT检查（T组）的阳性预测值和阴性预测值分别为63.2%（626/990）和72.5%（100/138），两者联合检测（H＋T组）阳性预测值和阴性预测值分别为75.5%（100/138）、100%（100/100）。H组和H＋T组的阳性预测值高于T组（X2值分别为22.690，28.822，P值均为0.000），H＋T组的阴性预测值高于H组和T组（X2值41.847,32.768，P值均为0.000）。结论： HPV分型检测是准确性高并能明确基因类型及多重感染的检测，联合TCT检查更能有效的筛查宫颈病变细胞，为临床防治宫颈癌及青岛地区HPV疫苗使用提供更可靠地科学依据。

Application of human papillomavirus genotyping detection and thinprep cytology test in screening of cervical lesions

Objective：To evaluate the role of human papillomavirus（HPV） genotyping detection and thinprep cytology test（TCT ）for screening cervical lesions.Methods：A retrospective analysis 1128 cases of cervical cytology specimens from September 2012 to September 2013 using HPV、TCT and cervical biopsy.Results： In 1128 cases of specimens, the positive rate for HPV infection was 64.4%（726/1128） and there were 21 kinds of genotypes, high-risk subtype 16 kinds, low-risk types 5 kinds. High-risk subtype infection were 16 （25.0%）, 58 （12.1%）, 52（10.2%） and low-risk subtype main was HPV 61（3.4%）, 11（1.9%）. Single subtype was detected in 555 cases,double or multiple 171 cases, and quadruple infection was also can be detected. TCT ≥ASC-US was 87.8%（990/1128）. In ASCUS, LSIL, HSIL and SCC, the detection rates of HPV infection were 60.3 %, 71.8%, 80.3%,100 % respectively. The positive predict value （PPV） of HPV genotype detection was 74.1% and negative predict value（NPV） was 68.7%. The PPV and NPV of TCT were 63.2% and 72.5%, and HPV joint TCT were 75.5% and 100%. The PPV of group H and group H＋T was higher than that of group T. The NPV of group H＋T were higher than that of group H and group T.Conclusions：The genotyping technology for detection HPV has very high accuracy, joint TCT screen diseased cells effectively in cervical lesions, and can provide more reliable scientific basis for the prevention and treatment of cervical cancer and for the use of HPV vaccine in Qingdao.