髙危型HPV检测在宫颈病变诊断中的价值

目的探讨高危型HPV检测在宫颈病变诊断中的价值。方法720例宫颈病变患者先进行HPV DNA的杂交捕获法二代（HPV—HCⅡ）和液基细胞学（TCT）的检测，其中224例因细胞学异常（意义未明的非典型鳞状细胞以及以上的病变）行阴道镜下活检。结果720例患者HPV阳性者264例（36．7％），阴性者456例（63．3％）。HPV阳性组患者年龄（37．77±8．48）岁，HPV阴性组年龄（39．25±8．83）岁，两组比较P〈0．05。224例细胞学异常患者HPV感染率分别为炎症和复鳞上皮乳头瘤样增生64．9％（61／94）、宫颈上皮内瘤变（CIN）Ⅰ82．8％（24／29）、CINⅡ89．7％（26／29）、CINⅢ93．5％（58／62）、浸润癌100％（10／10），随病理级别的升高HPV感染率显著升高（P〈0．05）。57例细胞学检测为ASC-US的患者中宫颈高度病变（≥CINⅡ）检出率为24．6％（14／57），HPV阳性组检出率为33．3％（12／36），阴性组为9．5％（2／21），两组比较，P〈0．05，阴性组无浸润癌和CINⅢ的检出。87例细胞学为LSIL的患者中宫颈高度病变检出率为34．5％（30／87），HPV阳性组检出率为39．5％（30／76），阴性组为0，两组比较P〈0．01，阴性组无高度病变的检出。结论高危型HPV检测可以明显提高宫颈高度病变在细胞学为ASC-US及LSIL中的检出率。

Value of high-risk HPV DNA testing in diagnosis of cervical lesions

Objective To investigate the significance of high-risk human papillomavirus （HR - HPV） DNA testing in diagnosis of cervical lesions. Methods A total of 720 cases had been detected by liquid-based cytology test and HR-HPV DNA testing with hybrid capture Ⅱ , in which 224 cases received cervical biopsy because of abnormal cytology （ ≥ ASCUS）. Results The overall prevalence of HPV infection was 36.7%. The age of 246 patients who were HPV positive was 37.77 ± 8.48, while 456 patients HPV negative was 39.25 ± 8.83, P 〈 0. 05. In the 224 cases （ ≥ASC-US） , the rates of HPV infection were 64.9% （61/94）in chronic cervicitis and tratified squamous epithelia papillomatous hyperplasia, 82. 8% （24/29） in CIN Ⅰ , 89.7% （ 26/29 ） in CIN Ⅱ ,93.5 % （ 58/62 ） in CIN Ⅲ and 100% （10/10） in invasive cervical cancer. The rate was increased with aggravation of cervical histology changes （ P 〈 0.05 ） . In 57 patients with abnormal cervical eytology of ASC-US ,the rate of high-grade cervical lesions was 24.6%, and it was higher in HPV positive group（33.3% ） than in HPV negative group （9.5 % ） , P 〈 0.05. Thero were no CIN Ⅲ and invasive cervical cancer in HPV negative group In 87 patients with abnormal cervical cytology of LSIL,the rate of high-grade cervical lesions was 34.5% , which was even higher in HPV positive group （39.5%）than in HPV negative group （0） ,P 〈 0.01. Conclusion High-risk HPV DNA testing can improve detection rate of high-grade cervical lesions in patients with cytology of ASC-US and LSIL and prevent misdiagnosis and improper therapy.