TCT联合高危型HPV基因检测在绝经后妇女宫颈上皮内瘤变筛查的价值评估

目的:评价宫颈薄层液基细胞检测(TCT)联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变(CIN)筛查的价值。方法:选取TCT检查结果异常,包括意义不明不典型鳞状细胞(ASCUS)、低度鳞状上皮内瘤变(LSIL)、高度鳞状上皮内瘤变(HSIL)和鳞状上皮癌(SCC)的163例绝经后妇女为研究对象,荧光定量PCR(FQ-PCR)法检测高危型人乳头状瘤病毒(HR-HPV16、18、31、33、45、52、56、58)分型,并以阴道镜下宫颈活检病理学诊断作为诊断金标准进行对比研究。结果:①不同年龄段绝经妇女TCT结果异常的类型构成比,差异无统计学意义(P>0.05)。②HPV分型检测阳性者80例,感染率49.1%,随着TCT检查宫颈病变级别的升高,HR-HPV感染率亦逐步增加,与低级别比,差异有统计学意义(P<0.05)。③163例TCT异常患者中,病理学诊断阳性51例(CINⅠ级24,CINⅡ级9例,CINⅢ级6例,宫颈浸润癌12例),阳性率31.3%(51/163)。随着TCT检查宫颈癌变级别的增高,宫颈组织病理学诊断阳性率逐步增加,差异有统计学意义(P<0.01)。④宫颈炎组中HR-HPV阳性40例,感染率35.71%,宫颈CIN阳性组中HR-HPV阳性29例,感染率74.4%(其中CIN I级70.8%,CIN II级77.8%,CIN III级83.3%),宫颈浸润癌组中HR-HPV阳性11例,感染率91.7%,随着宫颈病变病理级别的升高,HR-HPV感染率呈上升趋势(P<0.01)。⑤TCT联合HPV检测、单独HPV检测对CIN及宫颈癌筛查的敏感度均高于TCT检查,分别为96.1%、78.4%、66.7%(P<0.01)。TCT联合HPV分型检测、单独HPV检测对CIN及宫颈癌筛查的假阴性率低于TCT检测,有显著性统计学差异(P<0.01)。3种筛查方法的特异度、假阳性率比较,无统计学差异(P>0.05)。结论:TCT联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变筛查中具有重要意义。

Application of TCT Co-test High-risk Type HPV Genetic Testing in Cervical Cancer Screening of Postmenopausal Women

Objective: To evaluate the sensitivity and specificity of thinprep cytologic test(TCT) co-test high-risk type HPV(HR-HPV) genotyped detection in cervical intraepithelial neoplasia of postmenopausal women.Methods: A total of 163 post-menopausal women with abnormal results of TCT were collected.High-risk type human papilloma virus(HPV16,18,31,33,45,52,56,58) were detected in all the women by fluorescence quantitative polymerase chain reaction(FQ-PCR),based on the pathological diagnosis by cervical biopsy under vaginoscope.Results: 1) There was no statistically significant difference among 163 cases of different age stages(48-49,50-59,60-69,70-78 years old)(P>0.05).2) The total infection rate of HR-HPV in post-menopausal women with cervical lesions was 49.1%(80/163),and with the increase of TCT check level,the infection rate of HR-HPV increased gradually,the difference was statistically significant(c2=24.26,P<0.005).3) Among 163 cases with pathological,51 cases(31.3%) were positive,with the increase of TCT check level,the proportions of positive cases were gradually increased,the difference was statistically significant(c2=39.6,P<0.005).4) In cervicitis group,40 cases were HR-HPV positive,infection rate was 35.71%,29 patients in cervical CIN group were HR-HPV positive,infection rate was 74.4%,11 cases in cervical cancer group invaded the embellish HR-HPV positive,infection rate was 91.7%.With the cervical lesions degree of aggravating,HR-HPV infection rates had an increased trend.the difference was statistically significant(c2=26.41,P<0.005).5) The sensitivity of TCT joint HPV detection of cervical cancer screening was higher than HPV or TCT check alone(96.1%,78.4%,66.7%),the difference was statistically significant(P<0.01).The false negative rate of TCT joint HPV detection and HPVdetection alone of cervical cancer screening was lower than TCT check alone,the difference was statistically significant(P<0.01).There was no statistically significant difference of specificity and false positives among TCT and Hr-HPV and co-test of them.Conclusion: The co-test method was important in cervical cancer screening of post-menopausal women.