HPV、TCT检查联合阴道镜下活检筛查宫颈病变

目的探讨液基细胞学检查（Thinprep cytologic test，TCT）、高危型人乳头状瘤病毒（Human papilloma virus，HPV）检测及阴道镜检查用于宫颈癌筛查的临床价值。方法对1680例已婚妇女进行TCT、HPV-DNA检测，TCT检测未能明确意义的不典型鳞状细胞（ASC-US）以上、HPV-DNA检测阳性者共386例进行阴道镜下宫颈多点活组织检查。结果1680例患者中，TCT检查阳性86例，阳性率5．12％；HPV-DNA检测阳性386例，阳性检出率22．98％；HPV-DNA检测阳性检出率高于TCT（P〈0．01）。TCT检查阳性后于联合阴道镜下宫颈多点活组织检查86例，诊断慢性宫颈炎58例、轻度宫颈上皮瘤病变（CINI）7例、中度宫颈上皮瘤病变（CINⅡ）8例、重度宫颈上皮瘤病变（CINⅢ）10例、鳞状细胞癌（SCC）3例。HPV-DNA检查阳性后于联合阴道镜下宫颈多点活组织检查386例，诊断慢性宫颈炎322例、CINⅠ28例、CINⅡ18例、CINⅢ14例、SCC4例。结论TCT、高危型HPV-DNA检测联合阴道镜可明显提高CIN阳性检出率，是进行宫颈病变筛查的最佳方法，只有三者联合应用，才能早期发现宫颈癌前病变，阻断宫颈癌的发生。

Cervical Lesions Screened via HPV and TCT Combined with Biopsy under Colposcope

Objective To explore the clinical value of TCT, high- risk HPV detection and colpo scope examination in screening cervical lesions. Methods One thousand, six hundred and eighty married women received TCT and HPV - DNA detection. Of them ,386 cases had non - definite significance of atypi cal squamous cells（ ASC -US）in TCT detection and positive result of HPV - DNA;and they received cervi cal multiple biopsy under eolposcope additionally. Results Of 1680 cases, 86 cases had positive results in TCT detection,the positive rate was 5.12% ;386 cases had positive results in HPV- DNA detection and the positive rate was 22.98%. The positive detective rate in HPV - DNA was higher than that in TCT（ P 〈 0. 01）. Of 86 cases of positive results in TCT, receiving cervical multiple biopsy under colposcope,58 cases were diagnosed as chronic eervicitis ,7 eases as mild cervical epithelial neoplasia（ CIN Ⅰ ） ,8 cases as moder ate cervical epithelial neoplasia（ CIN Ⅱ ） , 10 cases as severe cervical epithelial neoplasia（ CNⅢ ） and 3 cases as squamous cell carcinoma（SCC）. Of 386 cases of positive results in HPV - DNA examination, after com bined with cervical multiple biopsy under colposcope,322 cases were diagnosed as chronic eervicitis ,28 cases as CIN Ⅰ , 18 cases as CIN Ⅱ , 14 cases as CIN Ⅲ and 4 cases as SCC. Conclusion TCT and high - risk HPV- DNA detection combined with colposcope examination improve obviously CIN positive detective rate. The combined method of 3 - in - 1 is the best one for the screening of cervical lesions. It detects early CIN and blocks the occurrence of cervical carcinoma.