高危型人乳头瘤病毒DNA检测在宫颈癌前病变筛查中的价值

目的评价高危型人乳头瘤病毒（HPV）DNA检测在宫颈癌筛查中的应用价值。方法2005—2007年期间,在连云港市第一人民医院进行健康检查的已婚妇女1240例（其中无临床症状1026例,有妇科症状214例）,门诊就诊宫颈异常者534例。进行宫颈癌前病变筛查,采用PCR荧光定量检测高危型HR-HPV.DNA,以病理组织学诊断结果为金标准,应用约登指数比较HPV.DNA和薄层液基细胞技术（LTCT）筛查效果。结果1774例受检者平均年龄（35±10.2）岁,经病理学诊断HPV感染51例（3.24%）,宫颈上皮内瘤变（CIN）Ⅰ级49例,Ⅱ级26例,Ⅲ级17例,浸润癌6例,内膜瘤2例,湿疣26例。以病理学确诊为金标准,HR-HPV.DNA检测CINⅡ、Ⅲ的敏感度95.35%,特异度91.67%,阳性预测值22.16%,阴性预测值99.87%,约登指数0.87;HR-HPV.DNA检测＋LTCT检测敏感度100.0%,特异度100.0%,阳性预测值100.0%,阴性预测值100%,约登指数1.0。HR-HPV.DNA在健康妇女和不同宫颈病变中的阳性率分别是正常（炎症）4.80%（78/1626）、不典型鳞状上皮细胞（ASCUS）50.67%（38/75）、低度鳞状上皮内病变（LSIL）94.44%（34/36）、高度鳞状上皮内病变（HSIL）100%（31/31）、鳞癌100（6/6）。结论HR-HPV.DNA检测在宫颈癌前病变和宫颈癌的筛查中具有敏感度高和阴性预测值高的特点,LTCT与HR-HPV.DNA联合检测可提高筛查的敏感度和阴性预测值。

Application Value of Detection of High Risk Human Papillomavirus DNA in Screening for Cervical Precancerous Lesions

[ Objective] To evaluate the application value of high risk human papillomavirus （ HPV ） DNA in sc.reening for cervical cancer. [ Methods] During 2005 - 2007, a total of 1240 married women who conducted health examination in Lianyungang First Peopleg Hospital { 1026 cases of non-clinical symptoms, 214 cases of gynecologic symptoms） and 534 cases of cervical abnormalities were screened cervical precancerous lesions by high risk HPV DNA test and liquid based Thinprep cytology test （LTCT） ; Youden index was adopted to conduct comparison between screening results of HPV · DNA and LTCT based on the histopathological diagnosis as the gold standard. [Results] Of 1774 patients, the average age was （35 ± 10.2） years,51 （3.24% ） were pathologically diagnosed HPV, 49 were cervical intraepithelial neoplasia（ CIN） level Ⅰ, 26 were level Ⅱ, 17 were level Ⅲ, 6 were invasive cervical cancer, 2 were endometrial cancer, 26 were condyloma. Based on histopathological diagnosis as gold standard, the sensitivity, specificity,positive predictive value, negative predictive value and Youden index of HR HPV · DNA test for detecting CIN Ⅱ ,Ⅲ were 95.35% ,91.67% ,22.16%, 99.87%, and 0.87 respectively; that of HR HPV · DNA test for detecting ＋ LTCT were 100.0%, 100.0%, 100%, and 1.0 respectively. The positive rates of HPV in healthy women and patients with cervical lesions were normal （ inflammation ） 4.80%, ASCUS 50.67% （ 38/75 ） , LSIL 94.44% （ 34/36 ） , HSIL 100% （ 31/31 ） , invasive carcinoma 100%. [ Conclusion] HR HPV · DNA test has high sensitivity and negative predictive value in detection of cervical precancerous lesions and cervical cancer screening . The combination of LTCT and HR-HPV · DNA test increases the sensitivity and negative predictive value of screening.