人乳头状瘤病毒DNA检测在宫颈病变筛查中的应用研究

目的：探讨高危型人乳头状瘤病毒（HR-HPV）DNA检测方法在宫颈病变筛查中的应用意义。方法：580例妇女同时进行薄层液基细胞学（TCT）、第2代杂交捕获法（HC Ⅱ）和阴道镜下宫颈组织活检,并以病理组织学检查结果作为确诊标准进行对比分析。结果：①580例受检者中病理诊断为炎症207例（35.69%）,CIN Ⅰ 224例（38.62%）,CIN Ⅱ 96例（16.55%）,CIN Ⅲ 38例（6.55%）,浸润癌15例（2.58%）;②TCT检测异常者中炎症52例（25.12%）,CIN Ⅰ 177例（79.02%）,CIN Ⅱ 85例（88.54%）,CIN Ⅲ36例（94.74%）,浸润癌15例（100%）,其中CIN Ⅱ和CIN Ⅲ组间差异无统计学意义（P〉0.05）,但显著高于炎症组和CIN Ⅰ组,低于湿润癌组（P〈0.01或0.05）;③HPV DNA检测阳性者中炎症66例（31.88%）,CIN Ⅰ 152例（67.86%）,CIN Ⅱ 83例（86.46%）,CINIII 35例（92.11%）,浸润癌组15例（100%）,除CIN Ⅱ和CIN Ⅲ组间差异无显著性外（P〉0.05）,其余各组间差异均有统计学意义（P〈0.05或0.01）,且HPV-DNA检测阳性组CIN和浸润癌发病率明显高于阴性组（P〈0.01）;④30岁以下高危险型HPV感染率（65.53%）显著高于30岁以上34.47%感染率（P〈0.01）;⑤联合应用TCT、HPV-DNA检测诊断宫颈癌及癌前病变的敏感度和特异度分别为96.14%和69.28%,高于TCT或HPV-DNA的单独检测。结论：宫颈高危险型HPV感染是CIN及宫颈癌的主要发病因素,并与病变严重程度密切相关,而HPV-DNA和TCT联合应用可提高宫颈癌及癌前病变的检出率。

Application of DNA Test of Human Papilloma Virusin in Cervical Lesion Screening

Objective：To evaluate the application of human papillomavirus（HPV） test in screening cervical epithelial lesions.Methods：580 cases were tested by thinprep cytology test（TCT）,hybrid capture（HC-Ⅱ） and histopathology,then comparative analysis was performed by using the results of pathologic examination as diagnosis criteria.Results：①By pathological examination,207（35.69%）,224（38.62%）,96（16.55%）,38（6.55%）and 15（2.58%）women were diagnosed as inflammation,CIN Ⅰ,CIN I,CIN Ⅲ and cervical cancer,respectively.② Among cases with abnormal cytology,52（25.12%）were inflammation,177（79.02%）CIN I,85（88.54%）CIN Ⅱ,36（94.74%）CIN Ⅲ,and 15（100%）cervical cancer,and there was a significant difference within groups（P0.05）.③ Among the HPV DNA positive cases,66（31.88%）were inflammation,152（67.86%）CIN I,83（86.46%）CIN Ⅱ,35（92.11%）CIN III,and 15（100%）cervical cancer,and significant difference were found among the groups（P0.05 or 0.01）,but not between CIN Ⅱ and CIN III（P0.05）.Notably,the incidence of CIN and cervical cancer in HPV positive group were higher than HPV negative group（P0.01）.④HPV detection rates in ≥30 years group was 65.53%,significantly higher than 34.47% in 30 years group（P0.01）.⑤The combination of TCT and HPV-DNA test had better sensitivity（96.14%） and specificity（69.28%） than used alone.Conclusion：HPV infection is the main risk factor for CIN and cervical carcinoma,and plays an important role in the pathogenesis.The combination of HPV-DNA and TCT could improve detection rate of preinvasive and invasive cervical carcinoma.