HPV16感染检测和TCT筛查联用的临床应用

目的评估人乳头瘤病毒(Human papillomavirus,HPV)16感染和液基薄层细胞学(thinprep cytologic test,TCT)筛查在预测宫颈病变中的临床价值。方法以门诊537例高危型HPV感染疑似宫颈病变女性为对象,进行HPV16感染分析、液基薄层细胞学和阴道镜病理检查,以病理活检为金标准,比较HPV16感染筛查方法、TCT筛查方法以及二者联用在筛查中的敏感度、特异度等指标,判断其临床应用价值。结果 HPV16感染筛查方法的敏感度为62.9%,特异度为83.5%,阳性预测值为53.4%,阴性预测值为88.2%;TCT筛查方法的敏感度为41.2%,特异度为92.7%,阳性预测值为62.9%,阴性预测值为84.0%;二者联合筛查,以HPV16感染或TCT异常为阳性,敏感度为84.7%,特异度为75.8%,阳性预测值为51.2%,阴性预测值为94.3%。结论 HPV16感染联合TCT异常筛查可以提高筛查的灵敏度,特异度也在可接受范围内,可以作为宫颈防癌初筛方法。

The clinical value of HPV16 and TCT in screening for cervical lesions

Abstract: Objective To access the clinical value of Thinprep Cytologic Test (TCT) and Human Papillomavirus 16 (HPV) detection in screening cervical lesions. Methods 537 women infected by HPV were included and divided into 3 groups: HPV16 positive group, TCT abnormal group or HPV16 positive and TCT normal or abnormal group. The three groups were compared in terms of cervical biopsy under colposcopy, the pathological results were considered as the gold standard. Results For HPV16 positive group, sensitivity was 62.9%, specificity was 83.5%, positive predictive value was 53.4%, negative predictive value was 88.2%; For TCT abnormal group, sensitivity was 41.2%, specificity was 92.7%, positive predictive value was 62.9%, negative predictive value was 84.0%; For HPV16 positive and TCT normal or abnormal group, sensitivity was 84.7%, specificity was 75.8%, positive predictive value was 51.2%, negative predictive value was 94.3%. Conclusions HPV16 positive test combined with TCT test is a better evidence for screening cervical precancerous and cervical cancer.