HPV DNA和TCT在宫颈病变中的应用价值

Application value of human papillomavirus DNA detection and ThinPrep liquidbased cytology testing in cervical lesions

摘要:

目的评价高危型人乳头瘤病毒(HPV DNA）与液基细胞学检测（TCT）在宫颈疾病筛查中的应用价值。方法收集2012年10月—2013年12月某院妇科宫颈病变就诊患者的标本进行HPV DNA分型和TCT检测, 阳性者进行阴道镜病理学检测，比较各TCT组、不同病变类型患者HPV DNA阳性率,比较TCT和HPV DNA检测的灵敏度和特异性，二者单独与联合检测的差异。结果HPV DNA阳性率为28.07%（1 045/3 723）,以高危型(HR)-HPV为主,阳性率为21.57％(803例)，最常见的HRHPV DNA基因型为HPV16、58、52、18型。各年龄组HR-HPV阳性率比较,差异有统计学意义（χ2=31.74，P＜0.001），其中20～30岁年龄组阳性率最高。TCT阳性率为13.46﹪（501例），共971例患者进行病理检测，293例病理诊断阳性。按TCT和不同病变类型分组，将HRHPV DNA阳性率进行趋势χ2检验,结果均显示随病变程度增加,HRHPV阳性率呈增高趋势（均P＜0.01）。 以病理诊断作为金标准，HRHPV DNA和TCT灵敏度分别为90.44％(265/293)、85.32％（250/293），两者联合检测灵敏度为95.90％。病理阳性者中，TCT和HPV DNA检出率分别为85.32%、90.44%，联合检测检出率为95.90%，3组比较，差异有统计学意义（χ2=18.185，P＜0.001）。其中联合检测检出率高于单独使用TCT、HPV DNA。 结论HPV DNA检测对宫颈癌筛查是一个有益的补充, HPV DNA联合TCT检测可以最大限度地降低漏诊率。

关键词:

人乳头瘤病毒; 宫颈癌; 液基细胞学检测; 上皮细胞内瘤变; 诊断; 病理学

Abstract:

ObjectiveTo evaluate the application value of  highrisk  human papillomavirus (HRHPV) DNA detection and ThinPrep liquidbased cytology testing（TCT）in cervical disease screening.  MethodsCervical specimens of women with cervical lesions in a hospital between October 2012 and December 2013 were taken and performed human papillomavirus DNA genotyping (HPV DNA) and ThinPrep liquidbased cytology testing(TCT). Positive patients were performed colposcopy pathological detection. HPV DNA positive rates among different TCT groups, and different cervical lesion groups were compared, the sensitivity and specificity of TCT and HPV DNA detection, as well as differences between  separate  and joint detection were also compared. ResultsThe positive rate of HPV DNA was 28.07% (1 045/3 723), most were HRHPV (21.57%, n=803), the major HRHPV genotypes were HPV 16,58,52,and 18 type. HRHPV positive rates were statistically different among different age groups（χ2=31.74，P＜0.001） , positive rate was highest in 20-30 year old age group . Positive rate of TCT was 13.46% (n=501), a total of 971 patients were performed pathological detection, 293 were positive. Patients were divided according to different TCT and different lesion type, χ2 testing of HRHPV DNA positive rate showed that positive rate of HRHPV had a increasing tendency with the increase in severity of diseases(all P<0.01). Pathological detection was as a gold standard , the sensitivity of HRHPV DNA and TCT  was 90.44％(265/293) and 85.32％(250/293)  respectively, the sensitivity of joint HRHPV DNA detection and TCT  was 95.90％. In positive pathological group, the detection rate of TCT and HRHPV DNA was 85.32％ and 90.44%, respectively, joint detection rate was 95.90％, the difference among three groups was significant (χ2=18.185，P<0.001）. Joint detection rate was higher than separate detection rate of TCT or HPV DNA. ConclusionHPV DNA detection is a useful supplement for cervical cancer screening, HPV DNA detection combined with TCT can reduce the misdiagnosis rate.

Key words:

human papillomavirus;cervical cancer; ThinPrep liquidbased cytology testing;cervical intraepithelial neoplasia; diagnosis; pathology