液基细胞学检查和高危性人类乳头状瘤病毒DNA检测对宫颈病变的诊断价值

摘要

Objective To explore the value of thinprep cytology test(TCT)and high-risk human papilloma virus(HPV) detection in the diagnosis of cervical lesions.Methods All 923 patients were selected with cervical cancer screening for the first time,to determine TCT and HPV detection value of early diagnosis of cervical lesions by taking positioning cervical biopsy under colposcope and high-risk HPV DNA examination and TCT,etc.Results The positive patients with TCT detection accounts for 13.0%,and there were 435 pa-tients show one or more HPV infections in the HPV-DNA examination.The positive rate of HPV was 47.1%.There were 139patients with CIN I and above lesions in pathological diagnosis.The TCT and HPV-DNA detection of squamous cell carcinoma of the positive the rate is 100%,and the combined detection of HPV-DNA and TCT detection in patients with CIN III and above got the high-est detection rate.The sensitivity of combined detection is higher than single detection.All 139 patients,except 1 patient with CIN I, showed positive results.However,with single TCT detection missed diagnosis rate 28.06% (39/139)and single HPV-DNA detection missed diagnosis rate 12.95% (18/139).The single TCT detection and single detection of HPV-DNA detection rate were significantly lower than that of combination detection (χ2 =71.283,P=0.000;χ2 =40.394,P=0.004).The single detection HPV-DNA detection ratewassignificantlyhigherthanthatofsingledetectionofTCT(χ2=7.922,P=0.005).Conclusion ThedetectionofTCTand HPV in the early diagnosis of cervical lesions has high clinical value.The combined detection can effectively reduce the rate of clinical misdiagnosis and improve the detection rate of cervical precancerous lesions.%目的 探讨高危性人类乳头状瘤病毒(HPV)DNA检测和液基细胞学检查(TCT)对宫颈病变的诊断价值.方法 选取923例初次接受宫颈癌筛查的病人,对病人进行阴道镜下定位宫颈活组织检查和TCT及HPV-DNA检测.结果 TCT检测中出现阳性结果病人比例占13.0%,而HPV-DNA检查中出现1种或多种HPV感染的病人有435例,其HPV阳性率为47.1%.在组织病理学诊断中有139例病人出现CINⅠ级及以上病变,其中TCT和HPV-DNA检测对鳞状细胞癌的阳性检出率均为100%,且HPV-DNA检测和TCT联合检测对CINⅢ及以上的病人检出率最高.联合检测的灵敏度比单一检测更高,所有139例病人除1例CIN I病人外均有一指标出现阳性结果,而单一TCT检测的漏诊率为28.06%(39/139),单一HPV-DNA检测的漏诊率为12.95%(18/139).单一TCT检测与单一HPV-DNA检测的检出率均明显低于联合检测(χ2=71.283,P=0.000;χ2=40.394,P=0.004);单一HPV-DNA检测的检出率则显著高于单一TCT检测(χ2=7.922,P=0.005).结论 TCT及HPV检测对宫颈病变的早期诊断均具有较高的临床价值,两者联合检测能够有效降低临床漏诊率以及更好地提高宫颈癌前病变的检出率.