Objective To evaluate the value of high-risk human papillomavirus(HR-HPV) DNA detection for cervical precancerous lesions screening in Nanjing.Methods A total of 10 221 cervical samples were performed using multiplex polymerase chain reaction for HR-HPV detection(12 HR types and individual HPV-16/HPV-18 types) and parallel Thinprepcytologic test(TCT),and meanwhile,187 colposcopic biopsy were also performed.Results HR-HPV positive rate in 10 221 samples was 10.15%(1037/10 221),of which HPV 12 types(unspecified) was the most common infective type with the rate of 7.86%.Stratified by age,HR-HPV positive rate in those <45 years old was much lower than those≥45 years old with statistic significance(P=0.020).The detected rate of high-grade cervical intraepithelial neoplasia(CIN) showed tendency to ascend after 45 years old compared with those before 45 years old(P=0.006).TCT showed that HR-HPV positive rate was 54.22%(199/367)in abnormal cytology group,higher than 8.50%(838/9854)in normal cytology and chronic inflammation group(P=0.000).Compared with 12 HR types,HPV-16/-18 types showed even more closer with the ascend of cytological lesion(P=0.0000).Moreover,a significant correlation was observed between 16 type and the ascending grade of CIN(P=0.003).Conclusion HR-HPV based screening should be moved forward to 25 years.Moreover,as a high-risk population,women older than 45 years should be closely followed.HPV-16 infection plays an important role in inducing higher grade of cytological lesions which then progress to cervical precancerous lesions.HR-HPV DNA detection can be an alternative screening method to increase the coverage of cervical precancerous lesions screening.%目的 探讨南京地区高危型人乳头瘤病毒(HR-HPV) DNA检测用于宫颈癌前病变筛查的效果.方法 收集南京地区10 221例女性体检的宫颈脱落细胞标本,运用多重荧光PCR技术进行HR-HPV DNA检测(包括12种不分型、HPV-16、HPV-18),并结合同时送检的薄层液基细胞学(TCT)和187例阴道镜宫颈活检病理结果进行比较分析.结果 10 221例受检标本检出HR-HPV感染1037例(10.15%);HPV不分型12种为最常见感染型别,占7.86%.<45岁与≥45岁人群比较,HR-HPV感染率显著降低,差异有统计学意义(P=0.020);随着年龄增加,HR-HPV 感染者中发生高度宫颈上皮内瘤变(CIN)的比例增加,≥45岁与<45岁患者比较,差异有统计学意义(P=0.006).TCT检测显示,细胞学异常组的HR-HPV感染率为54.22%(199/367),显著高于细胞学正常或慢性炎症组的8.50%(838/9854),差异有统计学意义(P=0.000).相比HPV不分型12种,16型和18型与细胞病变级别增加的关系更加密切(P=0.0000);随着病变病理级别增高,16型阳性率增高,即16型感染与CIN级别增加有关(P=0.003).结论 HR-HPV筛查可以考虑提前至25岁,且45岁以上女性作为HR-HPV高发人群应密切随访;HPV-16感染在诱发细胞高度病变进而进展为宫颈癌前病变中起重要作用;HR-HPV DNA检测可作为有效的初筛工具应用于宫颈癌前病变高风险人群的风险分层管理中.
展开▼
