HPV 基因分型在宫颈癌筛查风险分层管理中的价值

摘要

Objective To evaluate the clinical value of high-risk HPV( HR-HPV) genotyping in risk stratification and management of cervical cancer screening.Methods Totally 9 331 women underwent routine cervical cancer screening at the first time of medical visit in gynecological clinic at Taizhou Hospital of Zhejiang Province.Cervical samples were collected by liquid-based method and analyzed for cytology and HPV genotyping ( Co-testing ) .The clinical value of HPV 16 and 18 genotyping in risk stratification and management of cervical cancer screening was evaluated.Results Patients were comprised of women aged 30 to 65 years with HPV-positive 21.6% ( HR-HPV infection accounting for 79.0%) , with abnormal cytology 5.0%( HR-HPV infection accounting for 56.2%) .The sensitivity of HR-HPV genotyping for CIN2+was significantly higher than that of cytology using a positive cut point of ASCUS(χ2 =42.36,P<0.05). Histopathological diagnosis of CIN2+which in 80 cases (13.5%) , including HR-HPV types were 74 cases (92.5%) and abnormal cervical cytology were 59 cases (73.8%) .The positive of HR-HPV infection was a significant factor associated with the development of CIN (χ2 =10.00,P <0.05).Conclusions The sensitivity of HR-HPV genotyping in cervical cancer screening was significantly higher than cytology as suspicious or mildly abnormal cytology results who were followed up diversion can be found cytology missed cervical tissue lesions, thereby reducing cancer precancerous lesions and cervical cancer incidence and mortality.%目的：研究高危HPV基因分型在宫颈癌筛查风险分层管理中的临床应用价值。方法浙江省台州地区9331例妇科初诊者的宫颈脱落细胞采用HPV基因分型和液基薄层细胞学（ TCT）检测，以宫颈组织病理学诊断结果为金标准，分析这两种宫颈癌筛查方案的阳性率及方法学敏感性，并结合高危HPV16、18检测在宫颈癌高风险者的风险分层管理中的应用。结果30～65岁女性中HPV总感染率21.6％[其中高危HPV（HR-HPV）感染占79.0％]，细胞学检查结果异常5.0％（HR-HPV感染占56.2％）。 HR-HPV检测比细胞学筛查对宫颈组织病理学异常者检出的敏感性显著上升（χ2＝42.36，P＜0.05）。组织病理学诊断为CIN2＋占13.5％（80／592），其中HR-HPV女性CIN2＋的发生率占92.5％（74／80）、宫颈细胞学异常女性CIN2＋的发生率占73.8％（59／80）。 HR-HPV阳性率随宫颈组织恶变进程的发展而显著升高（χ2＝10.00，P＜0.05）。结论 HR-HPV基因分型在宫颈癌筛查中的敏感性显著高于细胞学检查，可作为细胞学结果可疑或轻度异常者的随访分流，可发现细胞学漏诊的宫颈组织病变者，从而降低癌前病变及宫颈癌的发生率和死亡率。