宫颈细胞学筛查阴性患者中高危型HPV－DNA 负荷量价值分析

摘要

目的：探讨高危型 HPV 负荷量对宫颈液基细胞学阴性妇女的宫颈上皮内瘤变（ cervical intraepithelial neoplasias，CIN）的诊断价值。方法收集宫颈液基细胞学联合 HC2法检测高危型 HPV－DNA 进行宫颈癌筛查中的细胞学阴性而 HR－HPV 阳性患者526例，并行阴道镜下宫颈活检。分析 HR－HPV 负荷量与宫颈癌及 CIN 的关系。结果526例细胞学阴性、HR－HPV 阳性的患者中，CIN2＋以上病变者共77例，占14．6％。以20～29岁年龄妇女组为参照年龄，30～39、40～49、60～72岁组患 CIN2＋风险高（均 P ＜0．05），在30～39、40～49、50～59岁组中，随着宫颈病变程度加重，HR－HPV－DNA 负荷量随之增加（均 P ＜0．05）。结论30～49岁是 HR－HPV 感染所致宫颈上皮内瘤变的高发年龄；HR－HPV－DNA 负荷量与宫颈上皮内瘤变级别密切相关，HR－HPV－DNA 负荷量越高，患CIN2＋的危险度越高。%Objective To evaluate the role of high-risk human papillomavirus ( HR-HPV) in detecting cervical intraepithelial neoplasia in women tested as negative with liquid-based cytology.Method A total of 526 women with positive HPV DNA and negative cytology were chosen as the subjects.All cases underwent colposcopic indicated biopsy and pathological diagnosis.Analysis was conducted into the correlation of HR-HPV to cervical cancer and CIN.Findings Of the 526 subjects with positive HPV DNA and negative cytology, 77 (14.6%) were found to have cervical intraepithelial neoplasia of grade 2 or worse (CIN2 +) lesions.Compared with those in the age bracket of 20 ~29 years, the subjects in the age brackets of 30 ~39 years, 40 ~49years, and 60 ~72years had a higher proportion of patients with CIN2 +.The difference was significant (P <0.05).Cervical lesions increased as the HR-HPV-DNA level increased in the women of the age brackets of 30 ~39 years, 40 ~49 years and 50 ~59 years (Pall <0.05).Conclusion The women in the age bracket of 30 to 49 years have the highest risk of suffering cervical intraepithelial neoplasia induced by HR-HPV infection.HR-HPV-DNA level is closely associated with cervical intraepithelial neoplasia.