细胞DNA定量分析及高危型HPV-DNA检测在宫颈病变筛查中的应用

摘要

目的:分析细胞DNA定量和高危型人乳头状瘤病毒(human papillomavirus,HPV)DNA检测在宫颈病变筛查中的作用.方法:选取2015年5月至2016年9月间在江苏省中医院同时行DNA倍体分析及薄层液基细胞学检查(thin-cytologic test,TCT)的5 042例妇女,其中1 573例行HPV检测,146例行病理活检.结果:宫颈病变筛查病例中DNA倍体异常390例,阳性率7.74％,TCT异常病例408例,阳性率8.10％,两者相比差异无统计学意义(P＞0.05).其中＜3个细胞且2.5≤DI＜4.5者TCT阳性率为33.74％;≥3个细胞且2.5≤DI＜4.5者,TCT阳性率为94.74％;DI≥4.5者,其TCT阳性率为98.5％,差异具有统计学意义(P＜0.01).不能明确意义的非典型鳞状上皮细胞,低度鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)及高度鳞状上皮内病变(high-grade squamousintraepithelial lesion,HSIL)病例DNA倍体定量分析阳性率分别为45.42％,97.14％和100％,差异具有统计学意义(p＜0.01).高危型HPV总体感染率为24.5％,并且随着DI指数的升高,高危型HPV感染率也随之升高,具有统计学意义(P＜0.01),DNA倍体异常病例及DNA倍体异常且TCT异常病例高危型HPV感染率分别为56.8％和60.4％,差异无统计学意义(P＞0.05).DNA倍体异常病例阴道镜活检组织病理学阳性率为70.5％,TCT异常病例阳性率为65.9％,两者差异无统计学意义(P＞0.05),总体检出率为74.6％.结论:细胞DNA定量分析是一种有效的宫颈病变筛查方法.%Objective:To analysis the role of DNA quantitative cytology and high risk HPV-DNA testing in screening of cervical lesions.Methods:We analyzed the data of 5 024 patients who were detected both by DNA ploidy analysis and cervical liquid-based cytology from May 2015 to September 2016 in Jiangsu Province Traditional Chinese Medicine Hospital,among which 1 573 patients were detected by HPV.A total of 146 women were followed by colposcopic examination,where biopsies were taken.Results:Positive rate was 7.74％ in 390 patients with DNA ploidy abnormality and it was 8.1％ in 408 patients detected by TCT,there was no significant difference (P＞0.05).The TCT positive rate were 33.7％,94.7％ and 98.5％ when the 2.5 ≤ DI＜4.5 less than 3 cells,2.5 ≤ DI＜4.5 more than 3 cells,DI ≥ 4.5,respectively,and there was statistically significant difference (P＜0.01).The positive rates of DNA ploidy quantitative analysis of ASC-US,low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) were 45.4％,97.1％ and 100％,respectively.The difference was statistically significant (P＜0.01).The total high-risk HPV infection rate was 24.5％,and with the increase of DI index,the rate of high-risk HPV infection was increasing,with statistical significance (P＜0.01).Histologically positive rate of biopsy was 70.5％ with DNA ploidy while TCT was 65.9％,the difference was not statistically significant (P＞0.05),the total detection rate was 74.6％.Conclusion:DNA quantitative cytology is an effective method of cervical lesion screening.