阴道镜联合 HPV - DNA 检测对宫颈不典型鳞状细胞的诊断价值

摘要

目的：探讨阴道镜联合人乳头瘤状病毒-脱氧核糖核酸（human papilloma virus deoxyribo nucleic acid，HPV -DNA）检测对宫颈不典型鳞状细胞的诊断价值。方法：选取2012年3月至2015年3月进行治疗的宫颈不典型鳞状细胞患者130例为研究对象，所有患者均行阴道镜下多点活检及 HPV - DNA 检测。结果：130例宫颈不典型鳞状细胞患者中，病理检查诊断为炎症为87例（66.92%），宫颈上皮内瘤变（cervical intraepithelial neoplasia，CIN）Ⅰ14例（10.77%）， CINⅡ17例（13.08%）、CINⅢ8例（6.15%），鳞癌4例（3.08%）。HPV 阳性58例，阳性率为44.62%（58/130），HPV阴性72例，阳性率为55.38%（72/130）。HPV - DNA 阳性组中 CIN 的检查率高于阴性组，差异具有显著性（ P <0.05）。HPV 检测的敏感度为72.09%（31/43），阴性预测值为83.33%（60/72）。阴道镜对 CIN 诊断符合率为76.79%（43/56），诊断敏感度为74.42%（32/43），阴性预测值为85.14%（63/74）。结论：临床应用阴道镜联合 HPV - DNA检测对宫颈不典型鳞状细胞进行有效的筛查，对及早发现宫颈及癌前病变、降低宫颈癌的发生率和死亡率具有重要的作用，值得临床推广及应用。%Objective:o discuss the value of colposcopy combined with human papilloma virus deoxyribo - nucleic acid(HPV - DNA)test in diagnosis of cervical atypical squamous cells(ASC). Nethods:130 cases of patients with cervical atypical squamous cells(ASC)treated in our hospital from March 2012 to March 2013 were chosen to undergo multiple punch biopsy under colposcopy and HPV - DNA test. Results:In the 130 cervical ASC patients,the pathological diagnosis confirmed that there were 87 cases of inflammation(66. 92 % ),14 cases of cervical intraepitheli-al neoplasia(CIN)Ⅰ(10. 77 % ),17 cases of CINⅡ(13. 08 % ),8 cases of CINⅢ(6. 15 % )and 4 cases of squamous cell carcinoma (3. 08 % );there were 58 cases of HPV - positive(44. 62 % )and 72 cases HPV - negative(55. 38 % ). The detection rate of CIN in HPV -positive group was significantly higher than that in the HPV - negative group( P < 0. 05). The sensitivity of HPV test was 72. 09%(31 / 43)and the negative predictive value was 83. 33 %(60 / 72). The diagnostic coincidence rate of colposcopy on CIN was 76. 79 %(43 / 56),the diagnostic sensitivity was 74. 42 %(32 / 43)and the negative predictive value was 85. 14 %(63 / 74). Conclusion:The clinical application of colposcopy combined with HPV - DNA test has been proven to be an effective tool to detect and screen cervical ASC and play an important role for early detec-tion of premalignant cervical lesion and the reduction of incidence and mortality of cervical cancer,worthy of clinical promotion and applications.