高危型HPV-DNA检测对ASCUS分流监测的临床价值

摘要

Objective; To evaluate high-risk human papilomavims DNA (HR-HPV DNA) testing in triage of women with a-typical squamous cells of undetermined significance (ASCUS). Methods; A total of 376 women with a diagnosis of ASCUS from the primary screening were selected for triage. Their cervical smears were collected and evaluated by using conventional cytological examination in combination with a high-risk HPV-DNA test ( hybrid capture 2) . The women were categorized into four groups; Group A, Cytology + /HPV + ; Group B, Cytology - /HPV + ; Group C , Cytology + /HPV - ; and Group D, Cytology - /HPV - . Women within Group A-C were admitted for colposcopy and cervical biopsy. Group D was considered as a low-risk group for tumor development, and was not brought into comparison. Results; In women in Group A(n = 113) , the prevalence of histological verified CIN Ⅱ/Ⅲ was 41.59% , in Group B (n = 80) 23.75% , and in Group C (n = 27) 3.70%. The prevalence of a high-risk HPV infection decreased with age in women with ASCUS. It was 71. 43% in women < 30 years and 26. 80% in women ≥50 years. Conclusion; Adding a high-risk HPV-DNA test in secondary screening increases the identification of women with CIN Ⅱ/Ⅲ lesions by 46. 15% in comparison with repeat cytology. The clinical significance of the ASCUS diagnosis varies with age of the women. HR-HPV DNA testing is a feasible method for triage of ASCUS.%目的 评价高危型人类乳头瘤病毒(HPV)检测对未明确意义的不典型鳞状细胞(Atypical squamous cells of undetermined significance,ASCUS) 分流监测的临床价值.方法 对376例初筛结果为ASCUS病例,3个月后进行宫颈液基细胞学复查和高危型HPV-DNA检测,并根据检查结果将病例分为4组:A组,细胞学+/HPV+;B组,细胞学-/HPV+;C组,细胞学+/HPV-;D组,细胞学-/HPV-.对A、B、C组病例进行了阴道镜检查及活检,比较3组间宫颈上皮内瘤变(cervical intraepithelial neoplasma,CIN)发生率的差异.由于D组发展成为肿瘤的风险极低,不纳入比较.结果 A组(细胞学+/HPV+)患者CINⅡ/Ⅲ发生率为41.59%,B组(细胞学-/HPV+)为23.75%,而C组(细胞学+/HPV-)为3.70%.高危型HPV在ASCUS患者中感染率随年龄增长而降低,其中30岁以下年龄组高危型HPV-DNA阳性率为71.43%,而50岁以上年龄组仅为26.80%.结论 在二次筛查中增加高危型HPV-DNA检测较单纯重查宫颈液基细胞学检测可提高CINⅡ/Ⅲ检出率.ASCUS临床意义可随年龄增长而出现明显变化.高危型HPV-DNA检测可对ASCUS进行有效的分流监测.