HPV分型检测在宫颈细胞学阴性妇女宫颈病变诊断中的临床意义

摘要

目的：探讨30岁及以上、宫颈细胞学检查未见异常的妇女行人乳头瘤病毒( HPV)分型检测在宫颈病变诊断中的临床价值。方法收集126例薄层液基细胞学( TCT)未见异常但HPV16、18、31、33、45阳性的30岁及以上妇女的资料,以阴道镜活检组织病理结果为诊断标准,分析HPV分型与宫颈组织病理结果的关系。结果126例受检妇女中,检出CINⅠ级10例(7.9%),CINⅡ/Ⅲ级18例(14.3%)；其中75例HPV16阳性妇女中检出CINⅡ/Ⅲ级15例(20%),15例HPV18阳性妇女中检出 CINⅡ/Ⅲ级1例(6.7%),16例 HPV31阳性、27例 HPV33阳性者中分别检出 CINⅡ/Ⅲ级1例(6.3%)、2例(7.4%)。按各型别是否检出CINⅡ/Ⅲ级进行单因素Logistic回归分析,发现感染HPV16者发生CINⅡ/Ⅲ级病变的风险是未感染HPV16者的4倍(95%CI 1.094-14.624,P=0.026<0.05)。结论宫颈细胞学无异常但HPV16、18、31、33、45阳性的30岁及以上妇女存在一定的发生宫颈高级别病变的风险,尤其是HPV16感染者,建议及时行阴道镜检查。%Objective To explore the clinical value of the human papillomavirus( HPV) typing in the diagnosis of cervical lesions of the women aged 30 years or above without cervical cytology abnormalities. Methods The information of 126 female patients was col-lected, and the female patients aged 30 years or above had no abnormalities in thinprep cytology test(TCT) with HPV16,18,31,33 and 45 positive. The pathological examination was chosen as the diagnostic criteria. The relationship between HPV typing and pathological examination was analyzed. Results Among 126 patients, 10 patients(7. 9%) were detected as CINⅠ, and 18 patients(14. 3%) were detected as CINⅡ/Ⅲ. Among 75 cases of positive HPV16, 15 cases(20. 0%) were detected as CINⅡ/Ⅲ. Among 15 cases of positive HPV18, 1 case(6. 7%) was detected as CINⅡ/Ⅲ. Among 16 cases of positive HPV31 and 27 cases of positive HPV33, 1 case(6. 3%) and 2 cases(7. 4%) were detected as CINⅡ/Ⅲ,respectively. Logistic regression analysis showed that the risk of CINⅡ/Ⅲ lesion infected with HPV16 was four times that of no HPV16 infection(95% CI 1. 094-14. 624,P=0. 026<0. 05). Conclusion The women aged 30 years or above without cervical cytology abnormalities but HPV16,18,31,33 and 45 positive have a certain risk of high-level cervical lesions, especially those patients infected with HPV16. Therefore, the colposcopy detection should be recommended timely.