摘要：
目的 评估液基细胞学检验(TCT)、人乳头状瘤病毒(HPV)、c-MYC、人染色体端粒酶RNA基因(hTERC)联合检测在宫颈癌筛查中的应用价值.方法 将本院妇科门诊接受检查的230例有性生活史的女性作为研究对象,分别进行TCT、HPV检测,并利用荧光原位杂交(FISH)法检测c-MYC、hTERC基因扩增情况,以病理组织学结果为金标准,分别比较四者单独及联合检测时对宫颈上皮内瘤变(CIN)Ⅱ/Ⅲ级及鳞状细胞癌(SCC)的敏感度、特异度、准确性.结果 230例筛查者中,TCT检测阳性124例,HPV阳性155例,c-MYC基因扩增118例,hTERC基因扩增128例.当TCT、HPV、c-MYC、hTERC单独使用时,HPV的敏感度最高(84.5％),c-MYC的特异度最高(97.6％);hTERC的准确性最高(85.2％).当两两组合时,TCT+ HPV与HPV+ hTERC的敏感度最高(均为89.2％),TCT+ hTERC的特异度最高(87.8％),c-MYC+ hTERC的准确性最高(86.5％).当三种指标任意配合使用时,TCT+ HPV+ hTERC的敏感度及准确性最高(98.6％、90.9％),TCT+ c-MYC+hTERC的特异度最高(79.3％).而四种指标联合使用时,敏感度为98.6％,特异度为72.0％,准确性为89.1％.结论 联合检查能提高宫颈病变筛查的敏感度和准确性,其中TCT+ HPV+ hTERC三者联合检查时诊断效率最佳,c-MYC基因检测具有最高的特异度.%Objective To investigate the application value of combination of thinprep cytologic test (TCT),human papilloma virus (HPV),c-MYC and human chromosome telomerase gene (hTERC) genes to screen cervical cancer.Methods A total of 230 cases of the study objects was detected with TCT and HP,respectively.Amplification of c-MYC and hTERC genes was tested with fluorescence in situ hybridization (FISH) method.The histopathological results were the gold standard,and the sensitivity,specificity and accuracy of cervical intraepithelial neoplasia (CIN) Ⅱ / Ⅲ and squamous cell carcinoma (SCC) were compared with the four combined detection.Results Of 230 screened patients,there were 124 cases of TCT positive,155 cases of HPV positive,c-MYC gene amplified in 118 cases,and hTERC gene amplified in 128 cases.When TCT,HPV,c-MYC,and hTERC were used alone,the highest sensitivity was HPV (84.5％),the highest specificity was c-MYC (97.6％),and the highest accuracy was hTERC (85.2％).When the three indexes were used in coordination with each other,the sensitivity and accuracy of TCT + HPV + hTERC were the highest (98.6％ and 90.9％),and the specificity of TCT + c-MYC + hTERC was the highest (79.3％).When the four indexes were used together,the sensitivity was 98.6％,the specificity was 72.0％,and the accuracy was 89.1％.Conclusions Combined examination can improve the sensitivity and accuracy of screening cervical lesions,and the three combination of TCT + HPV + hTERC had the best effect,and c-MYC gene detection had the highest specificity.
