CAJ | 학술논문

目的评价改良取样巴氏涂片(Pap)、液基细胞学检查(LCT)和第二代杂交捕获法(HC-Ⅱ)人乳头瘤病毒(HPV)筛查宫颈高度以上病变方案的价值.方法 2007年12月至2008年3月在深圳市福田区上梅林社区按年龄采取分层抽样法对425名30～59岁妇女进行宫颈癌筛查,同期在北京大学深圳医院宫颈癌早诊早治中心按年龄采取分层抽样法对75名30～59岁妇女进行宫颈癌筛查.每名妇女行改良Pap(采用液基细胞学刷取样)、LCT和HC-Ⅱ法HPV.对细胞学结果≥不典型鳞状细胞(ASCUS)或HPV检测阳性者行阴道镜下多点活检和宫颈管搔刮术,以病理检查结果为金标准评价改良Pap、LCT、HC-Ⅱ法HPV、Pap-HPV平行试验、Pap-HPV系列试验、LCT-HPV平行试验和LCT-HPV系列试验7种方案筛查宫颈高度以上病变方案的价值.结果 (1)社区筛查出宫颈上皮内瘤变(CIN)Ⅱ7例,CINⅢ7例,宫颈癌1例;医院筛查出CINⅡ9例,CINⅢ11例,宫颈癌3例.(2)HC-Ⅱ法HPV和细胞学联合HC-Ⅱ法HPV平行试验筛查CIN Ⅱ以上病变的灵敏度在95%以上,阴性预测值接近100%.(3)改良Pap和LCT的筛查效率和不满意率的差异无统计学意义.(4)Pap-HPV平行试验筛查宫颈高度以上病变的效价比优于LCT-HPV平行试验.结论筛查宫颈高度病变,建议采用HC-Ⅱ法HPV和细胞学联合HC-Ⅱ法HPV平行试验为首选,其中改良Pap联合HC-Ⅱ法HPV平行试验为最佳推荐方案.
목적 평개개량취양파씨도편(Pap)、액기세포학검사(LCT)화제이대잡교포획법(HC-Ⅱ)인유두류병독(HPV)사사궁경고도이상병변방안적개치.방법 2007년12월지2008년3월재심수시복전구상매림사구안년령채취분층추양법대425명30～59세부녀진행궁경암사사,동기재북경대학심수의원궁경암조진조치중심안년령채취분층추양법대75명30～59세부녀진행궁경암사사.매명부녀행개량Pap(채용액기세포학쇄취양)、LCT화HC-Ⅱ법HPV.대세포학결과≥불전형린상세포(ASCUS)혹HPV검측양성자행음도경하다점활검화궁경관소괄술,이병리검사결과위금표준평개개량Pap、LCT、HC-Ⅱ법HPV、Pap-HPV평행시험、Pap-HPV계렬시험、LCT-HPV평행시험화LCT-HPV계렬시험7충방안사사궁경고도이상병변방안적개치.결과 (1)사구사사출궁경상피내류변(CIN)Ⅱ7례,CINⅢ7례,궁경암1례;의원사사출CINⅡ9례,CINⅢ11례,궁경암3례.(2)HC-Ⅱ법HPV화세포학연합HC-Ⅱ법HPV평행시험사사CIN Ⅱ이상병변적령민도재95%이상,음성예측치접근100%.(3)개량Pap화LCT적사사효솔화불만의솔적차이무통계학의의.(4)Pap-HPV평행시험사사궁경고도이상병변적효개비우우LCT-HPV평행시험.결론 사사궁경고도병변,건의채용HC-Ⅱ법HPV화세포학연합HC-Ⅱ법HPV평행시험위수선,기중개량Pap연합HC-Ⅱ법HPV평행시험위최가추천방안.
Objective To evaluate the value of cervical cytology and hybrid capture Ⅱ (HC-Ⅱ) human papillomavarus (HPV) test for screening cervical lesion. Methods Conventional papanicolaou (Pap) smear by improved take-samples, liquid-based cytology test (LCT) and HC-Ⅱ human papillomavarus test were performed in 425 women in Shang Mei-lin community of Futian region in Shenzhen city, from December 2007 to March 2008 and the above methods were performed in 75 women in Shenzhen Hospital of Peking University at the same time. Age stratified sampling was used. Samples of Pap were taken a broom-type sampling device (take-samples used for LCT) with split-sampling method. Those women with HPV-positive, Pap≥atypical squamous cells of undetermined sign (ASCUS) or LCT≥ASCUS received multi-spot biopsy and endocervical curettage under colposcopy. Final diagnosis would depend on pathological findings as well, to evaluate the values of Pap, LCT, HC-Ⅱ HPV, Pap-HPV parallel test, LCT-HPV parallel test, Pap-HPV serial test and LCT-HPV serial test for the screening program on cervical cancer. Results (1) In this study, 7 women bad cervical intraepithelial neoplasia (CIN) Ⅱ, another 7 had CIN Ⅲ, 1 had cervical cancer in the community; 9 had CIN Ⅱ, 11 had CIN Ⅲ, 3 had cervical cancer in the hospital, respectively. (2) The sensitivity of HC-Ⅱ HPV and cytology-HPV parallel test for detecting≥CIN Ⅱ was >95.0% while negative pre-value were nearly 100.0%. (3) There were no significant differences of screening effectiveness and unsatisfactory rates between Pap of improved take-samples and LCT. (4) The cost-effectiveness ratio of Pap-HPV parallel test was higher than LCT-HPV parallel test. Conclusion It was suggested that the first choice for screening of cervical serious lesion were HC-Ⅱ HPV and cytology-HPV parallel test while Pap-HPV parallel test was the best method for screening purposes.