中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
4期
259-262
,共4页
宫颈上皮内瘤样病变%宫颈肿瘤%DNA%倍性%阴道镜检查
宮頸上皮內瘤樣病變%宮頸腫瘤%DNA%倍性%陰道鏡檢查
궁경상피내류양병변%궁경종류%DNA%배성%음도경검사
Cervical intraepithelial neoplasia%Uterine cervical neoplasms%DNA%Ploidies%Colposcopy
目的 探讨DNA倍体分析在未明确诊断意义的不典型鳞状上皮细胞(ASCUS)分流诊断中的意义.方法 对2009年1月至201 1年7月在湖北省妇幼保健院进行宫颈分泌物液基薄层细胞学检查(TCT)诊断为ASCUS的875例患者进行DNA倍体分析；其中294例同时进行了高危型HPV(HR-HPV)检测；全部受检者均在月经干净第3～ 10天内行电子阴道镜下宫颈活检进行诊断对照.结果 875例TCT结果为ASCUS者阴道镜活检病理检查结果分别为:慢性宫颈炎553例(63.2％),宫颈上皮内瘤变(CIN)Ⅰ 165例(18.9％),CINⅡ45例(5.1％),CINⅢ79例(9.0％),宫颈癌33例(3.8％).DNA倍体分析中可见DNA异倍体细胞者532例(DNA异倍体细胞阳性),未见DNA异倍体细胞者343例(DNA异倍体细胞阴性)；DNA异倍体细胞阴性、异倍体细胞≥3个用于筛查CINⅡ及以上病变的敏感度、特异度、阳性预测值、阴性预测值分别为98.7％和90.3％、47.5％和46.1％、29.1％和40.8％、99.4％和92.1％.DNA异倍体细胞阳性的慢性宫颈炎、CIN Ⅰ、CINⅡ、CINⅢ和宫颈癌组织每100个被测细胞中,出现细胞核DNA含量(DI) ＞1.25的细胞(＞2.5c细胞)数分别为(2.53±1.99)、(2.24±1.69)、(4.10±1.91)、(7.97±7.33)、(8.99±7.33)个；出现DI ＞2.5的细胞(＞5c细胞)数分别为(0.10±0.07)、(0.20±0.11)、(0.28±0.19)、(1.27±1.23)、(0.36±0.33)个,慢性宫颈炎与CIN Ⅰ及CINⅢ与宫颈癌患者DI＞ 1.25、＞2.5的细胞数分别比较,差异无统计学意义(P＞0.05),但慢性宫颈炎及CIN Ⅰ、CINⅢ及宫颈癌患者DI＞ 1.25、＞2.5的细胞数与CINⅡ分别比较,差异均有统计学意义(P＜0.05).行HR-HPV检测的294例患者中,HR-HPV阳性216例,HR-HPV阴性78例；HR-HPV阳性及阴性患者中,异倍体细胞阴性、异倍体细胞＜3个或≥3个者,阴道镜活检结果比较,差异有统计学意义(x2=115.2775,P＜0.01).结论 DNA倍体分析可辅助用于ASCUS的分流诊断,从而避免过多的阴道镜活检,同时减少CIN和宫颈癌的漏诊.
目的 探討DNA倍體分析在未明確診斷意義的不典型鱗狀上皮細胞(ASCUS)分流診斷中的意義.方法 對2009年1月至201 1年7月在湖北省婦幼保健院進行宮頸分泌物液基薄層細胞學檢查(TCT)診斷為ASCUS的875例患者進行DNA倍體分析；其中294例同時進行瞭高危型HPV(HR-HPV)檢測；全部受檢者均在月經榦淨第3～ 10天內行電子陰道鏡下宮頸活檢進行診斷對照.結果 875例TCT結果為ASCUS者陰道鏡活檢病理檢查結果分彆為:慢性宮頸炎553例(63.2％),宮頸上皮內瘤變(CIN)Ⅰ 165例(18.9％),CINⅡ45例(5.1％),CINⅢ79例(9.0％),宮頸癌33例(3.8％).DNA倍體分析中可見DNA異倍體細胞者532例(DNA異倍體細胞暘性),未見DNA異倍體細胞者343例(DNA異倍體細胞陰性)；DNA異倍體細胞陰性、異倍體細胞≥3箇用于篩查CINⅡ及以上病變的敏感度、特異度、暘性預測值、陰性預測值分彆為98.7％和90.3％、47.5％和46.1％、29.1％和40.8％、99.4％和92.1％.DNA異倍體細胞暘性的慢性宮頸炎、CIN Ⅰ、CINⅡ、CINⅢ和宮頸癌組織每100箇被測細胞中,齣現細胞覈DNA含量(DI) ＞1.25的細胞(＞2.5c細胞)數分彆為(2.53±1.99)、(2.24±1.69)、(4.10±1.91)、(7.97±7.33)、(8.99±7.33)箇；齣現DI ＞2.5的細胞(＞5c細胞)數分彆為(0.10±0.07)、(0.20±0.11)、(0.28±0.19)、(1.27±1.23)、(0.36±0.33)箇,慢性宮頸炎與CIN Ⅰ及CINⅢ與宮頸癌患者DI＞ 1.25、＞2.5的細胞數分彆比較,差異無統計學意義(P＞0.05),但慢性宮頸炎及CIN Ⅰ、CINⅢ及宮頸癌患者DI＞ 1.25、＞2.5的細胞數與CINⅡ分彆比較,差異均有統計學意義(P＜0.05).行HR-HPV檢測的294例患者中,HR-HPV暘性216例,HR-HPV陰性78例；HR-HPV暘性及陰性患者中,異倍體細胞陰性、異倍體細胞＜3箇或≥3箇者,陰道鏡活檢結果比較,差異有統計學意義(x2=115.2775,P＜0.01).結論 DNA倍體分析可輔助用于ASCUS的分流診斷,從而避免過多的陰道鏡活檢,同時減少CIN和宮頸癌的漏診.
목적 탐토DNA배체분석재미명학진단의의적불전형린상상피세포(ASCUS)분류진단중적의의.방법 대2009년1월지201 1년7월재호북성부유보건원진행궁경분비물액기박층세포학검사(TCT)진단위ASCUS적875례환자진행DNA배체분석；기중294례동시진행료고위형HPV(HR-HPV)검측；전부수검자균재월경간정제3～ 10천내행전자음도경하궁경활검진행진단대조.결과 875례TCT결과위ASCUS자음도경활검병리검사결과분별위:만성궁경염553례(63.2％),궁경상피내류변(CIN)Ⅰ 165례(18.9％),CINⅡ45례(5.1％),CINⅢ79례(9.0％),궁경암33례(3.8％).DNA배체분석중가견DNA이배체세포자532례(DNA이배체세포양성),미견DNA이배체세포자343례(DNA이배체세포음성)；DNA이배체세포음성、이배체세포≥3개용우사사CINⅡ급이상병변적민감도、특이도、양성예측치、음성예측치분별위98.7％화90.3％、47.5％화46.1％、29.1％화40.8％、99.4％화92.1％.DNA이배체세포양성적만성궁경염、CIN Ⅰ、CINⅡ、CINⅢ화궁경암조직매100개피측세포중,출현세포핵DNA함량(DI) ＞1.25적세포(＞2.5c세포)수분별위(2.53±1.99)、(2.24±1.69)、(4.10±1.91)、(7.97±7.33)、(8.99±7.33)개；출현DI ＞2.5적세포(＞5c세포)수분별위(0.10±0.07)、(0.20±0.11)、(0.28±0.19)、(1.27±1.23)、(0.36±0.33)개,만성궁경염여CIN Ⅰ급CINⅢ여궁경암환자DI＞ 1.25、＞2.5적세포수분별비교,차이무통계학의의(P＞0.05),단만성궁경염급CIN Ⅰ、CINⅢ급궁경암환자DI＞ 1.25、＞2.5적세포수여CINⅡ분별비교,차이균유통계학의의(P＜0.05).행HR-HPV검측적294례환자중,HR-HPV양성216례,HR-HPV음성78례；HR-HPV양성급음성환자중,이배체세포음성、이배체세포＜3개혹≥3개자,음도경활검결과비교,차이유통계학의의(x2=115.2775,P＜0.01).결론 DNA배체분석가보조용우ASCUS적분류진단,종이피면과다적음도경활검,동시감소CIN화궁경암적루진.
Objective To investigate the significance of DNA ploidy analysis in diagnosis of atypical squamous cell of undetermined significance ( ASCUS).Methods From Jan.2009 to Jul.2011,875 women with ASCUS confirmed by liquid based thin layer cytology technique underwent DNA ploid analysis in Hubei Maternal and Child Health Hospital.Among 294 women underwent high risk HPV detection.All subjective were examined colposcopy directed biopsy at day 3 to 10 after menstruation.Results Among 875 ASCUS cases,553 cases with histologically as chronic cervicitis (63.2％),165 cases with cervical intraepithelial neoplasia (CIN) Ⅰ (18.9％ ),45 cases with CIN Ⅱ (5.1％),79 cases with CIN Ⅲ (9.0％) and 33 cases with cervical invasive cancer (3.8％) were confirmed by colposcopy.Totally 532 cases were observed with DNA heteroploid,and 343 were not observed with DNA heteroploid.When DNA heteroploid negative and more than or equal to three ploid were used to predict CIN Ⅱ or more severe cervical diseases,the sensitivity,specificity,positive predictive values and negative predictive values were 98.7％ and 90.3％,47.5％ and 46.1％,29.1％ and 40.8％,99.4％ and 92.1％,respectively.The amount of heteroploid cells ＞2.5c and ＞ 5c among every 100 detected cells in chronic cervicitis and CIN Ⅰ,CIN Ⅱ,CIN Ⅲ and cervix cancer were respectively 2.53 ± 1.99 and 0.10 ±0.07,2.24 ± 1.69 and 0.20 ±0.11,4.10 ± 1.91 and 0.28 ±0.19,7.97 ±7.33 and 1.27 ± 1.23,8.99 ±7.33 and 0.36 ±0.33,there was no statistical difference in amount of heteropolid cells between ＞ 2.5c and ＞ 5c at group of chronic cervicitis and CIN Ⅰ,CIN Ⅲ and cervix cancer (P ＞ 0.05).However,the amount of heteroploid cells at ＞2.5c and ＞ 5c at group of chronic cervicitis,CIN Ⅰ,CIN Ⅲ and cervical were higher than that of CIN Ⅱ significantly (P ＜0.05).Among 294 cases with high risk (HR) HPV detection,216 cases were HR-HPV positive,and 78 cases were HR-HPV negative.The pathology result by colposcopy at group of negative heteroploid,heteroploid ＜ 3,or ≥ 3 showed statistical distribution (x2 =115.2775,P ＜ 0.01).Conclusion DNA ploidy analysis can be used for ASCUS diagnosis,which can avoid excessive biopsy under colposcopy,in the mean time,CIN and cervical cancer could decrease missed diagnosis.
