CAJ | 학술논문

目的探讨传统巴氏涂片、膜式液基薄层细胞学技术、全自动细胞DNA定量分析系统、人乳头瘤病毒检测、盲点活检及阴道镜下染色活检对宫颈细胞病变筛查的临床价值.方法选取妇科门诊患者8 780例作为研究对象,分四组统计不同筛查方法检测的阳性率及准确率；同时比较阴道镜下染色活检与盲点活检的阳性率,活检阳性、阴性患者中HPV阳性率及阳性患者各级病变中HPV感染率.结果 (1)四组(宫颈刮片组、TCT组、DNA组、HPV组)间阳性检出率呈递增趋势(P＜0.05),两两比较:除宫颈刮片组阳性与TCT组检出率差异无统计学意义(P＜0.05)外,其余差异均有统计学意义(均P＜0.05)；(2)四组间准确率亦呈递增趋势(P＜0.05),两两比较:除宫颈刮片组准确率低于与TCT组,但差异无统计学意义(P＞0.05)外,其余差异均有统计学意义(均P＜0.05).(3)阴道镜下醋酸染色活检阳性检出率高于盲点活检(P＞0.05)；(4)活检阳性者HPV阳性率高于活检阴性者(P＜0.05)；(5)阴道镜下醋酸染色活检组各级病变中HPV阳性率呈递增趋势(P＜0.05),盲点活检组各级病变中HPV阳性率呈递增趋势(P＜0.05).结论 (1)HPV在宫颈防癌筛查中敏感性最高、特异性最强,细胞DNA定量法次之,传统巴士涂片最差,HPV及DNA检测在临床应用中更有价值.(2)阴道镜下醋酸染色活检与盲点活检在临床应用上无明显差别,但HPV感染是宫颈上皮内瘤变发生、发展,并逐步进展为宫颈癌的关键因素.
목적 탐토전통파씨도편、막식액기박층세포학기술、전자동세포DNA정량분석계통、인유두류병독검측、맹점활검급음도경하염색활검대궁경세포병변사사적림상개치.방법 선취부과문진환자8 780례작위연구대상,분사조통계불동사사방법검측적양성솔급준학솔；동시비교음도경하염색활검여맹점활검적양성솔,활검양성、음성환자중HPV양성솔급양성환자각급병변중HPV감염솔.결과 (1)사조(궁경괄편조、TCT조、DNA조、HPV조)간양성검출솔정체증추세(P＜0.05),량량비교:제궁경괄편조양성여TCT조검출솔차이무통계학의의(P＜0.05)외,기여차이균유통계학의의(균P＜0.05)；(2)사조간준학솔역정체증추세(P＜0.05),량량비교:제궁경괄편조준학솔저우여TCT조,단차이무통계학의의(P＞0.05)외,기여차이균유통계학의의(균P＜0.05).(3)음도경하작산염색활검양성검출솔고우맹점활검(P＞0.05)；(4)활검양성자HPV양성솔고우활검음성자(P＜0.05)；(5)음도경하작산염색활검조각급병변중HPV양성솔정체증추세(P＜0.05),맹점활검조각급병변중HPV양성솔정체증추세(P＜0.05).결론 (1)HPV재궁경방암사사중민감성최고、특이성최강,세포DNA정량법차지,전통파사도편최차,HPV급DNA검측재림상응용중경유개치.(2)음도경하작산염색활검여맹점활검재림상응용상무명현차별,단HPV감염시궁경상피내류변발생、발전,병축보진전위궁경암적관건인소.
Objective To explore the clinical value of cervical lesion screening,which was detected by Pap smears,thinprep cytologic test (TCT),full automatic cellular DNA quantitative analysis system,human papilloma virus detection,colposcopy staining biopsy and blind biopsy.Methods 8 780 peoples were as the study object,divided into four groups,positive rate and accuracy of different screening methods;In addition,which were the positive rate of colposcopy staining biopsy and blind biopsy,the positive rate of HPV in all positive biopsy people and negative biopsy people,and the HPV infection rate of various lesions in positive patients were compared,respectivey.Results (1) The positive rates between the four groups showed an increasing trend (P ＜ 0.05).The positive rate of Pap smears and TCT had no statistical difference between every two of them (P ＜ 0.05),the rest were statistically significant (P ＜0.05).(2) The accuracy rates between the four groups showed an increasing trend (P ＜ 0.05).The accuracy rate of Pap smears and TCT had no statistical difference between two of them(P ＞ 0.05),the rest were statistically significant (P ＜ 0.05).(3)The positive rate of colposcopy biopsy under vision inspection with acetic acid (VIA) was higher than that of blind biopsy (P ＞ 0.05).(4) The positive rate of HPV detection of positive biopsy people was higher than that of negative biopsy people(P ＜0.05).(5)In colposcopy biopsy under vision inspection with acetic acid(VIA)group,the HPV positive rates of inflammation showed an increasing trend(P ＜ 0.05) ;in blind biopsy group,the HPV positive rates also showed an increasing trend (P ＜ 0.05).Conclusion (1) HPV test has the highest sensitivity and strongest specificity,cellular DNA quantitative analysis is second,Pap smears is worst,so HPV and DNA detection have more valuable in clinical.(2)There is no significant difference between colposcopy biopsy under vision inspection with acetic acid(VIA)and blind biopsy in clinical,but HPV infection is the key factor,which affects the occurrence,development of cervical intraepithelial neoplasia and gradually progresses to cervical cancer.