中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2013年
20期
3047-3050
,共4页
徐凤娟%黄珊珊%程雪菊%李爱琴
徐鳳娟%黃珊珊%程雪菊%李愛琴
서봉연%황산산%정설국%리애금
α乳头状瘤病毒属%肿瘤,鳞状细胞%宫颈上皮内瘤样病变%DNA探针,HPV
α乳頭狀瘤病毒屬%腫瘤,鱗狀細胞%宮頸上皮內瘤樣病變%DNA探針,HPV
α유두상류병독속%종류,린상세포%궁경상피내류양병변%DNA탐침,HPV
Alpha papillomavirus%Neoplasms,squamous cell%Cervical intraepithelial neoplasia%DNA probes,HPV
目的 探讨HR-HPV在意义不明确的不典型鳞状细胞(ASCUS)分级诊疗中的作用,寻求ASCUS患者的最佳处理方案.方法 对470例宫颈薄层液基细胞学(TCT)检查结果为ASCUS的患者,联合进行HR-HPV DNA检测及行阴道镜下宫颈活检,分析其临床特点.结果 470例ASCUS中包含各种宫颈病变:炎症/湿疣69.15％ (325/470)；宫颈上皮内瘤样病变(CIN) 29.57％(139/470)；宫颈浸润癌1.28％(6/470).宫颈病理检测阳性率为30.85％(≥CIN Ⅰ,145/470).470例ASCUS中,HR-HPV感染阳性率为50.43％(237/470).HR-HPV阳性组≥CIN Ⅰ的检出率为55.27％(131/237),≥CINⅡ的检出率为36.71％(87/237)；HR-HPV阴性组≥CIN Ⅰ的检出率为6.01％(14/233),≥CINⅡ的检出率为1.29％ (3/233),组间差异有统计学意义(P＜0.01).HR-HPV阳性组发生≥CIN Ⅰ和浸润癌的风险是阴性组的19.332倍(95％CI=10.632～35.152),发生≥CINⅡ和浸润癌的风险是阴性组的44.467倍(95％ CI=13.812～ 143.152).HR-HPV检测≥CIN Ⅰ患者的灵敏度、特异度、阳性预测值和阴性预测值分别为90.34％、67.38％、61.60％、93.99％,而检测≥CINⅡ的指标分别为96.67％、60.53％、36.71％、98.71％.结论 ASCUS患者包含部分高级别病变甚至宫颈癌,并存在相当比例的HPV感染,HR-HPV检测对ASCUS患者的临床处理具有科学分级诊疗的作用.
目的 探討HR-HPV在意義不明確的不典型鱗狀細胞(ASCUS)分級診療中的作用,尋求ASCUS患者的最佳處理方案.方法 對470例宮頸薄層液基細胞學(TCT)檢查結果為ASCUS的患者,聯閤進行HR-HPV DNA檢測及行陰道鏡下宮頸活檢,分析其臨床特點.結果 470例ASCUS中包含各種宮頸病變:炎癥/濕疣69.15％ (325/470)；宮頸上皮內瘤樣病變(CIN) 29.57％(139/470)；宮頸浸潤癌1.28％(6/470).宮頸病理檢測暘性率為30.85％(≥CIN Ⅰ,145/470).470例ASCUS中,HR-HPV感染暘性率為50.43％(237/470).HR-HPV暘性組≥CIN Ⅰ的檢齣率為55.27％(131/237),≥CINⅡ的檢齣率為36.71％(87/237)；HR-HPV陰性組≥CIN Ⅰ的檢齣率為6.01％(14/233),≥CINⅡ的檢齣率為1.29％ (3/233),組間差異有統計學意義(P＜0.01).HR-HPV暘性組髮生≥CIN Ⅰ和浸潤癌的風險是陰性組的19.332倍(95％CI=10.632～35.152),髮生≥CINⅡ和浸潤癌的風險是陰性組的44.467倍(95％ CI=13.812～ 143.152).HR-HPV檢測≥CIN Ⅰ患者的靈敏度、特異度、暘性預測值和陰性預測值分彆為90.34％、67.38％、61.60％、93.99％,而檢測≥CINⅡ的指標分彆為96.67％、60.53％、36.71％、98.71％.結論 ASCUS患者包含部分高級彆病變甚至宮頸癌,併存在相噹比例的HPV感染,HR-HPV檢測對ASCUS患者的臨床處理具有科學分級診療的作用.
목적 탐토HR-HPV재의의불명학적불전형린상세포(ASCUS)분급진료중적작용,심구ASCUS환자적최가처리방안.방법 대470례궁경박층액기세포학(TCT)검사결과위ASCUS적환자,연합진행HR-HPV DNA검측급행음도경하궁경활검,분석기림상특점.결과 470례ASCUS중포함각충궁경병변:염증/습우69.15％ (325/470)；궁경상피내류양병변(CIN) 29.57％(139/470)；궁경침윤암1.28％(6/470).궁경병리검측양성솔위30.85％(≥CIN Ⅰ,145/470).470례ASCUS중,HR-HPV감염양성솔위50.43％(237/470).HR-HPV양성조≥CIN Ⅰ적검출솔위55.27％(131/237),≥CINⅡ적검출솔위36.71％(87/237)；HR-HPV음성조≥CIN Ⅰ적검출솔위6.01％(14/233),≥CINⅡ적검출솔위1.29％ (3/233),조간차이유통계학의의(P＜0.01).HR-HPV양성조발생≥CIN Ⅰ화침윤암적풍험시음성조적19.332배(95％CI=10.632～35.152),발생≥CINⅡ화침윤암적풍험시음성조적44.467배(95％ CI=13.812～ 143.152).HR-HPV검측≥CIN Ⅰ환자적령민도、특이도、양성예측치화음성예측치분별위90.34％、67.38％、61.60％、93.99％,이검측≥CINⅡ적지표분별위96.67％、60.53％、36.71％、98.71％.결론 ASCUS환자포함부분고급별병변심지궁경암,병존재상당비례적HPV감염,HR-HPV검측대ASCUS환자적림상처리구유과학분급진료적작용.
Objective To explore the clinical value of high risk human papillomavirus(HR-HPV) test in shunting monitoring of atypical squamous cell of undetermined significance (ASCUS) and to seek the best treatment for patients with ASCUS.Methods 470 patients with ASCUS tested by TCT were given HR-HPV testing and biopsy under colposcopy.The clinical characteristics were analyzed.Results 470 cases of ASCUS contained a variety of cervical lesions:inflammation/acuminate accounted for 69.15％ (325/470),cervical intraepithelial neoplasia (CIN)accounted for 29.57％ (139/470),and invasive carcinoma accounted for 1.28％ (6/470).The positive rate of cervical pathological examination was 30.85％ (≥ CIN Ⅰ,145/470).The positive rate of HR-HPV was 50.43％(237/470).The detection rate of ≥CIN Ⅰ in HR-HPV positive group and negative group was 55.27％ (131/237)and 6.01％ (14/233),while the detection rate of ≥ CIN Ⅱ in HR-HPV positive group and negative group was 36.71％ (87/237) and 1.29％ (3/233).The differences were statistically significant(P ＜ 0.01).Incidence of ≥ CIN Ⅰ and invasive carcinoma in HR-HPV positive group was about 19.332 fold of that in HR-HPV negative group(95％ CI =10.632 ～ 35.152),while the incidence of ≥CIN Ⅱ and invasive carcinoma was about 44.467 fold of HR-HPV negative group (95％ CI =13.812 ～ 143.152).The detection sensitivity,specificity,positive predictive value,negative predictive value(NPV) of HR-HPV in the≥ CIN Ⅰ patients were 90.34％,67.38％,61.60％,93.99％.Those of ≥ CIN Ⅱ patients were 96.67％,60.53％,36.71％,98.71％.Conclusion ASCUS included partial CIN of high grades and cervical cancer,and the proportion of HPV infection is large,detection of high risk HPV-DNA is an effective shunting management method of ASCUS.
