CAJ | 학술논문

目的探讨宫颈癌筛查中,不同方法检测HPV的临床效果.方法选择2011年8-11月在中日友好医院行宫颈癌筛查的妇女424例,均行宫颈脱落细胞的液基细胞学检测(LCT)、第二代杂交捕获HPV检测(HC-Ⅱ)和核酸实时荧光PCR同时对HPV16和HPV18进行分型检测(PCR12+2).检测结果分两组进行评价:HC-Ⅱ组(LCT联合HC-Ⅱ),共计424例；PCR12+2组(LCT联合PCR12+2),剔除3例脱落病例,共计421例.两组均对LCT结果在未明确诊断意义的不典型鳞状上皮细胞(ASCUS)及以上和(或)高危型HPV阳性者行阴道镜活检及组织病理学检查.此外,PCR12+2组同时还对LCT阴性,但HPV 16或18阳性者行阴道镜活检及组织病理学检查.结果 (1)两组患者中,组织病理学检查结果≥宫颈上皮内瘤变Ⅱ级(CINⅡ)病变的筛查结果比较,差异无统计学意义(x2=3.35,P＞0.05).HC-Ⅱ和PCR12+2用于筛查≥CINⅡ病变的敏感度、特异度、阳性预测值和阴性预测值分别为:77.8％,79.4％,20.4％,98.1％和96.3％,78.2％,23.2％,99.7％.(2)在PCR12+2组中,HPV16阳性34例,HPV18阳性5例(其中1例同时HPV16阳性),其他高危型HPV阳性74例,阴性309例.其中HPV16和(或)HPV18阳性比其他高危型HPV阳性导致组织病理学≥CINⅡ病变的风险更高,分别为51.3％ (20/39)和8.1％ (6/74).(3)在PCR12+2组中,HPV16阳性、HPV18阳性、其他高危型HPV阳性及HPV阴性者的致癌风险比较,差异有统计学意义(x2=93.98,P＜0.01).结论 LCT联合PCR12+2检测用于筛查宫颈癌,可以鉴别出宫颈病变≥CINⅡ风险更高的患者.
목적 탐토궁경암사사중,불동방법검측HPV적림상효과.방법 선택2011년8-11월재중일우호의원행궁경암사사적부녀424례,균행궁경탈락세포적액기세포학검측(LCT)、제이대잡교포획HPV검측(HC-Ⅱ)화핵산실시형광PCR동시대HPV16화HPV18진행분형검측(PCR12+2).검측결과분량조진행평개:HC-Ⅱ조(LCT연합HC-Ⅱ),공계424례；PCR12+2조(LCT연합PCR12+2),척제3례탈락병례,공계421례.량조균대LCT결과재미명학진단의의적불전형린상상피세포(ASCUS)급이상화(혹)고위형HPV양성자행음도경활검급조직병이학검사.차외,PCR12+2조동시환대LCT음성,단HPV 16혹18양성자행음도경활검급조직병이학검사.결과 (1)량조환자중,조직병이학검사결과≥궁경상피내류변Ⅱ급(CINⅡ)병변적사사결과비교,차이무통계학의의(x2=3.35,P＞0.05).HC-Ⅱ화PCR12+2용우사사≥CINⅡ병변적민감도、특이도、양성예측치화음성예측치분별위:77.8％,79.4％,20.4％,98.1％화96.3％,78.2％,23.2％,99.7％.(2)재PCR12+2조중,HPV16양성34례,HPV18양성5례(기중1례동시HPV16양성),기타고위형HPV양성74례,음성309례.기중HPV16화(혹)HPV18양성비기타고위형HPV양성도치조직병이학≥CINⅡ병변적풍험경고,분별위51.3％ (20/39)화8.1％ (6/74).(3)재PCR12+2조중,HPV16양성、HPV18양성、기타고위형HPV양성급HPV음성자적치암풍험비교,차이유통계학의의(x2=93.98,P＜0.01).결론 LCT연합PCR12+2검측용우사사궁경암,가이감별출궁경병변≥CINⅡ풍험경고적환자.
Objective To evaluate clinical efficacy of different HPV methods in screening of cervical cancers.Methods Between August 2011 and November 2011,424 women in the China-Japan Friendship Hospital were enrolled in this study.All participants were undergone liquid-based cytology test (LCT),Hybrid capture Ⅱ (HC-Ⅱ) and real-time (RT)PCR high risk HPV DNA test for HPV16 and HPV18 genotyping.Those results were classified into two group:424 women at HC-Ⅱ group with LCT and HC-Ⅱ test and 421 women at PCR group with LCT and PCR test.All women with atypical squamous cell of undetermined significance (ASCUS) or above in cytological result with high risk HPV positive at two group underwent cervical biopsy by colposcopy.In the mean time,women with negative in cytological results and with HPV 16 and(or) HPV 18 positive also underwent histo-pathological examination by and colposcopy.The results in two groups were discussed:LCT + HC-Ⅱ group (424 patients) and LCT + PCR12+2 group (421 patients).Results (1) There was no significant difference in cervical intraepithelial neoplasia (CIN) Ⅱ or above disease between LCT + HC-Ⅱ group and LCT + PCR12+2 group (x2 =3.35,P ＞ 0.05).Sensitivity,specificity,positive predictive value and negative predictive value for detection of CIN Ⅱ or above using HC-Ⅱ and PCR12 +2 were 77.8％,79.4％,20.4％,98.1％ and 96.3％,78.2％,23.2％,99.7％,respectively.(2) In LCT + PCR12+2 group,it was found 34 women with HPV16 positive,5 women with HPV 18 positive including 1 women combined with HPV 16 positive,74 women with other high risk HPV positive and 309 women with HPV negative.Compared to the infection of other high-risk HPV types,HPV 16 and HPV 18 infection leads to a higher chance of cervical lesions with CIN Ⅱ or above [51.3％(20/39) and 8.1％ (6/74)].(3) A significant difference of causing cervical cancer and CIN Ⅱ or above was found among women who were infected with HPV 16 and/or HPV 18 infection,with other high-risk HPV types and negative in high-risk HPV infection (x2 =93.98,P ＜ 0.01).Conclusion LCT combined with PCR genotyping HPV could identify CIN Ⅱ or above disease efficiently.