河北医学
河北醫學
하북의학
HEBEI MEDICINE
2015年
3期
436-440
,共5页
宫颈癌%传统巴氏涂片%改良取样%液基细胞学%人乳头瘤病毒%筛%查
宮頸癌%傳統巴氏塗片%改良取樣%液基細胞學%人乳頭瘤病毒%篩%查
궁경암%전통파씨도편%개량취양%액기세포학%인유두류병독%사%사
Cervical cancer%Conventional papanicolaou smear%Improved take-samples%Liq-uid-based cytology test%Human papillomavirus%Hybrid capture Ⅱscreening
目的：研究深圳妇女改良巴氏涂片联合HC－Ⅱ法HPV筛查宫颈癌的应用前景。方法：2012年2月至2012年7月对深圳市3年内从未行宫颈癌筛查的30～59岁的1000名妇女进行子宫颈癌筛查。单数妇女行改良取样巴氏涂片（ Pap）（采用液基细胞学刷取样）和HC－Ⅱ法HPV检测；双数妇女行薄层液基细胞学（LCT）和HC－Ⅱ法HPV检测。对细胞学结果≥不典型鳞状细胞（ASCUS）或HP V检测阳性者行阴道镜下多点活检，以病理为金标准评价各种宫颈癌筛查方案的价值，研究改良巴氏涂片联合HPV筛查方案的性价比。结果：本次筛查Pap阳性50例；LCT阳性57例；高危型HPV阳性200例。213例取病理：CINⅠ（含HPV感染）97例，CINⅡ23例，CINⅢ37例，宫颈癌3例，慢性宫颈炎和鳞状上皮化生40例。改良 Pap 的灵敏度、特异度、阴性预测值及约登指数分别是63．2％、94．43％、96．9％及0．58；LCT以上相应指数分别是76．0％、92．0％、98．7％及0．64；HC－Ⅱ法HPV的相应指数分别是96．8％、85．0％、98．5％及0．82；改良Pap联合HC－Ⅱ法HPV 平行试验的相应指数分别100．0％、83．3％、100．0％及0．83；LCT联合HC－Ⅱ法HPV平行试验的相应指数分别是100．0％、83．2％、100．0％及0．83；改良Pap联合HC－Ⅱ法HPV系列试验的相应指数分别60．5％、95．9％、96．7％及0．56；LCT联合HC－Ⅱ法HPV系列试验的相应指数分别是72．0％、94．3％、98．5％及0．66。不同筛查试验受试者工作特征（ receiver operating characteristic ， ROC）曲线下面积分别为Pap 0．788、LCT 0．840、HPV 0．910、Pap－HPV平行0．917、LCT－HPV平行0．916、Pap－HPV系列0．782、LCT－HPV 系列0．832。 Pap－HPV平行试验筛查宫颈癌ROC曲线面积最大。改良巴氏涂片的筛查宫颈癌的效价比最高。结论：改良Pap联合HC－Ⅱ法HPV平行试验对深圳妇女宫颈癌筛查具有最大的应用前景。
目的：研究深圳婦女改良巴氏塗片聯閤HC－Ⅱ法HPV篩查宮頸癌的應用前景。方法：2012年2月至2012年7月對深圳市3年內從未行宮頸癌篩查的30～59歲的1000名婦女進行子宮頸癌篩查。單數婦女行改良取樣巴氏塗片（ Pap）（採用液基細胞學刷取樣）和HC－Ⅱ法HPV檢測；雙數婦女行薄層液基細胞學（LCT）和HC－Ⅱ法HPV檢測。對細胞學結果≥不典型鱗狀細胞（ASCUS）或HP V檢測暘性者行陰道鏡下多點活檢，以病理為金標準評價各種宮頸癌篩查方案的價值，研究改良巴氏塗片聯閤HPV篩查方案的性價比。結果：本次篩查Pap暘性50例；LCT暘性57例；高危型HPV暘性200例。213例取病理：CINⅠ（含HPV感染）97例，CINⅡ23例，CINⅢ37例，宮頸癌3例，慢性宮頸炎和鱗狀上皮化生40例。改良 Pap 的靈敏度、特異度、陰性預測值及約登指數分彆是63．2％、94．43％、96．9％及0．58；LCT以上相應指數分彆是76．0％、92．0％、98．7％及0．64；HC－Ⅱ法HPV的相應指數分彆是96．8％、85．0％、98．5％及0．82；改良Pap聯閤HC－Ⅱ法HPV 平行試驗的相應指數分彆100．0％、83．3％、100．0％及0．83；LCT聯閤HC－Ⅱ法HPV平行試驗的相應指數分彆是100．0％、83．2％、100．0％及0．83；改良Pap聯閤HC－Ⅱ法HPV繫列試驗的相應指數分彆60．5％、95．9％、96．7％及0．56；LCT聯閤HC－Ⅱ法HPV繫列試驗的相應指數分彆是72．0％、94．3％、98．5％及0．66。不同篩查試驗受試者工作特徵（ receiver operating characteristic ， ROC）麯線下麵積分彆為Pap 0．788、LCT 0．840、HPV 0．910、Pap－HPV平行0．917、LCT－HPV平行0．916、Pap－HPV繫列0．782、LCT－HPV 繫列0．832。 Pap－HPV平行試驗篩查宮頸癌ROC麯線麵積最大。改良巴氏塗片的篩查宮頸癌的效價比最高。結論：改良Pap聯閤HC－Ⅱ法HPV平行試驗對深圳婦女宮頸癌篩查具有最大的應用前景。
목적：연구심수부녀개량파씨도편연합HC－Ⅱ법HPV사사궁경암적응용전경。방법：2012년2월지2012년7월대심수시3년내종미행궁경암사사적30～59세적1000명부녀진행자궁경암사사。단수부녀행개량취양파씨도편（ Pap）（채용액기세포학쇄취양）화HC－Ⅱ법HPV검측；쌍수부녀행박층액기세포학（LCT）화HC－Ⅱ법HPV검측。대세포학결과≥불전형린상세포（ASCUS）혹HP V검측양성자행음도경하다점활검，이병리위금표준평개각충궁경암사사방안적개치，연구개량파씨도편연합HPV사사방안적성개비。결과：본차사사Pap양성50례；LCT양성57례；고위형HPV양성200례。213례취병리：CINⅠ（함HPV감염）97례，CINⅡ23례，CINⅢ37례，궁경암3례，만성궁경염화린상상피화생40례。개량 Pap 적령민도、특이도、음성예측치급약등지수분별시63．2％、94．43％、96．9％급0．58；LCT이상상응지수분별시76．0％、92．0％、98．7％급0．64；HC－Ⅱ법HPV적상응지수분별시96．8％、85．0％、98．5％급0．82；개량Pap연합HC－Ⅱ법HPV 평행시험적상응지수분별100．0％、83．3％、100．0％급0．83；LCT연합HC－Ⅱ법HPV평행시험적상응지수분별시100．0％、83．2％、100．0％급0．83；개량Pap연합HC－Ⅱ법HPV계렬시험적상응지수분별60．5％、95．9％、96．7％급0．56；LCT연합HC－Ⅱ법HPV계렬시험적상응지수분별시72．0％、94．3％、98．5％급0．66。불동사사시험수시자공작특정（ receiver operating characteristic ， ROC）곡선하면적분별위Pap 0．788、LCT 0．840、HPV 0．910、Pap－HPV평행0．917、LCT－HPV평행0．916、Pap－HPV계렬0．782、LCT－HPV 계렬0．832。 Pap－HPV평행시험사사궁경암ROC곡선면적최대。개량파씨도편적사사궁경암적효개비최고。결론：개량Pap연합HC－Ⅱ법HPV평행시험대심수부녀궁경암사사구유최대적응용전경。
Objective:To study the prospect of apply improved papanicolaou smear ( Pap) by improved take-samples and high-risk human papillomavirus detection for Shenzhen women cervical cancer screening . Method:Conventional Pap smear by improving take-samples and hybrid capture Ⅱ human papillomavarus ( HC-ⅡHPV) test were performed in odd number women , LCT and HC-ⅡHPV test were performed in even number women ,Total 1000 women in study with 30~59 years old no any cervical screening in 3 yeals in Shenzhen from Feb.2012 to Jul.2012.The women with HPV-positive, Pap≥atypical squamous cells of un-determined sign ( ASCUS ) or LCT≥ASCUS received multi-spot biopsy under colposcopy .Result: In the study, Pap-positive, LCT-positive and HPV-positive were 50, 57 and 220 cases, respectively.A total of 213 women received biopsy in the study .97 cases had cervical intraepithelial neoplasia ( CIN)Ⅰ, 23 cases had CINⅡ,37 cases had CINⅢ, 3 cases had cervical cancer , 40 cases had chronic cervititis and metapla-sia.The sensitivity,specificity, negative predicted value , Youden's index of Pap was 63.2%,94.43%,96. 9%,0.58, respectively.The corresponding index of LCT was 76.0%,92.0%,98.7%,0.64, respectively.The corresponding index of HPV was 96.8%,85.0%,98.5%,0.82, respectively.The corresponding index of Pap-HPV parallel test was 100.0%,83.3%,100.0%,0.83 respectively.The corresponding index of LCT-HPV parallel test was 100.0%,83.2%,100.0%,0.83, respectively.The corresponding index of Pap-HPV parallel test was 60.5%,95.9%,96.7%,0.56, respectively.The corresponding index of Pap-HPV serial test was 72. 0%,94.3%,98.5%,0.66, respectively.The receiver operating characteristic (ROC)of Pap, LCT, HPV, Pap-HPV parallel test, LCT-HPV parallel test, Pap-HPV serial test, Pap-HPV serial test was 0.788, 0. 840, 0.910, 0.917, 0.916, 0.782, 0.832, respectively.The ROC of Pap-HPV parallel test was the highest . The cost-effectiveness ratio of Pap-HPV parallel test was best test .Conclusion: The Pap-HPV parallel screening test is best apply prospect in the study for Shenzhen women cervical cancer screening .
