CAJ | 학술논문

目的探索适合农村地区和少数民族地区的方便快捷有效的人乳头瘤病毒(HPV)取样方法,以便提高宫颈癌筛查效率.方法采用横断面整群抽样研究的方法,于2006-2007年在新疆于田县选择有性生活、16 ～59岁的维吾尔族女性,行宫颈癌流行病学问卷调查、HPV检测及临床检查.HPV采样分为HPV自我采样和医生采样(会阴、阴道下段、阴道上段、宫颈)两部分.将收集的脱落细胞用第二代杂交捕获技术(HC2)行HPV检测.筛查结果阳性者行阴道镜检查及宫颈组织学检查.比较HPV自我采样和医生采样的灵敏度、特异度、阳性预测值和阴性预测值.结果由于精神紧张和方向错误,2例妇女将HPV取样毛刷折断在阴道内,后通过医生取出.4例妇女报告取样时用力过大,造成阴道少量点滴出血2～3d.经过检查,无下生殖道损伤,但有3例宫颈表面有点滴出血合并严重的生殖道炎症,经过局部用药后症状消失.未发现活动性出血.共纳入883例新疆维吾尔族女性.HPV医生采样(宫颈)与自我采样相比,灵敏度分别为94.12％ (91.74％,96.50％)和88.24％(87.56％,88.92％),特异度分别为94.46％(91.80％,97.12％)和93.84％ (91.66％,96.02％),差异均无统计学意义.宫颈采样的灵敏度高于会阴采样47.06％ (46.94％,47.18％),但与阴道上段采样88.24％ (87.56％,88.92％)、阴道下段采样70.59％(70.42％,70.76％)的灵敏度差异无统计学意义.宫颈采样的特异度与其他部位采样差异无统计学意义,其阳性预测值(x2 =4.653,P=0.031)和阴性预测值(x2=5.009,P =0.025)均高于会阴采样.结论阴道上段HPV自我采样具有与宫颈HPV医生采样相似的效果,可以作为宫颈癌筛查首选的HPV采样方法.宫颈部位采样为HPV采样的最佳部位.
목적 탐색괄합농촌지구화소수민족지구적방편쾌첩유효적인유두류병독(HPV)취양방법,이편제고궁경암사사효솔.방법 채용횡단면정군추양연구적방법,우2006-2007년재신강우전현선택유성생활、16 ～59세적유오이족녀성,행궁경암류행병학문권조사、HPV검측급림상검사.HPV채양분위HPV자아채양화의생채양(회음、음도하단、음도상단、궁경)량부분.장수집적탈락세포용제이대잡교포획기술(HC2)행HPV검측.사사결과양성자행음도경검사급궁경조직학검사.비교HPV자아채양화의생채양적령민도、특이도、양성예측치화음성예측치.결과 유우정신긴장화방향착오,2례부녀장HPV취양모쇄절단재음도내,후통과의생취출.4례부녀보고취양시용력과대,조성음도소량점적출혈2～3d.경과검사,무하생식도손상,단유3례궁경표면유점적출혈합병엄중적생식도염증,경과국부용약후증상소실.미발현활동성출혈.공납입883례신강유오이족녀성.HPV의생채양(궁경)여자아채양상비,령민도분별위94.12％ (91.74％,96.50％)화88.24％(87.56％,88.92％),특이도분별위94.46％(91.80％,97.12％)화93.84％ (91.66％,96.02％),차이균무통계학의의.궁경채양적령민도고우회음채양47.06％ (46.94％,47.18％),단여음도상단채양88.24％ (87.56％,88.92％)、음도하단채양70.59％(70.42％,70.76％)적령민도차이무통계학의의.궁경채양적특이도여기타부위채양차이무통계학의의,기양성예측치(x2 =4.653,P=0.031)화음성예측치(x2=5.009,P =0.025)균고우회음채양.결론 음도상단HPV자아채양구유여궁경HPV의생채양상사적효과,가이작위궁경암사사수선적HPV채양방법.궁경부위채양위HPV채양적최가부위.
Objective To explore the human papilloma virus (HPV) sampling methods to reduce the incidence and mortality of cervical cancer in rural areas and among minority population.Methods A cross-sectional study with the entire cluster sampling method for cervical cancer screening in Yutian County between 2006 and 2007 was conducted.All women with an active sex life were 16-59-years old.With consented epidemiological survey of cervical cancer,eligible women were examined by HPV test and clinical examinations.HPV sampling way was divided into two parts:HPV self-sampling and HPV physician-sampling (vulva,vaginal lower segment,the upper vagina and cervix).Exfoliated cells were collected for HPV test by using the second-generation hybrid capture (HC2).The women with positive results accepted colposcopy and cervical biopsy.Results A total of 883 Uygur women were included in this study.The sensitivity of HPV physician-sampling and self-sampling was 94.12％ (91.74％,96.50％) and 88.24％ (87.56％,88.92％).The specificity of HPV physician-sampling and self-sampling was 94.46％ (91.80％,97.12％) and 93.84％ (91.66％,96.02％).There was no statistical significance in sensitivity and specificity between the two sampling ways.The sensitivity of cervical sampling (94.12％) was higher than that of vulva sampling (47.06％) (46.94％,47.18％),but there was no statistical difference between cervical sampling and upper vaginal sampling (88.24％) (87.56％,88.92％) ; vaginal lower segment sampling was 70.59％ (70.42％,70.76％).The positive predicting values and negative predicting values of cervical sampling were higher than those of vulva sampling.Conclusions HPV self sampling can replace physician sampling.Cervix is the optimistic site for HPV sampling.