中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2015年
4期
246-252
,共7页
马莉%丛笑%卞美璐%石劢%王秀红%刘军%刘海燕
馬莉%叢笑%卞美璐%石勱%王秀紅%劉軍%劉海燕
마리%총소%변미로%석매%왕수홍%류군%류해연
宫颈肿瘤%宫颈上皮内瘤样病变%乳头状瘤病毒科%细胞学技术%阴道涂片%活组织检查%普查
宮頸腫瘤%宮頸上皮內瘤樣病變%乳頭狀瘤病毒科%細胞學技術%陰道塗片%活組織檢查%普查
궁경종류%궁경상피내류양병변%유두상류병독과%세포학기술%음도도편%활조직검사%보사
Uterine cervical neoplasms%Cervical intraepithelial eoplasia%Papillomaviridae%Cytological techniques%Vaginal smears%Biopsy%Mass screening
目的探讨高危型HPV分型检测作为子宫颈癌及其癌前病变初筛手段的可行性。方法2013年1月—2014年6月,在中日友好医院妇科门诊就诊且自愿接受高危型HPV分型检测的妇女共15192例,其年龄为(33±8)岁,高危型HPV分型检测采用荧光PCR技术,可检测13种高危型HPV亚型,包括HPV16、18、31、33、35、39、45、51、52、56、58、59和68型;对其中4315例行液基细胞学(LCT)检查;在HPV分型检测阳性患者(共2366例)中,对其中LCT检查阳性、LCT检查阴性但HPV16型阳性、非HPV16阳性但临床症状明确者(共648例)行阴道镜下活检后病理检查,将病理诊断≥子宫颈上皮内瘤变(CIN)Ⅱ或≥子宫颈腺上皮内瘤变(CGIN)Ⅱ者视为病理检查阳性,病理诊断≤CINⅠ或≤CGINⅠ者视为病理检查阴性。(1)分析15192例妇女高危型HPV感染状况。(2)以病理诊断为诊断子宫颈病变的“金标准”,分析高危型HPV感染及其病毒负荷量与子宫颈病变的关系。(3)评价高危型HPV分型检测作为子宫颈癌及其癌前病变初筛手段的价值。结果(1)接受HPV分型检测的15192例妇女中,HPV阳性(即感染)2366例,总感染率为15.57%(2366/15192)。其中,HPV单一亚型感染者1767例,单一亚型感染率为11.63%(1767/15192);HPV多重感染(即两种及以上亚型感染)者599例,多重感染率为3.94%(599/15192)。13种HPV亚型中,感染率最高的3种亚型依次为HPV16、52、58型,其感染率分别为3.95%(600/15192)、2.86%(435/15192)和2.67%(406/15192)。(2)以病理诊断为金标准,与≥CIN Ⅱ病变最相关的亚型是HPV16、52和58型,占所有≥CINⅡ病变的57.7%(154/267);与≥CGINⅡ病变最相关的亚型是HPV18型,3例≥CGINⅡ病变均为单一HPV18型感染。在HPV病毒负荷量≤103拷贝数/104个细胞的患者中,病理检查阳性患者所占比例为18.2%(25/137),而在HPV病毒负荷量≥104拷贝数/104个细胞的患者中,病理检查阳性患者所占比例则为33.3%(247/742),两者比较,差异有统计学意义(χ2=27.06,P=0.000)。(3)HPV分型检测筛查子宫颈癌及其癌前病变的敏感度为96.11%,特异度为85.76%,阳性预测值为30.94%,阴性预测值为99.70%。结论高危型HPV分型检测在子宫颈癌及其癌前病变的筛查中具有指导意义,HPV16、52和58型感染者发生≥CINⅡ病变的可能性大,HPV18型虽不是主要HPV感染亚型,但其与≥CGINⅡ病变密切相关。在有条件的医院,机会性筛查首选HPV分型检测作为初筛手段是可行的。
目的探討高危型HPV分型檢測作為子宮頸癌及其癌前病變初篩手段的可行性。方法2013年1月—2014年6月,在中日友好醫院婦科門診就診且自願接受高危型HPV分型檢測的婦女共15192例,其年齡為(33±8)歲,高危型HPV分型檢測採用熒光PCR技術,可檢測13種高危型HPV亞型,包括HPV16、18、31、33、35、39、45、51、52、56、58、59和68型;對其中4315例行液基細胞學(LCT)檢查;在HPV分型檢測暘性患者(共2366例)中,對其中LCT檢查暘性、LCT檢查陰性但HPV16型暘性、非HPV16暘性但臨床癥狀明確者(共648例)行陰道鏡下活檢後病理檢查,將病理診斷≥子宮頸上皮內瘤變(CIN)Ⅱ或≥子宮頸腺上皮內瘤變(CGIN)Ⅱ者視為病理檢查暘性,病理診斷≤CINⅠ或≤CGINⅠ者視為病理檢查陰性。(1)分析15192例婦女高危型HPV感染狀況。(2)以病理診斷為診斷子宮頸病變的“金標準”,分析高危型HPV感染及其病毒負荷量與子宮頸病變的關繫。(3)評價高危型HPV分型檢測作為子宮頸癌及其癌前病變初篩手段的價值。結果(1)接受HPV分型檢測的15192例婦女中,HPV暘性(即感染)2366例,總感染率為15.57%(2366/15192)。其中,HPV單一亞型感染者1767例,單一亞型感染率為11.63%(1767/15192);HPV多重感染(即兩種及以上亞型感染)者599例,多重感染率為3.94%(599/15192)。13種HPV亞型中,感染率最高的3種亞型依次為HPV16、52、58型,其感染率分彆為3.95%(600/15192)、2.86%(435/15192)和2.67%(406/15192)。(2)以病理診斷為金標準,與≥CIN Ⅱ病變最相關的亞型是HPV16、52和58型,佔所有≥CINⅡ病變的57.7%(154/267);與≥CGINⅡ病變最相關的亞型是HPV18型,3例≥CGINⅡ病變均為單一HPV18型感染。在HPV病毒負荷量≤103拷貝數/104箇細胞的患者中,病理檢查暘性患者所佔比例為18.2%(25/137),而在HPV病毒負荷量≥104拷貝數/104箇細胞的患者中,病理檢查暘性患者所佔比例則為33.3%(247/742),兩者比較,差異有統計學意義(χ2=27.06,P=0.000)。(3)HPV分型檢測篩查子宮頸癌及其癌前病變的敏感度為96.11%,特異度為85.76%,暘性預測值為30.94%,陰性預測值為99.70%。結論高危型HPV分型檢測在子宮頸癌及其癌前病變的篩查中具有指導意義,HPV16、52和58型感染者髮生≥CINⅡ病變的可能性大,HPV18型雖不是主要HPV感染亞型,但其與≥CGINⅡ病變密切相關。在有條件的醫院,機會性篩查首選HPV分型檢測作為初篩手段是可行的。
목적탐토고위형HPV분형검측작위자궁경암급기암전병변초사수단적가행성。방법2013년1월—2014년6월,재중일우호의원부과문진취진차자원접수고위형HPV분형검측적부녀공15192례,기년령위(33±8)세,고위형HPV분형검측채용형광PCR기술,가검측13충고위형HPV아형,포괄HPV16、18、31、33、35、39、45、51、52、56、58、59화68형;대기중4315례행액기세포학(LCT)검사;재HPV분형검측양성환자(공2366례)중,대기중LCT검사양성、LCT검사음성단HPV16형양성、비HPV16양성단림상증상명학자(공648례)행음도경하활검후병리검사,장병리진단≥자궁경상피내류변(CIN)Ⅱ혹≥자궁경선상피내류변(CGIN)Ⅱ자시위병리검사양성,병리진단≤CINⅠ혹≤CGINⅠ자시위병리검사음성。(1)분석15192례부녀고위형HPV감염상황。(2)이병리진단위진단자궁경병변적“금표준”,분석고위형HPV감염급기병독부하량여자궁경병변적관계。(3)평개고위형HPV분형검측작위자궁경암급기암전병변초사수단적개치。결과(1)접수HPV분형검측적15192례부녀중,HPV양성(즉감염)2366례,총감염솔위15.57%(2366/15192)。기중,HPV단일아형감염자1767례,단일아형감염솔위11.63%(1767/15192);HPV다중감염(즉량충급이상아형감염)자599례,다중감염솔위3.94%(599/15192)。13충HPV아형중,감염솔최고적3충아형의차위HPV16、52、58형,기감염솔분별위3.95%(600/15192)、2.86%(435/15192)화2.67%(406/15192)。(2)이병리진단위금표준,여≥CIN Ⅱ병변최상관적아형시HPV16、52화58형,점소유≥CINⅡ병변적57.7%(154/267);여≥CGINⅡ병변최상관적아형시HPV18형,3례≥CGINⅡ병변균위단일HPV18형감염。재HPV병독부하량≤103고패수/104개세포적환자중,병리검사양성환자소점비례위18.2%(25/137),이재HPV병독부하량≥104고패수/104개세포적환자중,병리검사양성환자소점비례칙위33.3%(247/742),량자비교,차이유통계학의의(χ2=27.06,P=0.000)。(3)HPV분형검측사사자궁경암급기암전병변적민감도위96.11%,특이도위85.76%,양성예측치위30.94%,음성예측치위99.70%。결론고위형HPV분형검측재자궁경암급기암전병변적사사중구유지도의의,HPV16、52화58형감염자발생≥CINⅡ병변적가능성대,HPV18형수불시주요HPV감염아형,단기여≥CGINⅡ병변밀절상관。재유조건적의원,궤회성사사수선HPV분형검측작위초사수단시가행적。
Objective To explored high-risk HPV genotyping PCR testing whether as a feasible means for the early screening of cervical cancer and precancerous lesions. Methods From January 2013 to June 2014, 15 192 outpatients in China-Japan Friendship Hospital voluntary were tested by high-risk type HPV genotyping PCR. The average age of them were (33±8) years old. High-risk HPV types genotyping PCR tested by fluorescence PCR technology,in which 13 kinds of high-risk HPV subtypes were detected, <br> including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. A total of 4 315 cases of them were tested by the liquid-based cytology (LCT), among them with positive of high-risk HPV genotyping tested by PCR (n=2 366) were biopsy under colposcope (648 cases) in those LCT results were positive or LCT negative but HPV16 positive or LCT negative but had the clear clinical symptoms or and non-HPV16 positive but with clear clinical symptoms. (1) Analysis high-risk HPV infection status of 15 192 women.(2)As the pathological diagnosis was the gold standard in the diagnosis of cervical lesions, analysis of the relationship among high-risk HPV infection,virus loads and cervical lesions. (3) To evaluated the value of high-risk HPV genotyping PCR tested method in screening of cervical cancer and precancerous lesions. Results ⑴ Of 15 192 cases tested by high-risk HPV genotyping PCR, 2 366 cases were HPV positive (HPV infection), the overall infection rate was 15.57%(2 366/15 192), in which a single subtype of HPV infection in 1 767 cases, infection rate was 11.63%(1 767/15 192), and multiple subtypes of HPV infection (two and more subtypes HPV infection) in 599 cases, infection rate was 3.94%(599/15 192). The HPV16, 52 and 58 infections were the most common HPV subtypes in 13 subtypes, the infection rate was 3.95% (600/15 192), 2.86%(435/15 192) and 2.67% (406/15 192), respectively. (2) The most relevant subtypes with cervical intraepithelial neoplasia (CIN)Ⅱand even higher lesion were HPV16, 52 and 58, accounted for 57.7%(154/267) of all above CINⅡlesions. The most relevant subtype with the cervical glandular intraepithelial neoplasia (CGIN) Ⅱ or above lesions was HPV18, 3 cases with CGIN Ⅱ or above lesions were all single HPV18 infection. The pathologic examination positive percentage of patients which HPV virus loads≤103 copys/104 cells was 18.2%(25/137), while the pathologic examination positive proportion was 33.3%(247/742) which HPV virus loads≥104 copys/104 cells , there was statistically significant difference between them (χ2=27.06, P=0.000).(3)Sensitivity, specificity, positive predictive value and negative predictive value for detection of CINⅡ or above using HPV genotyping PCR were 96.11%, 85.76%, 30.94% and 99.70%, respectively. Conclusions There were a guiding significance for high-risk HPV genotyping PCR tested in screening of cervical cancer and precancerous lesion. HPV16, 52 and 58 were related to the severe cervical squamous epithelial lesions, while HPV18 was related to cervical severe glandular cell pathological changes. HPV genotyping is feasible and economical as the first choice of opportunistic screening in tertiary hospitals.