人乳头状瘤高危病毒在宫颈癌筛查中的作用(1)
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[摘要] 目的 研究人乳头状瘤高危病毒在宫颈癌筛查中的作用。方法 选取在我院门诊妇科要求宫颈癌筛查的患者1300例，同时行HPV-DNA检测和薄层液基细胞学技术(TCT)，其中任何一项阳性进行阴道镜下活检，活检病理结果为金标准。结果 随着宫颈病变级别的上升，HPV检查的敏感性上升；HPV-DNA检查对宫颈各级病变的敏感性明显高于TCT，对比两种筛查方法对病理结果≥CIN2筛查的敏感度、特异度、阳性预测值、阴性预测值，分别为：HPV-DNA检测96.67%、80.40%、19.27%和99.80%；液基薄层细胞学检查80.00%、85.40%、20.96%和98.88%。结论 在宫颈癌筛查中，HPV-DNA检测较TCT检查更敏感，且阴性预测值更高，是一种首选的高效宫颈癌筛查方法，值得临床推广。
[关键词] 人乳头状瘤病毒；宫颈癌；筛查
[中图分类号] R737.33 [文献标识码] B [文章编号] 1673-9701(2011)33-07-02
The Role of High-risk Human Papillomavirus(HPV) in Screening for Cervical Cancer
GUO Mingyan
Department of Gynecology, Xiangshan County Hospital of Traditional Chinese Medcine in Zhejiang Province, Xiangshan 315700, China
[Abstract] Objective To analyze the role of high-risk human papillomavirus (HPV) in screening for cervical cancer. Methods HPV-DNA and Thinprep Cytology Testings(TCT)were applied in 1300 samples screened for cervical cancer in our hospital. If either of the testing results was positive, colposcope biopsy was carried out and the findings were gold standard. Results With the rising of the grades of cervical lesions, the sensibility of the HPV testings was also increasing; and the sensibility of the HPV-DNA testing for cervical lesions was significantly higher than that of TCT, When pathological findings were≥CIN2, sensibility, specificity, positive predictive value and negative predictive value were respectively 96.67%, 80.40%, 19.27 %, 99.80% in HPV-DNA testing while 80.00%, 85.40%,20.96%, 98.88% in Thinprep cytology test(TCT). Conclusion HPV-DNA testing is more sensitive than TCT testing and has a higher negative predictive value. Therefore, HPV-DNA testing is the first effective method to carry out screening for cervical cancer, which deserves clinical application.
[Key words] Human papillomavirus; Cervical cancer; Screening
宫颈癌是最常见的女性生殖道肿瘤之一，全球每年约有50万新发患者，其病死率居女性肿瘤死亡率的第2位[1]。但宫颈癌的发生是一个渐变的过程，从不典型增生到宫颈癌要经历10年左右时间[2]。从原发人乳头状瘤病毒(human papillomavirus，HPV)感染到发生肿瘤的时间约为20～50年[3]，若此期间及时诊断、正确处理则可阻断癌变的发生。宫颈癌是唯一病因明确的癌症，HPV感染是宫颈癌发生的必要条件。HPV阴性者患病的风险几乎为零[4]。本研究选取在我院门诊妇科要求宫颈癌筛查的患者1300例，同时行HPV-DNA检测和薄层液基细胞学技术(TCT)，对比两种方法在宫颈癌筛选中的作用，现报道如下。
1 资料与方法
1.1 一般资料
选取2009年2月～2011年1月来我院门诊妇科要求宫颈癌筛查的患者1300例，均符合以下条件：无子宫切除史、无身孕、无盆腔放射治疗史、无细胞学检查异常或宫颈上皮内病变史，1年内未参加过宫颈癌普查的未处于月经期的妇女。患者年龄23～65岁 ......
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