高危型人乳头状瘤病毒配合液基薄层细胞学检查在宫颈癌早期癌前病变筛查中的应用价值分析
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摘要
目的研究HR-HPV配合TCT检查在宫颈癌早期癌前病变筛查中的应用价值,为临床诊治提供参考。方法选择2017年1月-2018年6月于本院妇科接诊患者400例纳入观察对象,所有患者均接受HR-HPV、TCT检查,将组织病理学检查结果作为"金标准",对比分析HR-HPV、TCT单独检查与联合检查的灵敏度、特异度及准确率。结果 CINⅠ及炎症患者175例,HR-HPV检查显示阳性患者52例,TCT检查显示73例为NILM,102例为ASCUS及ASC-H、HSIL、LSIL;CINⅡ及CINⅢ、宫颈癌患者为225例,HR-HPV检查显示阳性患者180例,TCT检查显示23例为NILM,202例为ASCUS及ASC-H、HSIL、LSIL;炎症及CINⅠ、CINⅡ、CINⅢ、宫颈癌的HR-HPV检查阳性率逐渐升高,差异有统计学意义(P<0.05);联合检测的灵敏度高于HR-HPV、TCT单独检测,且HR-HPV的诊断灵敏度高于TCT,差异有统计学意义(P<0.05);HR-HPV诊断的阳性预测值、特异度、准确率均高于TCT单独检测、联合检测,差异有统计学意义(P<0.05);不同TCT检查患者HR-HPV阳性率对比差异有统计学意义(P<0.05);NILM多数HR-HPV阴性,而ASC-H、HSIL多见为HR-HPV感染阳性。结论 HR-HPV配合TCT检查在宫颈癌早期癌前病变筛查中的应用价值高,能有效提高宫颈癌早期癌前病变的检出率,减少漏诊率,进而为临床早期防治宫颈癌提供理论基础。
Objective To study the application value of HR-HPV(high-risk human papillomavirus) combined with TCT(liquid-based thin-layer cytology) in the screening of early precancerous lesions of cervical cancer, so as to provide reference for clinical diagnosis and treatment. Methods 400 patients who were treated in the gynaecological clinic of our hospital from January 2017 to June 2018 were selected as the subjects. All the patients were given HR-HPV, TCT examinations, and the results of histopathological examination was set as the gold standard. To compare the sensitivity, specificity and accuracy of HR-HPV, TCT alone and joint examination. Results The pathological diagnosis revealed that there were 175 cases of CIN I and inflammatory patients, of which 52 cases were positive by HR-HPV, while TCT showed that 73 cases were NILM and 102 cases were ASCUS and ASC-H, HSIL and LSIL. 225 patients with cervical cancer were CIN Ⅱ and CIN Ⅲ, of which HR-HPV examination showed 180 positive patients, while TCT examination showed 23 cases of NILM, 202 cases were ASCUS and ASC-H, HSIL, LSIL; The positive rate of HR-HPV in inflammation and CIN I, CIN II, CIN III, and cervical cancer increased gradually, with the differences statistically significant(P<0.05). The sensitivity of combined detection was higher than that of HR-HPV and TCT alone, and the diagnostic sensitivity of HR-HPV was higher than that of TCT, with the differences statistically significant(P<0.05). The positive predictive value, specificity and accuracy in HR-HPV diagnosis were higher than those of TCT alone and combined detection, with the differences statistically significant(P<0.05). There was statistical significance on the difference in the positive rate of HR-HPV infection among patients with different TCT findings(P<0.05). NILM mainly showed negative HR-HPV, while ASC-H and HSIL mainly showed HR-HPV infection. Conclusion The application of HR-HPV combined with TCT in the screening of early precancerous lesions of cervical cancer is high, which can effectively improve the detection rate of early precancerous lesions of cervical cancer, reduce the rate of missed diagnosis, and provide a theoretical basis for early prevention and treatment of cervical cancer.
Objective To study the application value of HR-HPV(high-risk human papillomavirus) combined with TCT(liquid-based thin-layer cytology) in the screening of early precancerous lesions of cervical cancer, so as to provide reference for clinical diagnosis and treatment. Methods 400 patients who were treated in the gynaecological clinic of our hospital from January 2017 to June 2018 were selected as the subjects. All the patients were given HR-HPV, TCT examinations, and the results of histopathological examination was set as the gold standard. To compare the sensitivity, specificity and accuracy of HR-HPV, TCT alone and joint examination. Results The pathological diagnosis revealed that there were 175 cases of CIN I and inflammatory patients, of which 52 cases were positive by HR-HPV, while TCT showed that 73 cases were NILM and 102 cases were ASCUS and ASC-H, HSIL and LSIL. 225 patients with cervical cancer were CIN Ⅱ and CIN Ⅲ, of which HR-HPV examination showed 180 positive patients, while TCT examination showed 23 cases of NILM, 202 cases were ASCUS and ASC-H, HSIL, LSIL; The positive rate of HR-HPV in inflammation and CIN I, CIN II, CIN III, and cervical cancer increased gradually, with the differences statistically significant(P<0.05). The sensitivity of combined detection was higher than that of HR-HPV and TCT alone, and the diagnostic sensitivity of HR-HPV was higher than that of TCT, with the differences statistically significant(P<0.05). The positive predictive value, specificity and accuracy in HR-HPV diagnosis were higher than those of TCT alone and combined detection, with the differences statistically significant(P<0.05). There was statistical significance on the difference in the positive rate of HR-HPV infection among patients with different TCT findings(P<0.05). NILM mainly showed negative HR-HPV, while ASC-H and HSIL mainly showed HR-HPV infection. Conclusion The application of HR-HPV combined with TCT in the screening of early precancerous lesions of cervical cancer is high, which can effectively improve the detection rate of early precancerous lesions of cervical cancer, reduce the rate of missed diagnosis, and provide a theoretical basis for early prevention and treatment of cervical cancer.
引文
[1] 曹立萍.HPV-DNA分型联合宫颈脱落细胞类型检测在宫颈癌早期诊断中的价值[J].贵州医科大学学报,2015,40(12):1046-1048.
[2] 姜仙姣,李奕平,牟虹.TCT联合HPV分型检测在宫颈癌前病变筛查中的应用分析[J].浙江临床医学,2017,19(3):481-482.
[3] Rijkaart DC,Heideman DAM,Coupe VMH,et al.High-risk human papillomavirus (hr HPV) E6 / E7 mRNA testing by Pre Tect HPV-Proofer for detection of cervical high-grade intraepithelial neoplasia and cancer among hr HPV DNA-positive women with normal cytology[J].J Clin Microbiol,2012,50(7):2390-2396.
[4] 陶志梅,潘敏,俞美娟,等.高危型人乳头瘤病毒感染联合液基薄层细胞检测对宫颈癌及宫颈癌前病变筛查与随访的临床意义[J].中华医院感染学杂志,2017,27(10):2340-2343.
[5] 王琳.高危型HPV检测及TCT检查在宫颈癌筛查和诊断中的应用[J].中国医药导刊,2017,19(2):128-129.
[6] 张建宏.基于TCT标本检测高危型HPV-DNA和HPVE6/E7mRNA在宫颈病变中的临床价值研究[J].现代实用医学,2017,29(3):311-312.
[7] 师晓艳,雷侠.宫颈液基细胞学检查与高危型HPV检测用于宫颈癌前病变并发感染早期筛查的对比研究[J].中国性科学,2017,26(1):33-35.
[8] 叶丽君,喻长法,蔡莎莎,等.高危型人乳头瘤病毒E6/E7mRNA联合液基细胞学检查在宫颈病变诊断中的应用[J].中国慢性病预防与控制,2017,25(7):499-501.
[9] 许育绚,崔永胜,耿建祥,等.968例宫颈细胞中人乳头瘤病毒E6/E7mRNA基因分析[J].中国妇幼保健,2015,30(4):617-619.
[10] 张永欣,张璐.人乳头瘤病毒 E6/E7 mRNA检测在宫颈癌筛查中的意义[J].中国妇幼健康研究,2016,27(7):816-818,830.
[11] 陈海迎,郑小冬,吕杰强,等.高危型人乳头瘤病毒E6/E7检测在宫颈细胞学ASC-US分流管理中的应用[J].中国妇幼保健,2015,30(35):6186-6188.
[12] 沈丽蕊,游平弟,毛瑛玉,等.HPV E6/E7 mRNA与HPV-DNA检测技术在宫颈病变筛查中的诊断效度比较[J].中外医学研究,2017,15(29):75-77.
[13] 王竟,孙海珠,徐爱丽,等.宫颈癌前病变早期筛查技术新进展[J].中国综合临床,2018,34(2):189-192.
[14] 徐舜,陈洁瑛,江海燕,等.宫颈癌前病变HPV感染与宫颈液基细胞早期筛查的临床分析[J].中华医院感染学杂志,2017,27(20):4739-4742.
[15] 李玲,张秋莹,刘杨.人乳头状瘤病毒持续感染状态下E6,E7 蛋白 mRNA 在宫颈癌不同分期的表达结果[J].检验医学与临床,2016,13 (4):514-516.
[16] 黄宝英,周伦顺,富显果.HPV E6 /E7 mRNA 检测对宫颈癌筛查意义的初步评价[J].中华肿瘤防治杂志,2013,20(14):1061-1064.
[17] Ronco G,Dillner J,Elfstrom KM,et al.Efficacy of HPV-based screening for prevention of invasive cervical cancer :follow-up of four European randomised controlled trials[J].Lancet,2014,383(9916):524-532.
[18] 李剑,曲芃芃.HPV E6/E7 m RNA与 HPV DNA 检测在宫颈癌早期筛查中的临床价值[J].天津医药,2016,44(4):466-469.
[19] 王丹,李一春,刘霞,等.人乳头瘤病毒E6/E7mRNA表达联合液基薄层细胞学检测对宫颈癌早期筛查和诊断的意义[J].中国妇幼保健,2017,32 (24):6147-6150.
[20] 王玉兰,彭梅,冯楠,等.人乳头瘤病毒52/58 E6/E7 mRNA检测对宫颈组织病理级别诊断的价值[J].中国药物与临床,2017,17(11):1683-1685.
[21] 钟兴明,杜明娣,荆春霞,等.高危型HPV持续感染与宫颈癌前病变的相关性[J].中国热带医学,2018,18(3):267-270.
[22] 汪晓菁.液基细胞学检查联合人乳头瘤病毒检测诊断宫颈癌前病变的临床价值[J].中国妇幼保健,2017,32(21):5443-5446.
[23] 尤小燕,王雅莉,刘文枝,等.高危型HPV联合细胞学检测在宫颈癌及癌前病变筛查中临床意义[J].实用预防医学,2017,24(8):986-988.
[24] 陶志梅,潘敏,俞美娟,等.高危型人乳头瘤病毒感染联合液基薄层细胞检测对宫颈癌及宫颈癌前病变筛查与随访的临床意义[J].中华医院感染学杂志,2017,27(10):2340-2343.
[2] 姜仙姣,李奕平,牟虹.TCT联合HPV分型检测在宫颈癌前病变筛查中的应用分析[J].浙江临床医学,2017,19(3):481-482.
[3] Rijkaart DC,Heideman DAM,Coupe VMH,et al.High-risk human papillomavirus (hr HPV) E6 / E7 mRNA testing by Pre Tect HPV-Proofer for detection of cervical high-grade intraepithelial neoplasia and cancer among hr HPV DNA-positive women with normal cytology[J].J Clin Microbiol,2012,50(7):2390-2396.
[4] 陶志梅,潘敏,俞美娟,等.高危型人乳头瘤病毒感染联合液基薄层细胞检测对宫颈癌及宫颈癌前病变筛查与随访的临床意义[J].中华医院感染学杂志,2017,27(10):2340-2343.
[5] 王琳.高危型HPV检测及TCT检查在宫颈癌筛查和诊断中的应用[J].中国医药导刊,2017,19(2):128-129.
[6] 张建宏.基于TCT标本检测高危型HPV-DNA和HPVE6/E7mRNA在宫颈病变中的临床价值研究[J].现代实用医学,2017,29(3):311-312.
[7] 师晓艳,雷侠.宫颈液基细胞学检查与高危型HPV检测用于宫颈癌前病变并发感染早期筛查的对比研究[J].中国性科学,2017,26(1):33-35.
[8] 叶丽君,喻长法,蔡莎莎,等.高危型人乳头瘤病毒E6/E7mRNA联合液基细胞学检查在宫颈病变诊断中的应用[J].中国慢性病预防与控制,2017,25(7):499-501.
[9] 许育绚,崔永胜,耿建祥,等.968例宫颈细胞中人乳头瘤病毒E6/E7mRNA基因分析[J].中国妇幼保健,2015,30(4):617-619.
[10] 张永欣,张璐.人乳头瘤病毒 E6/E7 mRNA检测在宫颈癌筛查中的意义[J].中国妇幼健康研究,2016,27(7):816-818,830.
[11] 陈海迎,郑小冬,吕杰强,等.高危型人乳头瘤病毒E6/E7检测在宫颈细胞学ASC-US分流管理中的应用[J].中国妇幼保健,2015,30(35):6186-6188.
[12] 沈丽蕊,游平弟,毛瑛玉,等.HPV E6/E7 mRNA与HPV-DNA检测技术在宫颈病变筛查中的诊断效度比较[J].中外医学研究,2017,15(29):75-77.
[13] 王竟,孙海珠,徐爱丽,等.宫颈癌前病变早期筛查技术新进展[J].中国综合临床,2018,34(2):189-192.
[14] 徐舜,陈洁瑛,江海燕,等.宫颈癌前病变HPV感染与宫颈液基细胞早期筛查的临床分析[J].中华医院感染学杂志,2017,27(20):4739-4742.
[15] 李玲,张秋莹,刘杨.人乳头状瘤病毒持续感染状态下E6,E7 蛋白 mRNA 在宫颈癌不同分期的表达结果[J].检验医学与临床,2016,13 (4):514-516.
[16] 黄宝英,周伦顺,富显果.HPV E6 /E7 mRNA 检测对宫颈癌筛查意义的初步评价[J].中华肿瘤防治杂志,2013,20(14):1061-1064.
[17] Ronco G,Dillner J,Elfstrom KM,et al.Efficacy of HPV-based screening for prevention of invasive cervical cancer :follow-up of four European randomised controlled trials[J].Lancet,2014,383(9916):524-532.
[18] 李剑,曲芃芃.HPV E6/E7 m RNA与 HPV DNA 检测在宫颈癌早期筛查中的临床价值[J].天津医药,2016,44(4):466-469.
[19] 王丹,李一春,刘霞,等.人乳头瘤病毒E6/E7mRNA表达联合液基薄层细胞学检测对宫颈癌早期筛查和诊断的意义[J].中国妇幼保健,2017,32 (24):6147-6150.
[20] 王玉兰,彭梅,冯楠,等.人乳头瘤病毒52/58 E6/E7 mRNA检测对宫颈组织病理级别诊断的价值[J].中国药物与临床,2017,17(11):1683-1685.
[21] 钟兴明,杜明娣,荆春霞,等.高危型HPV持续感染与宫颈癌前病变的相关性[J].中国热带医学,2018,18(3):267-270.
[22] 汪晓菁.液基细胞学检查联合人乳头瘤病毒检测诊断宫颈癌前病变的临床价值[J].中国妇幼保健,2017,32(21):5443-5446.
[23] 尤小燕,王雅莉,刘文枝,等.高危型HPV联合细胞学检测在宫颈癌及癌前病变筛查中临床意义[J].实用预防医学,2017,24(8):986-988.
[24] 陶志梅,潘敏,俞美娟,等.高危型人乳头瘤病毒感染联合液基薄层细胞检测对宫颈癌及宫颈癌前病变筛查与随访的临床意义[J].中华医院感染学杂志,2017,27(10):2340-2343.