液基细胞学检查联合人乳头状瘤病毒DNA检测在宫颈癌变早期筛查中的作用及其意义
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摘要
目的探讨液基薄层细胞学检查(TCT)联合人乳头状瘤病毒(HPV)DNA检测在宫颈病变筛查诊断中的作用及其临床意义。方法采用TCT联合HPV DNA检测对2856例女性进行宫颈癌变筛查,筛查阳性者再行阴道镜检查及组织病理学检查,分析HPV DNA检测与组织病理学结果,对HPV DNA结果与TCT结果进行相关性分析。结果 2856例受检者中,TCT阳性者144例(5.04%),其中非典型鳞状上皮细胞(ASC)79例(2.77%);低度鳞状上皮细胞内病变(LSIL)54例(1.90%);高度鳞状上皮细胞内病变(HSIL)11例(0.39%)。各组平均年龄比较,差异有统计学意义(F=17.984,P<0.01)。HPV检测结果显示,HPV高危型感染607例(21.25%);HPV低危型感染125例(4.38%);HPV阴性2124例(74.37%)。各组平均年龄比较,差异有统计学意义(F=11.045,P<0.01)。HPV高危组年龄显著低于HPV阴性组,差异有统计学意义(F=11.758,P<0.001)。HPV高危型组与HPV低危型组TCT结果比较,差异有统计学意义(χ~2=16.946,P<0.01)。宫颈活检组织病理学检查133例,118例有不同程度宫颈病变。不同宫颈病变类型的组织病理学结果比较,差异有统计学意义(χ~2=42.41,P<0.01);不同HPV类型的组织病理学结果比较,差异有统计学意义(χ~2=329.935,P<0.01)。结论 TCT联合HPV DNA检测在早期宫颈病变筛查中具有重要意义,在检出率以及检测敏感性方面均优于单一检测,值得临床推广。
Objective To investigate the role of liquid-based thin-layer cytology(TCT) combined with human papillomavirus(HPV)DNA detection in the diagnosis of cervical lesions and its clinical significance. Methods A total of 2856 women were selected in this large sample study. They all had both TST and HPV DNA test for cervical disease screening. Those with positive results further had colposcopy and histopathological examination. The correlation between the results was analyzed. Results Of the 2856 subjects, 144 were positive for TCT, accounting for 5.04%. Among them, 79 cases had atypical squamous epithelial cells(ASC), accounting for 2.77% of the total number, 54 cases with low-grade squamous intraepithelial lesions(LSIL), accounting for 1.90%, and 11 cases with high-grade squamous intraepithelial lesions(HSIL), accounting for 0.39%. There were significant differences in the mean age between the subgroups(F=17.984,P<0.01). HPV test results showed that 607 cases suffered from high-risk HPV infection, accounting for 21.25%. There were 125 cases of low-risk HPV infection and 2124 cases of HPV-negative, accounting for 4.38% and 74.37% respectively. The mean age of each subgroup was significantly different from each other(F=11.045, P<0.01). There was also a significant difference in age between the HPV negative group and the HPV high-risk group(F=11.758, P<0.001), and the age of the high-risk group was significantly lower than that of the HPV negative group. In addition, there was a significant difference in TCT results between the HPV high-risk group and the HPV low-risk group(χ~2=16.946, P<0.01). A total of 133 cases finally got cervical biopsy histopathological examination.118 of them had different degrees of cervical lesions. The histopathological results were significantly different between subgroups of different TCT results(χ~2=42.41, P<0.01),and between the subgroups of different HPV results(χ~2=329.94, P<0.01). Conclusion TCT combined with HPV DNA detection is the best choice for early cervical lesion screening. The detection rate and sensitivity of the combination detection are better than those of the single detection method. It is worthy of strengthening promotion and application in clinical practice.
Objective To investigate the role of liquid-based thin-layer cytology(TCT) combined with human papillomavirus(HPV)DNA detection in the diagnosis of cervical lesions and its clinical significance. Methods A total of 2856 women were selected in this large sample study. They all had both TST and HPV DNA test for cervical disease screening. Those with positive results further had colposcopy and histopathological examination. The correlation between the results was analyzed. Results Of the 2856 subjects, 144 were positive for TCT, accounting for 5.04%. Among them, 79 cases had atypical squamous epithelial cells(ASC), accounting for 2.77% of the total number, 54 cases with low-grade squamous intraepithelial lesions(LSIL), accounting for 1.90%, and 11 cases with high-grade squamous intraepithelial lesions(HSIL), accounting for 0.39%. There were significant differences in the mean age between the subgroups(F=17.984,P<0.01). HPV test results showed that 607 cases suffered from high-risk HPV infection, accounting for 21.25%. There were 125 cases of low-risk HPV infection and 2124 cases of HPV-negative, accounting for 4.38% and 74.37% respectively. The mean age of each subgroup was significantly different from each other(F=11.045, P<0.01). There was also a significant difference in age between the HPV negative group and the HPV high-risk group(F=11.758, P<0.001), and the age of the high-risk group was significantly lower than that of the HPV negative group. In addition, there was a significant difference in TCT results between the HPV high-risk group and the HPV low-risk group(χ~2=16.946, P<0.01). A total of 133 cases finally got cervical biopsy histopathological examination.118 of them had different degrees of cervical lesions. The histopathological results were significantly different between subgroups of different TCT results(χ~2=42.41, P<0.01),and between the subgroups of different HPV results(χ~2=329.94, P<0.01). Conclusion TCT combined with HPV DNA detection is the best choice for early cervical lesion screening. The detection rate and sensitivity of the combination detection are better than those of the single detection method. It is worthy of strengthening promotion and application in clinical practice.
引文
[1]殷霞,狄文.宫颈癌筛查的新进展[J].国外医学(妇幼保健分册), 2005, 16(2):103-105. doi:10.3969/j. issn.1673-5293.2005.02.016.
[2]卢振华.宫颈癌常用筛查技术综述[J].检验医学与临床,2011, 8(2):206-208. doi:10.3969/j. issn.1672-9455.2011.02.046.
[3]Sawaya GF, Brown AD, Washington AE, et al. Clinical practice. Current approaches to cervical-cancer screening[J]. N Engl J Med, 2001, 344(21):1603-1607. doi:10.1056/NEJM200105243442107.
[4]Lu Z, Chen J. Introduction of WHO classification of tumours of female reproductive organs, fourth edition[J]. Zhonghua Bing Li Xue Za Zhi, 2014, 43(10):649-650. doi:10.3760/cma. j. issa0529-5807.2014.10.001.
[5]黄晨玲子,罗新.清除下生殖道高危型人乳头瘤病毒感染的可行性与必要性[J].中国计划生育和妇产科, 2016,8(9):8-10, 23. doi:10.3969/j. issn.1674-4020.2016.09.03.
[6]温开镇,张荣君,吴淑玲,等.人乳头状瘤病毒基因分型联合薄层液基细胞学检测在宫颈病变筛查中的应用[J].国际检验医学杂志, 2015, 36(11):1518-1519, 1522. doi:10.3969/j. issn.1673-4130.2015.11.016.
[7]Siriaunkgul S, Settakorn J, Sukpan K, et al. Populationbased cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in northern Thailand[J].Asian Pac J Cancer Prev, 2014, 15(16):6837-6842. doi:10.1097/01. PAT.0000454334.20620.60.
[8]任红娟,王运贤,刘志远.南阳市人乳头状瘤病毒分型感染调查[J].中国妇幼保健, 2015, 30(34):6086-6088.doi:10.7620/zgfybj. j. issn.1001-4411.2015.34.57.
[9]朱彩英,刁雯静,汪清,等.上海市475例宫颈鳞状上皮内病变患者HPV型别分布状况分析[J].复旦学报(医学版), 2016,43(4):447-452. doi:10.3969/j. issn.1672-8467.2016.04.011.
[10]俞玫君,刘巧英,吴玉坤.高危妇女人群宫颈癌病变认知程度及接种HPV疫苗预防效果调查研究[J].中国妇幼保健, 2017, 32(1):145-148. doi:10.7620/zgfybj. j.issn.1001-4411.2017.01.51.
[11]王卡娜,郄明蓉. HPV治疗性疫苗研究现状[J].实用妇产科杂志, 2017, 33(2):89-91.
[12]潘敏,邓再兴,桂启芳.液基细胞学联合高危型人乳头状瘤病毒-DNA检测在早期宫颈癌及癌前病变诊断中的临床价值[J].中国卫生检验杂志, 2017, 27(15):2208-2210.
[13]Holthoff ER, Jeffus SK, Gehlot A, et al. Perineural Invasion Is an Independent Pathologic Indicator of Recurrence in Vulvar Squamous Cell Carcinoma[J]. Am J Surg Pathol, 2015, 39(8):1070-1074. doi:10.1097/PAS.0000000000000422.
[14]Capek S, Howe BM, Froemming AT, et al. Perineural spread in pelvic malignancies can be an alternate explanation for pelvic bony metastases rather than hematogenous spread.A report of two cases[J]. Skeletal Radiol, 2015, 44(9):1365-1370. doi:10.1007/s00256-015-2143-3.
[15]Latsuzbaia A, Hebette G, Fischer M, et al. Introduction of liquid-based cytology and human papillomavirus testing in cervical cancer screening in Luxembourg[J]. Diagn Cytopathol, 2017, 45(5):384-390. doi:10.1002/dc.23678.
[16]王勇,张蔚,黄玥,等.人乳头状瘤病毒DNA联合薄层液基细胞学检查在宫颈癌及早期宫颈病变筛查中的价值[J].中华实用诊断与治疗杂志, 2015, 29(11):1125-1127.doi:10.13507/j. issn.1674-3474.2015.11.031.
[17]Saville AM. Cervical cancer prevention in Australia:Planning for the future[J]. Cancer Cytopathol, 2016, 124(4):235-240. doi:10.1002/cncy.21643.
[2]卢振华.宫颈癌常用筛查技术综述[J].检验医学与临床,2011, 8(2):206-208. doi:10.3969/j. issn.1672-9455.2011.02.046.
[3]Sawaya GF, Brown AD, Washington AE, et al. Clinical practice. Current approaches to cervical-cancer screening[J]. N Engl J Med, 2001, 344(21):1603-1607. doi:10.1056/NEJM200105243442107.
[4]Lu Z, Chen J. Introduction of WHO classification of tumours of female reproductive organs, fourth edition[J]. Zhonghua Bing Li Xue Za Zhi, 2014, 43(10):649-650. doi:10.3760/cma. j. issa0529-5807.2014.10.001.
[5]黄晨玲子,罗新.清除下生殖道高危型人乳头瘤病毒感染的可行性与必要性[J].中国计划生育和妇产科, 2016,8(9):8-10, 23. doi:10.3969/j. issn.1674-4020.2016.09.03.
[6]温开镇,张荣君,吴淑玲,等.人乳头状瘤病毒基因分型联合薄层液基细胞学检测在宫颈病变筛查中的应用[J].国际检验医学杂志, 2015, 36(11):1518-1519, 1522. doi:10.3969/j. issn.1673-4130.2015.11.016.
[7]Siriaunkgul S, Settakorn J, Sukpan K, et al. Populationbased cervical cancer screening using high-risk HPV DNA test and liquid-based cytology in northern Thailand[J].Asian Pac J Cancer Prev, 2014, 15(16):6837-6842. doi:10.1097/01. PAT.0000454334.20620.60.
[8]任红娟,王运贤,刘志远.南阳市人乳头状瘤病毒分型感染调查[J].中国妇幼保健, 2015, 30(34):6086-6088.doi:10.7620/zgfybj. j. issn.1001-4411.2015.34.57.
[9]朱彩英,刁雯静,汪清,等.上海市475例宫颈鳞状上皮内病变患者HPV型别分布状况分析[J].复旦学报(医学版), 2016,43(4):447-452. doi:10.3969/j. issn.1672-8467.2016.04.011.
[10]俞玫君,刘巧英,吴玉坤.高危妇女人群宫颈癌病变认知程度及接种HPV疫苗预防效果调查研究[J].中国妇幼保健, 2017, 32(1):145-148. doi:10.7620/zgfybj. j.issn.1001-4411.2017.01.51.
[11]王卡娜,郄明蓉. HPV治疗性疫苗研究现状[J].实用妇产科杂志, 2017, 33(2):89-91.
[12]潘敏,邓再兴,桂启芳.液基细胞学联合高危型人乳头状瘤病毒-DNA检测在早期宫颈癌及癌前病变诊断中的临床价值[J].中国卫生检验杂志, 2017, 27(15):2208-2210.
[13]Holthoff ER, Jeffus SK, Gehlot A, et al. Perineural Invasion Is an Independent Pathologic Indicator of Recurrence in Vulvar Squamous Cell Carcinoma[J]. Am J Surg Pathol, 2015, 39(8):1070-1074. doi:10.1097/PAS.0000000000000422.
[14]Capek S, Howe BM, Froemming AT, et al. Perineural spread in pelvic malignancies can be an alternate explanation for pelvic bony metastases rather than hematogenous spread.A report of two cases[J]. Skeletal Radiol, 2015, 44(9):1365-1370. doi:10.1007/s00256-015-2143-3.
[15]Latsuzbaia A, Hebette G, Fischer M, et al. Introduction of liquid-based cytology and human papillomavirus testing in cervical cancer screening in Luxembourg[J]. Diagn Cytopathol, 2017, 45(5):384-390. doi:10.1002/dc.23678.
[16]王勇,张蔚,黄玥,等.人乳头状瘤病毒DNA联合薄层液基细胞学检查在宫颈癌及早期宫颈病变筛查中的价值[J].中华实用诊断与治疗杂志, 2015, 29(11):1125-1127.doi:10.13507/j. issn.1674-3474.2015.11.031.
[17]Saville AM. Cervical cancer prevention in Australia:Planning for the future[J]. Cancer Cytopathol, 2016, 124(4):235-240. doi:10.1002/cncy.21643.