摘要
为探讨电视阴道镜，HPV16,18(Human Papillomavirus)，HSVⅡ(Herpes simplex virus)诊断宫颈癌及癌前病变的价值。本研究对87例可疑宫颈病变的妇女常规行电视阴道镜检查，并对可疑病变行多点活组织检查，同时采用聚合酶链反应技术(PCR)检测HPV16,18-DNA，HSVⅡ-DNA，并对16例经病理证实的宫颈癌患者行放疗前后的HPV-DNA检测。结果显示：HPV16,18-DNA随着病变程度的加重，检出率逐渐升高，有显著性差异(P<0.05)，放疗前后的HPV16,18-DNA值有显著性差异(P<0.05)，而HSVⅡ在癌变组与非癌变组的差异显著(P<0.05)，电视阴道镜对CINⅠ、CINⅡ、CINⅢ及宫颈癌的检测符合率为(90.80%、87.35%、93.24%、91.95%)(P<0.05)，HPV16,18-DNA可作为宫颈癌放疗后的随访指标之一，电视阴道镜指引下准确选择活检部位，评价病变的程度，阴道镜检查辅以HPV16,18DNA检测，可以提高宫颈癌的确诊率。
Objective: To investigate the value of video colposcopy Human papilloma virus typing 16,18 and herpes simplex virus in diagnosis of cervical carcinoma. Methods: a total of 87 women with suspicious appearance of the cervix were examined through video colposcopy and taken several biopsies. Polymerase chain reaction (PCR) assay was employed to detect HPV16,18-DNA and HSVⅡ-DNA. We analysed the HPV16,18-DNA among 16 cervical carcinoma patients before and after radiotherpy. Results: The HPV16,18-DNA positive rates for patients are increasing with the severe extent of disease. (P<0.05) The differences of HPV among 16 patients after radiotherapy were signicant (P<0.05). The HSVⅡpositive rates for patient with non-carcinoma and cervical carcinoma were 41.9%, 0 (P<0.05). The accuracy for patients with CINⅠ、CINⅡ、CINⅢ and cervical carcinoma were 90.80%、87.35%、93.24%、91.95% respectively. Conclusion: HPV16,18 is one of traking indexes of cervical carcinoma after radio therapy. The video colposcopy can identify the most severe disease for diopsy and evaluate the extent of disease. The combination of two methods can improwe the accuracy of diagnosis.
引文
[1] 郎景和. 子宫颈癌及其普查. 现代妇产科进展. 1994, (3): 275-278
[2] 舒仪经, 伊·克洛. 子宫颈肿瘤细胞学与组织病理学. 美国纽约. 中国北京: 美国Mcgraw Hill出版集团与中国人民卫生出版社联合出版, 1995
[3] 章文华, 吴爱如等. 宫颈癌普查中应用阴道镜的初步报告. 中华肿瘤杂志, 1994,16:59
[4] Coppleson N(ed) "Gynecological Oncology" Edinburgh: churichill Livingstone, 1992,11-29, 572
[5] 钱德英, 曾仁海. 宫颈上皮内瘤样病变的阴道镜与病理学观察. 中国内镜杂志. 1998, 10.30; 4(5): 13-14
[6] 钱德英, 曾仁海. 子宫颈上皮内瘤样病变. 外阴子宫颈病变与阴道镜, 1999, 15-28
[7] Daron G. Ferris. 阴道镜新知识教程. 美国阴道镜与子宫颈病理学会（ASCCP）
[8] 曹泽毅. 中华妇产科学. 第一版. 北京：人民卫生出版社, 1999: 183-184
[9] 袁莉云, 卡美璐, 李挺等. 宫颈癌癌前病变及宫颈癌与HPV感染的关系. 中日友好医院学报, 1999-08-15; 13(4): 203-206
[10] 杨玲, 章文华, 李爱玲. 山西子宫颈癌筛查方法比较的可行性研究.中国肿瘤2000-09-05; 9(9): 391-392
[11] 伍欣星, 赵文先, 杨平. 用通用引物聚合酶链反应对宫颈刮片中HPV感染的快速筛检. 中华实验和临床病毒学杂志. 1995-09-30; 9(3): 272-274
[12] Cecchini S, et al. Colposcopy as a primary screening test for cerrical cancer Tumori 1997, 83(5): 810
[13] 戴丽玉, 叶敏华. 阴道镜异常血管图像与病理关系. 中国急救医学. 1999, 19(6): 363
[14] 郑英, 刘玉玲. 阴道镜图谱. 第1版, 河南：河南科学技术出版社, 1998, 38