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目的:探讨高危型人乳头瘤病毒(HPV)及其分型检测在意义不明的非典型鳞状上皮细胞(ASCUS)分流诊治中的临床应用价值。方法:选择宫颈液基细胞学(TCT)检查为ASCUS 407例。采用基因芯片法进行高危型HPV及其分型检测,并行阴道镜检查。观察分析宫颈组织病理学与高危型HPV感染的关系,以及高危型HPV亚型与宫颈组织病理学的关系。结果:本组407例中,高危型HPV检测阳性(阳性组)211例,占51.8%;低危及阴性(阴性组)196例,占48.2%。高危型HPV阳性组中,宫颈上皮内瘤变(CIN)检出率为62.6%(132/211),非常显著高于阴性组的13.8%(27/196)(P<0.01);CINⅠ、CINⅡ、CINⅢ和浸润癌的检出率分别为79.6%、84.8%、94.1%和100.0%,均非常显著高于阴性组中的20.4%、15.2%、5.9%和0.0%(P<0.01)。且高危型HPV感染率随着宫颈病变程度的加重而增高。高危型HPV阳性211例中,病理学诊断为CINⅡ及以上58例,以HPV16亚型最为常见,其次分别为HPV52、HPV18、HPV58和HPV33;HPV16、HPV52和HPV18亚型在CINⅡ及以上中占77.6%。结论:高危型HPV及其分型的检测,能够有效分流出ASCUS中高危人群,对ASCUS患者管理具有重要临床指导价值。
Objective: To investigate the clinical value of high risk human papillomavirus (HPV) and its typing detection in the diagnosis and treatment of atypical squamous epithelial cells (ASCUS) of unknown significance. Methods: Cervical liquid-based cytology (TCT) was selected as ASCUS in 407 cases. Gene chip method for high-risk HPV and its genotyping, colposcopy and collateral. The relationship between cervical histopathology and high-risk HPV infection, and the relationship between high-risk HPV subtypes and cervical histopathology were observed and analyzed. Results: In the group of 407 cases, high-risk HPV positive (positive group) 211 cases, accounting for 51.8%; low-risk and negative (negative group) 196 cases, accounting for 48.2%. The positive rate of CIN in high-risk HPV positive group was 62.6% (132/211), which was significantly higher than that in negative group (13.8%, 27/196) (P <0.01); CINⅠ, CINⅡ The positive rates of CINⅢ and invasive carcinoma were 79.6%, 84.8%, 94.1% and 100.0%, respectively, which were significantly higher than those of negative group (20.4%, 15.2%, 5.9% and 0.0%, P <0.01). And high-risk HPV infection rate with the severity of cervical lesions increased. High-risk HPV positive 211 cases, the pathological diagnosis of CIN Ⅱ and 58 cases, the most common HPV16 subtype, followed by HPV52, HPV18, HPV58 and HPV33; HPV16, HPV52 and HPV18 subtypes in CIN Ⅱ and above accounted for 77.6 %. Conclusion: The detection of high-risk HPV and its typing can effectively divert the high-risk population of ASCUS, which has important clinical value for the management of ASCUS.