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目的探讨薄层液基细胞学(thinprep cytololgy test,TCT)检测及高危型人乳头瘤病毒(human papillomavirus,HPV)检测在宫颈癌初筛中的不同临床应用价值。方法选择2012年10月—2013年10月自愿参加“两癌”筛查的青岛市崂山区户籍妇女1 568名,所有对象同时进行TCT检测和HPV分型检测,检出阳性病例均在电子阴道镜下行宫颈病理活检。计数资料采用χ2检验,P<0.05为差异有统计学意义。结果 1 568例受检者中,TCT阳性236例,病理活检为宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)及以上者150例,符合率为63.56%。随着其细胞学分级的增高,组织学符合率逐渐升高。HPV阳性512例,病理活检为CIN及以上者180例,符合率为35.16%。比较差异有统计学意义(P<0.05)。126名液基细胞学检测结果为非典型鳞状上皮意义不明确(atypical squamous cell of undermined significance,ASCUS)HPV阳性者病理符合率为61.76%,阴性者病理符合率为27.59%,HPV阳性者病理符合率高于阴性者,比较差异有统计学意(P<0.05)。且随着病变程度的加深,HPV感染率逐渐升高。结论与HPV病毒检测相比,TCT检测的组织学诊断符合率更高,特别是对于TCT检测结果为HSIL者;对于TCT检测结果为ASCUS者,HPV病毒检测可以起到有效的分流管理作用。
Objective To investigate the different clinical value of thinprep cytololgy test (TCT) and high-risk human papillomavirus (HPV) detection in screening of cervical cancer. Methods A total of 1 568 women were enrolled in Laoshan district of Qingdao City from October 2012 to October 2013. All subjects were tested by TCT and HPV genotyping at the same time. All the positive cases were detected Electronic colposcopy cervical biopsy. Count data using χ2 test, P <0.05 for the difference was statistically significant. Results Of the 568 subjects, 236 were TCT positive and 150 were cervical biopsy of cervical intraepithelial neoplasia (CIN), the coincidence rate was 63.56%. With the increase of their cytological grade, histological coincidence rate gradually increased. There were 512 cases of HPV positive and 180 cases of biopsy of CIN and above, the coincidence rate was 35.16%. The difference was statistically significant (P <0.05). The results of 126 liquid-based cytology tests showed that the pathological coincidence rate of atypical squamous cell of under-mined significance (ASCUS) HPV-positive was 61.76% and that of negative HPV-positive was 27.59% The coincidence rate was higher than negative, the difference was statistically significant (P <0.05). And with the deepening of the degree of lesion, HPV infection rate gradually increased. Conclusion The detection rate of TCT is higher than that of HPV detection, especially for TCIL-HSIL. TCV-ASCUS is the most effective way to detect HPV infection.