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目的探讨液基细胞学检查(TCT)联合人乳头瘤病毒(HPV)检测诊断宫颈癌前病变的临床价值。方法选取2013年12月-2015年12月来浙江省人民医院实施宫颈癌筛查的23~67岁7 160例女性作为研究对象,采用TCT法筛查宫颈癌及HPV分型基因芯片检测系统进行13种高危型HPV基因亚型的检测,对上述检查阳性者进行阴道镜下宫颈活组织病理检查,而对于阴性者则采取自愿进行宫颈活组织病理检查的方式。根据TCT、高危型HPV检测及宫颈活组织检查的结果进行对比分析,确定宫颈癌前病变的检出率。结果受检女性TCT涂片结果阳性率为1.5%(106/7 160),其中低度鳞状上皮内病变(LSIL)占60.4%(64/106),高度鳞状上皮内病变(HSIL)占34.9%(37/106),宫颈鳞状细胞癌(SCC)占4.7%(5/106)。与病理结果对照,TCT诊断LSIL的符合率为41.7%(43/103),诊断HSIL的符合率为71.4%(5/7),诊断SCC符合率为71.4%(5/7),TCT诊断与组织学检查总体符合率为65.0%(106/163);7 160例受检者中HPV感染者占7.4%(533/7 160),HPV感染者中宫颈上皮内瘤变(CIN)Ⅰ的检出率为72.8%(75/103),CINⅡ+CINⅢ的检出率为86.8%(46/53),检测出SCC 4例,占57.1%,HPV检测的总体符合率为76.7%(125/163)。其中,宫颈的病变越重,检测出的HPV感染阳性率越高,各级的病变HPV感染率比较差异有统计学意义(χ~2=18.2,P<0.01);患宫颈上皮内病变的年龄多集中在30~55岁,占检出病变的78.6%,其中<30岁和>55岁的受检者病理诊断为阳性的构成比为17.5%和3.9%。30~55岁年龄段患病率与其他年龄段相比较差异有统计学意义(χ~2=12.6,P<0.01);HPV对于癌前病变及宫颈癌的检出率为65.0%,TCT的总检出率为76.7%,二者联合筛查病变的总检出率为95.1%,差异有统计学意义(P<0.05)。HPV检测的检出率高于TCT检测,且二者联合检查的检出率更高。结论 TCT技术和高危型HPV检测的联合应用效果优于单项技术检测,对于宫颈癌前病变的筛检具有重要意义。
Objective To investigate the clinical value of liquid-based cytology (TCT) combined with human papillomavirus (HPV) in the diagnosis of cervical precancerous lesions. Methods A total of 7 160 women aged 23-67 years from December 2013 to December 2015 were enrolled in Zhejiang Provincial People’s Hospital for screening cervical cancer and HPV genotyping chip detection system Thirteen high-risk HPV genotypes were detected by colposcopy biopsy under the pathological examination of cervical biopsy, and negative for cervical biopsy by voluntary biopsy. According to the results of TCT, high-risk HPV test and cervical biopsy, comparative analysis was made to determine the detection rate of cervical precancerous lesions. Results The positive rate of TCT smears in female subjects was 1.5% (106/7 160), of which, LSIL accounted for 60.4% (64/106) and HSIL 34.9% (37/106), cervical squamous cell carcinoma (SCC) 4.7% (5/106). The coincidence rate of TCT and LSIL was 41.7% (43/103) and 71.4% (5/7), respectively. The coincidence rate of diagnosis of SCC was 71.4% (5/7) The overall coincidence rate of histological examination was 65.0% (106/163). Among 7 160 subjects, HPV infection accounted for 7.4% (533/7 160), cervical intraepithelial neoplasia (CIN) Ⅰ in HPV infection The positive rate was 72.8% (75/103). The positive rate of CINⅡ + CINⅢ was 86.8% (46/53). SCC was detected in 4 cases (57.1%). The overall coincidence rate of HPV detection was 76.7% (125/163 ). Among them, the more severe cervical lesions, the higher the positive rate of HPV infection detected, the HPV infection rates at all levels showed statistically significant difference (χ ~ 2 = 18.2, P <0.01); the age of patients with cervical intraepithelial lesions Mostly concentrated in the 30 to 55 years old, accounting for 78.6% of detected lesions, of which <30 years old and> 55 years old subjects pathologically diagnosed as posed by the proportion of 17.5% and 3.9%. The prevalence rate of 30 ~ 55 age group was significantly different from other age groups (χ ~ 2 = 12.6, P <0.01). The detection rate of HPV in precancerous lesions and cervical cancer was 65.0% The total detection rate was 76.7%. The total detection rate of combined screening of the two was 95.1%, the difference was statistically significant (P <0.05). The detection rate of HPV test is higher than that of TCT test, and the detection rate of the combined test of the two is higher. Conclusion The combined effect of TCT technique and high-risk HPV test is better than that of single technique test, which is of great significance for the screening of cervical precancerous lesions.