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目的评估阴道镜和高危型HPV-DNA检测及两种方法联合在宫颈病变筛查中的应用价值。方法采用HPV-DNA检测、阴道镜检查结合Reid评分系统及镜下多点活检对196例超薄液基细胞学检查(TCT)阴性(炎症反应性细胞改变)的接触性阴道出血症状患者进行分流诊断。结果 196例患者中,阴道镜检查阳性率(Reid评分≥1分)达31.6%(62/196);高危型HPV-DNA阳性率达33.2%(65/196);宫颈活检诊断为宫颈病变率31.1%(61/196),且随着活检病变程度加重,阴道镜Reid评分(rp=0.713,P<0.001)和高危型HPV-DNA检测阳性率(rp=0.538,P<0.001)逐渐上升。以宫颈组织病理学检查结果为确诊标准,阴道镜、高危型HPV-DNA检测及两方法联合诊断宫颈病变的灵敏度、特异度、阳性预测值及阴性预测值分别为72.1%、88.1%、73.3%、87.5%;68.9%、83.0%、64.6%、85.5%;90.2%、92.6%、84.6%、95.4%。结论接触性阴道出血患者即使TCT阴性仍然存在一定的宫颈癌前病变及癌变风险,联合应用阴道镜和高危型HPV-DNA检测有助于建立良好的分流诊断,降低漏诊率和过度诊断率。
Objective To evaluate the value of colposcopy and high-risk HPV-DNA testing and the combination of the two methods in screening cervical lesions. Methods Ninety-six patients with contact vaginal bleeding who had an ultrathin liquid-based cytology (TCT) -negative (inflammatory reactive cell change) were divided by HPV-DNA test, colposcopy combined with Reid scoring system and microscopic multipoint biopsy. diagnosis. Results Among the 196 patients, the positive rate of colposcopy (Reid score ≥1) was 31.6% (62/196), the positive rate of high-risk HPV-DNA was 33.2% (65/196), and the cervical biopsy was diagnosed as cervical lesion rate (Rp = 0.713, P <0.001), and the positive rate of high-risk HPV-DNA test (rp = 0.538, P <0.001) increased with the severity of biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of colposcopy, high-risk HPV-DNA test and the combination of the two methods were 72.1%, 88.1% and 73.3% respectively, with the results of cervical histopathology as the diagnostic criteria. , 87.5%; 68.9%, 83.0%, 64.6%, 85.5%; 90.2%, 92.6%, 84.6%, 95.4%. Conclusion Although patients with contact vaginal bleeding still have a certain degree of cervical precancerous lesions and cancerous lesions even though TCT is negative, the combination of colposcopy and high-risk HPV-DNA testing can help to establish a good shunt diagnosis and reduce the rate of missed diagnosis and over-diagnosis.