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目的评价薄层液基细胞学(Thinprep Cytology Test,TCT)与高危型人乳头瘤病毒(human papilloma-virus,HR-HPV)检测在宫颈上皮病变筛查中的应用价值。方法对广东省潮州市3723名农村妇女同时进行TCT检查和HR-HPV检测,阳性的妇女进行宫颈组织病理学检查,分析TCT与HR-HPV检测以及联合检查在宫颈上皮病变筛查中的应用价值。结果 78例农村妇女TCT检查阳性,其中鳞状细胞(ASC)15例(19.2%);低级别鳞状上皮病变(LSIL)44例(56.4%);高级别鳞状上皮病变(HSIL)19例(24.4%)。65例检测出HR-HPV阳性,阳性率为1.7%(65/3723)。94例患者宫颈组织病理诊断为炎症者19例(20.2%);宫颈上皮内瘤样病变(CIN)Ⅰ级39例(41.5%)、CINⅡ级15例(16.0%)、CINⅢ级20例(21.3%);鳞状细胞癌(SCC)1例(1.1%)。TCT对诊断宫颈癌与癌前病变的阳性预测值0.45,阴性预测值0.94;HR-HPV检测宫颈上皮病变的阳性预测值为0.52,阴性预测值为0.93。TCT联合HR-HPV检测宫颈上皮病变的阳性预测值为0.69(34/49),高于TCT的阳性预测值,差异有统计学意义(χ2=7.290,P=0.007),与HR-HPV阳性预测值差异无统计学意义(χ2=3.386,P=0.066)。结论 TCT与HR-HPV检测是宫颈上皮病变筛查的理想方法,两种方法联合应用可提高宫颈上皮病变的阳性预测值。
Objective To evaluate the value of Thinprep Cytology Test (TCT) and high-risk human papilloma-virus (HR-HPV) in the screening of cervical epithelial lesions. Methods 3723 rural women in Chaozhou City, Guangdong Province were tested by TCT and HR-HPV at the same time. Positive women were examined by cervical histopathology. The diagnostic value of TCT and HR-HPV and the combined examination in cervical epithelial disease screening . Results 78 cases of rural women had positive TCT, including 15 cases of squamous cell carcinoma (ASC), 44 cases of low grade squamous cell carcinoma (LSIL), 19 cases of high grade squamous cell carcinoma (HSIL) (24.4%). 65 cases were detected positive for HR-HPV, the positive rate was 1.7% (65/3723). Nineteen patients (20.2%) had histological diagnosis of inflammation in the 94 patients, 39 patients (41.5%) had grade Ⅰ cervical intraepithelial neoplasia (CIN), 15 patients (16.0%) had CINⅡ grade, 20 %); Squamous cell carcinoma (SCC) in 1 case (1.1%). The positive predictive value of TCT for diagnosis of cervical cancer and precancerous lesions was 0.45 and the negative predictive value was 0.94. The positive predictive value of HR-HPV for detecting cervical epithelial lesions was 0.52, and the negative predictive value was 0.93. The positive predictive value of TCT combined with HR-HPV in detection of cervical epithelial lesions was 0.69 (34/49), which was higher than the positive predictive value of TCT (χ2 = 7.290, P = 0.007) The difference was not statistically significant (χ2 = 3.386, P = 0.066). Conclusion The detection of TCT and HR-HPV is an ideal method for screening cervical epithelial lesions. The combination of the two methods can improve the predictive value of cervical epithelial lesions.