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目的:探讨人乳头状瘤病毒(HPV)分型检测在宫颈细胞学诊断为不典型鳞状细胞意义不明确(ASCUS)分层处理中的价值。方法:对230例宫颈细胞学诊断为ASCUS的患者进行HPV检测和阴道镜下宫颈组织活检,以阴道镜活检组织学诊断为依据,分析HPV-DNA分型检测结果与病理检查结果的关系。结果:230例患者中经病理学检查证实为炎症157例,CINⅠ级41例,CINⅡ级26例,CINⅢ级6例。230例ASCUS患者中,HR-HPV阳性率为42.61%(98/230),高危型HPV阳性组CINⅡ及以上检出率为28.57%(28/98),HR-HPV阴性组CINⅡ及以上检出率为3.03%(4/132),两组比较差异有统计学意义(P<0.01)。98例HR-HPV感染患者中,感染率居前5位的亚型依次为HPV16、52、58、18和33,其中HPV16亚型及52亚型阳性率分别为34.69%及32.65%。HPV16亚型及52亚型阳性组中CINII及以上检出率分别为15.31%(15/98)和6.12%(6/98),两组比较差异有统计学意义(P<0.05)。结论:HPV-DNA分型检测在ASCUS患者分层处理中有重要价值,对HR-HPV16、52、58、18和33亚型阳性的患者应警惕高级别CIN的可能,尤其是16亚型阳性的患者需立即行阴道镜检查及活检。
Objective: To investigate the value of human papillomavirus (HPV) typing in the stratification of ASCUS in the diagnosis of atypical squamous cell carcinoma by cervical cytology. Methods: 230 cases of cervical cytology diagnosed as ASCUS patients with HPV testing and biopsy of colposcopic cervical biopsy based on colposcopic biopsy histological analysis of HPV-DNA typing test results and pathological findings. Results: Of the 230 patients, 157 were confirmed by pathology, 41 were CINⅠ, 26 were CINⅡ, and 6 were CINⅢ. The HR-HPV positive rate was 42.61% (98/230) in 230 ASCUS patients, 28.57% (28/98) in high-risk HPV positive patients and CINⅡ in HR-HPV negative patients and above The rate was 3.03% (4/132), the difference between the two groups was statistically significant (P <0.01). Among the 98 cases of HR-HPV infection, the top five infection subtypes were HPV16, 52, 58, 18 and 33, of which the positive rates of HPV16 subtype and subtype 52 were 34.69% and 32.65% respectively. The positive rates of CINII and above in HPV16 and 52 subtypes were 15.31% (15/98) and 6.12% (6/98), respectively, with significant difference between the two groups (P <0.05). Conclusion: The detection of HPV-DNA typing is of great value in the stratification of patients with ASCUS. The patients with positive HR-HPV16, 52, 58, 18 and 33 subtypes should be alert to the possibility of high-grade CIN, especially the 16 subtype positive Of patients need colposcopy and biopsy immediately.