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目的:评价HPV L1壳蛋白与h TERC基因联合检测诊断新疆维、汉妇女宫颈病变CIN2~+的临床价值。方法:选择HPV感染阳性或TCT阳性或两项同时阳性的新疆维、汉妇女465例纳入研究。所有研究病例均行阴道镜下活检送病理组织学检查,并通过免疫细胞化学法检测HPV L1蛋白的表达、通过F1SH技术检测h TERC基因的表达。通过诊断试验评价与接收者工作特征曲线评价其联合检测诊断新疆维、汉妇女宫颈病变CIN2~+的价值。结果:HPV L1壳蛋白与h TERC基因联合检测用于区分CIN2~+与正常或慢性炎症患者及CIN1患者时,其诊断CIN2~+的ROC曲线下面积为0.5左右(维吾尔族0.577,汉族0.572);用于区分CIN2~+与CIN1患者时,其ROC曲线下面积可达0.7左右(维吾尔族0.706,汉族0.699)。此时,其诊断新疆维族妇女CIN 2~+的灵敏度、特异度、正确率、假阳性率、假阴性率、阳性预测价值和阴性预测价值分别为92.37%、48.84%、81.61%、15.38%、32.26%、84.62%和67.74%;诊断汉族妇女CIN2~+的灵敏度、特异度、正确率、假阳性率、假阴性率、阳性预测价值和阴性预测价值分别为93.69%、46.15%、81.33%、16.80%、28.00%、83.20%和72.00%。维、汉之间的灵敏度、特异度、正确率、假阳性率、假阴性率、阳性预测价值和阴性预测价值均无显著差异(P>0.05)。结论:HPV L1壳蛋白与h TERC基因联合检测诊断维、汉妇女CIN 2~+时,其适用人群为具有CIN的患者。此时其诊断维、汉族妇女宫颈高度病变CIN 2~+的灵敏度、正确率和阳性预测价值较高,特异度和阴性预测价值较低,且均不存在民族差异。
Objective: To evaluate the clinical value of combined detection of HPV L1 capsid protein and h TERC gene in the diagnosis of cervical lesions CIN2 ~ + in Xinjiang Uygur and Han women. Methods: 465 Xinjiang women and Uygur and Han women who were HPV positive or TCT positive or both were positive were included in the study. All cases underwent colposcopy biopsy for histopathological examination. The HPV L1 protein expression was detected by immunocytochemistry, and the expression of hTERC gene was detected by F1SH. The value of CIN2 ~ + in the diagnosis of cervical lesions in Victoria and Han women in Xinjiang was evaluated by diagnostic test evaluation and receiver operating characteristic curve. Results: The area under the ROC curve of diagnosis of CIN2 + was 0.5 (Uygur 0.577, Han 0.572) when HPV L1 capsid protein and h TERC gene were used to distinguish CIN2 + from normal or chronic inflammatory patients and CIN1 patients. ; The area under the ROC curve of CIN2 ~ + and CIN1 patients was about 0.7 (Uighur 0.706, Han 0.699). The sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value and negative predictive value of CIN 2 ~ + in Uygur women diagnosed in Xinjiang were 92.37%, 48.84%, 81.61% and 15.38% The sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value and negative predictive value of CIN2 ~ + were 93.69%, 46.15% and 81.33%, respectively, which were respectively 32.26%, 84.62% and 67.74% 16.80%, 28.00%, 83.20% and 72.00%. The sensitivity, specificity, accuracy, false positive rate, false negative rate, positive predictive value and negative predictive value were not significantly different between Victoria and Han (P> 0.05). Conclusion: The detection of HPV L1 capsid protein and h TERC gene in patients with CIN 2 ~ + in both Victoria and Han women is suitable for patients with CIN. In this case, the sensitivity, accuracy and positive predictive value of CIN 2 ~ + in cervical hyperplastic lesions of Han women were higher, and the predictive values of specificity and negative were lower, and there was no national differences.