【摘要】 目的:探讨宫颈细胞学和高危型人乳头瘤病毒(HR-HPV)检测筛查宫颈病变的卫生经济学指标,为预防措施的经济效果评价提供依据。方法:对北京地区6 185名已婚妇女采用宫颈液基薄层细胞学(TCT)和TCT联合HR-HPV检测进行宫颈病变流行病学调查,对比分析不同筛查试验的病理学诊断指标,并利用成本-效果分析(CEA)不同筛查方法结局。结果:1)北京地区已婚妇女宫颈细胞学异常的发生率为9.73%,病理结局为宫颈上皮内瘤变(CIN)的构成比为61.79%。其中,宫颈低度病变为79.30%,高度病变为20.16%,镜下早期浸润癌为0.54%。宫颈细胞学异常合并HR-HPV感染阳性人群中病理诊断为CIN的构成比为75.40%。其中,宫颈低度病变为62.57%,高度病变为35.29%,镜下早期浸润癌为2.14%。两种筛查方法病理结局为CIN的构成比比较,诊断宫颈病变差异有统计学意义,P<0.05;诊断宫颈高度病变方面,差异有统计学意义,P<0.05。2)宫颈癌筛查人群以30～44岁年龄阶段为筛查的最佳人群。3)细胞学联合HR-HPV筛查组每筛查出1例组织病理CIN阳性患者平均成本为7 041.47元,而细胞学筛查组为3 131.89元。前者为后者的2.24倍。相同年龄阶段TCT筛查组和TCT+HPV筛查组的成本-效果比较,差异有统计学意义,P<0.01。结论:细胞学检查在筛查宫颈病变方法上具有明显的卫生经济学优势,可以作为宫颈病变的初筛方法。对细胞学检查异常者,HR-HPV检测可以作为诊断CIN的分流措施。这种措施对年龄在30～44岁的人群意义尤为重要。更多还原

【Abstract】 OBJECTIVE: To assess whether the combination of cytology test and high risk-human papillomavirus(HR-HPV DNA) testing or the sole cytology screening is more effective and cost-effective in prevention of cervical cancer.METHODS: Potential subjects(6 185 women) were screened using two different preventive strategies including sole thin-prep cytology test(TCT) and HR-HPV DNA testing triage for cytology-positive women taken colposcolpy and biopsy as golden standard.A cost-effectiveness analysis(CEA) was adopted to plot the two different strategies and to compare the screening cost and effectiveness.RESULTS: The incidence of cervical lesions was 9.73% in Beijing area.The prof which CIN Ⅰ,CIN Ⅱ&Ⅲ and cervical carcinoma in situ were 79.30%,20.16%,0.54% respectively.And the incidence of CIN of the HR-HPV DNA testing triage cytology positive was 75.40%,of which CIN Ⅰ,CIN Ⅱ&Ⅲ and cervical carcinoma in situ were 62.57%,35.29%,2.14%,respectively.There were significant difference in detection of CIN and CIN Ⅱ&Ⅲ between the two different strategies(P<0.05).The optimal age groups were group 30-44 which could detect more CIN cases.The sole cytology(C/E=$7 041.47) was more cost-effective than the HR-HPV DNA testing combined with cytology(C/E=$3 131.89).CONCLUSION: The sole cytology screening strategy was more cost-effective.HPV-DNA testing can be as a standard in the triage of high-versus low-risk patients which seems more important in group 30-44.更多还原