【摘要】 目的探讨不同年龄段高危型人乳头瘤病毒(HR-HPV)阳性者阴道镜病理检查结果在宫颈癌筛查中的价值。方法收集2017年1月至12月在绍兴市妇幼保健院门诊就诊检测HR-HPV者16 510例,选取有阴道镜组织学活检病例908例,分析不同年龄组(≤30岁、31～40岁、41～50岁、51～60岁、≥61岁)患者HR-HPV感染状况及与病理组织结果的关系。结果①在908例阴道镜组织病理结果中,HPV16型阳性活检人群的高级别及以上病变[≥高级别鳞状上皮内病变(HSIL)]检出率占47.27%(104/220)、HPV18型占25.61%(21/82)、其他12型HR-HPV占19.07%(90/472)、HR-HPV阴性占4.48%(6/134),组间比较差异有统计学意义(χ~2=57.64,P<0.05)。活检人群鳞状上皮病变[HSIL、鳞癌(SCC)]中,HPV16型检出率占87.18%(102/117)、HPV18型占12.82%(15/117);宫颈腺上皮病变[原位腺癌(AIS)、腺癌(AC)]中,HPV16型检出率占25.00%(2/8)、HPV18型占75.00%(6/8),HPV16与18型组间比较差异有统计学意义(χ~2=20.71,P<0.05)。②各个年龄组活检人群中≥HSIL检出率组间比较及与低级别鳞状上皮内病变(LSIL)检出率(除≥61岁组)比较,差异均有统计学意义(χ~2值分别为15.78、22.12,均P<0.05)。③在472例其他12型HR-HPV阳性活检人群中,细胞学诊断未见上皮内病变或恶性细胞(NILM)者≥HSIL检出率占6.06%(8/132),≥意义不明的非典型鳞状细胞(ASCUS)者≥HSIL检出率占24.12%(82/340),两者比较差异有统计学意义(χ~2=14.71,P<0.05)。④HPV16/18阳性联合细胞学分流其他12型HR-HPV的检测方法在活检人群中筛查≥HSIL的敏感度为97.29%(215/221),特异度为18.63%(128/687),阳性预测值为27.78%(215/774),阴性预测值为95.52%(128/134)。结论 HPV分型检测作为宫颈癌初筛策略是合理且可行的。对≤30岁者可选择性行HR-HPV检测;在>30岁的HR-HPV阳性女性中应重点关注41～50岁组,建议直接行阴道镜检查。若36～51岁伴有HPV18型阳性者,行阴道镜检查的同时应注重宫颈管内膜搔刮术。对HR-HPV阴性者,建议应定期接受宫颈癌筛查,若有异常症状体征,可联合细胞学与HPV检查,必要时可行阴道镜及宫颈管内膜搔刮术。更多还原

【Abstract】 Objective To evaluate the value of histology pathology examination for women with high-risk human papillomavirus(HR-HPV) positive in different age groups in cervical cancer screening.Methods From January to December 2017,totally 16 510 cases underwent HR-HPV test in department of outpatient of Shaoxing Women and Children Health Hospital.Among them,908 cases with colposcopy histological biopsy examination were selected to analyze the relationship between HR-HPV infection and pathological examination results among different age groups(≤30 years old,30-40 years old,41-50 years old,51-60 years old and≥61 years old).Results The detection rate high grade and above lesions,meaning above high-grade squamous intraepithelial lesion(HSIL) accounted for 47.27%(104/220) of the HPV16-positive women,25.61%(21/82) of women with HPV18-positive,19.07%(90/472) of women with other 12 kinds of HR-HPV subtypes positive and 4.48%(6/134) of women with HR-HPV negative,the difference among those groups was statistically significant(χ~2=57.64,P<0.05).Among the women with pathological examination of cervical squamous epithelial lesions including HSIL and squamous carcinoma(SCC),the women with HPV16 accounted for 87.18%(102/117) and HPV18 accounted for 12.82%(15/117).And in the women with cervical glandular epithelial lesions including adenocarcinoma(AC) and adenocarcinoma in situ(AIS),HPV16 accounted for 25.00%(2/8) and HPV18 accounted for 75.00%(6/8),the difference between HPV16 and HPV18 was statistically significant(χ~2=20.71,P<0.05).In addition,comparison of the detection rates of≥HSIL in all age groups and the detection rate of LSIL in all ages groups(except for≥61 years old) showed statistical significance(χ~2=15.78 and 22.12,respectively,both P<0.05).Moreover,in 472 cases of other 12 subtypes of HR-HPV,the detection rate of≥HSIL was 6.06%(8/132) in patients with no intraepithelial lesions or malignant cells(NILM) and 24.12%(82/340) in patients with≥atypical squamous cells of unknown significance(ASCUS),the difference between the two detection rates was statistically significant(χ~2=14.71,P<0.05).Overall,the sensitivity of HPV16/18 test combined with cytologic shunting other 12 subtypes of HR-HPV in women with biopsy screening≥HSIL was 97.29%(215/221),the specificity was 18.63%(128/687),the positive predictive value was 27.76%(215/774) and the negative predictive value was 95.52%(128/134).Conclusion As a preliminary screening strategy,HPV genotyping detection was reasonable and feasible for cervical cancer.For women under 30 years old,HPV genotyping detection can be performed selectively.For women over 30 years old and with HR-HPV positive,the focus should be on women aged 41 to 50,and colposcopy is recommended directly.In addition,for women aged 36 to 51 with HPV18 positive,it’s suggested that colposcopy should be performed at the same time with cervical endocervical curettage.And for those with HR-HPV negative,it’s recommended to receive cervical cancer screening regularly.Cytology test and HPV genotyping detection should be combined if any abnormal sign appears,when necessary,colposcopy and endotracheal curettage should be further performed.更多还原