【作者】 陶林；

【导师】 潘晓琳；

【作者基本信息】 石河子大学 ， 病理学与病理生理学， 2009， 硕士

【摘要】 目的:本研究采用TCT(液基薄层细胞学检测)技术结合TBS分级、DNA定量分析、HPV16/18DNA检测和组织学诊断对新疆喀什地区伽师县夏普桃勒乡维吾尔族妇女进行普查,得出该地区维吾尔族新的患病率。了解新疆宫颈癌患病率状况,探讨新疆宫颈癌早诊早治的重要性。同时对宫颈癌普查方法进行对比研究,为宫颈癌普查选择高效、准确、经济的检测方法。方法:采取新疆喀什地区伽师县夏普桃勒乡2572名维吾尔族妇女宫颈脱落细胞应用TCT技术制片,一张进行巴氏染色,应用TBS进行分级;一张进行Feulgen染色用AcCell全自动细胞图像分析系统对所有Feulgen染色片进行扫描处理和DNA定量分析;同时对脱落细胞采用PCR方法进行HPV16/18 DNA检测。凡细胞学检查为“ASCH以上”、DNA定量分析为“可见或可见大量DNA倍体异常细胞”以及“ASCUS合并HPV16/18感染”病例,均建议进行宫颈病变组织4点活检。以组织学结果为标准,分析研究普查方法的敏感性和特异性。数据分析采用卡方检验。结果: (1) TCT对高级别宫颈上皮内瘤变(CINⅡ/Ⅲ)及浸润性宫颈鳞癌(ISCC)的敏感性为64.52%,特异性为97.30%;(2) DNA定量分析对CINⅡ/Ⅲ及ISCC敏感性为90.32%,特异性为93.24%;(3) HPV16/18 DNA检测对CINⅡ/Ⅲ及ISCC敏感性为54.83%,特异性为94.14%;(4) TCT结合DNA定量分析对CINⅡ/Ⅲ及ISCC敏感性为96.15%,特异性为94.91%;(3) TCT结合HPV16 /18DNA检测对CINⅡ/Ⅲ及ISCC敏感性为88.24%,特异性为98.00%。通过比较发现DNA定量分析比TCT和HPV16 /18DNA检测的敏感性高,差异有统计学意义(P<0.025);TCT结合DNA定量分析或HPV16 /18DNA检测的敏感性差异无统计学意义(P>0.50),而TCT结合HPV16 /18DNA检测的特异性更高,差异有统计学意义(P<0.025)。结论: (1)通过本次普查发现新疆喀什地区维族宫颈癌的新的患病率622/10万;(2)三种方法单独使用,DNA定量分析敏感性最高,但特异性较低,TCT诊断特异性最高,但敏感性较低,HPV16/18DNA检测敏感性和特异性均较低,说明每种方法单独使用会降低普查的效率。(3) TCT结合DNA定量分析或HPV16/18DNA检测都可提高敏感性,且TCT结合HPV16/18DNA检测特异性很高,不仅适合普查,而且适合临床诊断;(4)对TCT诊断为ASCUS的患者,结合HPV16/18DNA检测或DNA定量分析进行分流是行之有效的办法,同时TCT结合HPV16/18DNA检测由于经济、准确,利于开展,更适合在新疆维族地区进行宫颈癌普查。更多还原

【Abstract】 Object: To explore the value of using TCT (Thinperp cytology test) technique combined TBS (The Bethesda System) classification, along with DNA imaging cytometry and HR-HPV16/18 (high-risk human papillomavirus) test in cervical lesion screening. Then select a better way to cervical cancer screening and find out the latest incidence of cervical carcinoma in Xinjiang province.Methods: A total of 2572 Uigur women were involved in this study. Cervical samples were taken by a cervix brush. The cytological samples are all from the screening of Xiaputule County (close to kashgar, Xinjiang). Every specimen was diagnosed by Application of TCT technology producers, one for Papanic- olaou stain, the application of TBS classification in 2004, and also tested by DNA imaging cytometry and HPV16/18. HPV16/18 were detected by PCR (Polymerase Chain Reaction). Women who were diagnosed ASCH or even worse, ASCUS with HPV positive or abnormal in DNA imaging cytometry were underwent cervical biopsy directly. We perform cervical biopsy to observe the sensitive and specificity of these detection methods when used alone or combined each other, including TCT inspection, DNA imaging cytometry, and HPV test.Results: The sensitivity rates of HPV, TCT, DNA imaging cytometry, HPV+TCT and DNA imaging cytometry +TCT were 54.83%, 64.52%, 90.32%, 88.24%, 96.15%; and the specificity rates were 94.59%, 97.30%, 93.24%, 98.95%, 94.91% respectively. We found that DNA imaging cytometry is more sensitive than HPV test and TCT inspection; and TCT with HPV are more specific than the other methods.Conclusion: (1) From the Xiaputule County screening, the incidence of cervical cancer is 622 per 100,000 people. (2) DNA imaging cytometry is most sensitive method while TCT inspection is the most specific. (3) TCT inspection with HR-HPV test is more specific, it can not only use in screening, but also use in clinic diagnosis. (4) HPV+TCT seemed to be more useful, efficiency and cheaper than other screening methods in the cervical cancer screening program.更多还原