【摘要】 目的:探讨高危型人乳头瘤状病毒(human papillomavirus,HPV)检测对宫颈液基细胞学诊断为不能明确意义的不典型鳞状细胞(atypical squamous cells undetermined significance,ASC-US)和低度鳞状上皮内病变(lowsquamous intraepithelial lesion,LSIL)的分流管理作用。方法:对940例宫颈液基细胞学检查结果为ASC-US或LSIL的患者采用二代杂交捕获(hybird captureⅡ,HC-Ⅱ)方法检测高危型HPV DNA,并在阴道镜指导下进行宫颈活检。结果:940例中,ASC-US497例,LSIL443例。行宫颈活检病理诊断,慢性宫颈炎417例,宫颈湿疣315例,宫颈上皮内瘤变(cervical intraepithelial lesions,CIN)1级124例,CIN2级65例,CIN3级或宫颈浸润癌19例。在宫颈细胞学异常的ASC-US和LSIL组中,高危型HPV阳性率分别是59.6%和84.9%。在ASC-US和LSIL组HPV阴性时CIN2级及其以上病变(CIN2级,CIN3级或宫颈浸润癌)检出率为0.5%和6.0%,HPV阳性时检出率是8.8%和14.1%,HPV阳性时CIN2级及其以上病变检出率高于HPV阴性患者,差异具有统计学意义。在ASC-US组中,高危型HPV检测对CIN2级及其以上病变的阴性预测值达99.5%;当高危型HPV DNA检测结果在1~9.99时,CIN2级及其以上病变仅占1.6%;在10以上时,CIN2级及其以上病变占10.7%。结论:宫颈细胞学为ASC-US的患者如果高危型HPV阳性,检出CIN2级及其以上病变的概率增加,并且高危型HPV检测的阴性预测值高,在ASC-US患者中,随着HPV载量增高,检出CIN2级及其以上病变的概率随之增高。高危型HPV检测和病毒载量有助于ASC-US的分流管理,而对LSIL无分流管理作用。更多还原

【Abstract】 Objective: To explore the role of high-risk human papillomavirus (HPV) DNA testing in improvement of recognition of cervical intraepithelial lesions (CIN) 2, 3 or cervical cancer confirmed by biopsy in women with abnormal cervical cytology including atypical squamous cells undetermined significance (ASC-US) and low squamous intraepithelial lesion (LSIL). Methods: Total 940 patients with abnormal cervical liquid-based cytology including ASC-US and LSIL were included in this study. Hybrid capture Ⅱ assay was applied in the high-risk HPV detection. The cervical pathologic diagnoses were obtained under colposcopy guided biopsy. Results: Of the 940 cases, 497 were ASC-US, and 443 LSIL. With pathological diagnosis of cervical biopsy, 417 cases were chronic inflammation, 315 condyloma, 124 CIN 1, 65 CIN 2, 19 CIN 3 or cervical cancer. The positive rate of high-risk HPV DNA in groups of ASC-US and LSIL were 59.6% and 84.9%, respectively. In each group of abnormal cytology, detection rates of CIN 2, 3 or cervical cancer in patients with positive HPV DNA were 8.8% and 14.1%,respectively, which were higher than those with negative HPV DNA (0.2% and 6.0%,P<0.05). In group of ASC-US, high-risk HPV DNA test had a negative predictive value of 99.5%;detection rates of CIN 2, 3 or cervical cancer in patients with HPV DNA virus load 1-9.99 and ≥10 was 1.6% and 10.7%,respectively. Conclusion: High-risk HPV DNA test were helpful to improve the detection rates of CIN 2, 3 or cervical cancer in patients with ASC-US.更多还原