TCT、HR-HPV检测及宫颈活检在宫颈早期病变中诊断价值.doc

TCT、HR-HPV检测及宫颈活检在宫颈早期病变中诊断价值[摘要]目的：评价膜式液基薄层细胞学技术（thin prep liquid-based cytology test，TCT）、高危型人乳头状瘤病毒（high-risk human papillomavirus，HR-HPV）检测及阴道镜下宫颈活检对宫颈早期病变的诊断价值。方法： 640例TCT检查异常的患者中，320例应用杂交捕获技术（HC－Ⅱ）检测HR－HPV，372例进行阴道镜检查并取宫颈组织活检，同时行HR－HPV检测及阴道镜检查并取宫颈组织活检者272例。以病理学为标准，比较三种方法对宫颈早期病变的诊断价值。结果：①HR-HPV检测能降低TCT假阴性，且随宫颈细胞学检查级别增加，HR-HPV阳性率增加（P＜0.05）。②宫颈活检细胞阳性检出率明显高于TCT阳性检出率（P＜0.01）；HR－HPV阳性组CIN发病率明显高于阴性组（P＜0.01）； HR－HPV阳性组宫颈病变程度明显高于阴性组（P＜0.05）；HPV感染病理诊断率明显高于阴性组（P＜0.01）。③阴道镜下宫颈活检可降低HR－HPV检测的漏诊率。④随宫颈细胞学检查级别增加，HPV感染发生率增加，CIN发生率增加，宫颈活检病理诊断HPV感染率增加（P＜0.01）；TCT、HR-HPV检测联合阴道镜下宫颈活检阳性率可达100%。结论：TCT、HR－HPV检测及阴道镜下宫颈活检是子宫颈病变早期诊断不可或缺的辅助手段；三者各有优缺点，不能相互替代，三者结合可提高宫颈早期病变的检出率。 [关键词]TCT；HR－HPV检测；阴道镜；宫颈活检；宫颈早期病变 [中图分类号]R711[文献标识码]A [文章编号]1673-7210（2007）05（b）-013-03 The significance of TCT，HR-HPV testing and colposcopy in diagnosis of cervical lesions YUAN Xin-rong, LI Hong-wei* (Department of Gynecology and Obstetrics,No.422 Hospital of PLA，Zhanjiang 524009,China) [Abstract]Objective：To study the value of thin prep liquid-based cytology test(TCT)，high-risk human papillomavirus (HPV-DNA) testing and colposcopy with biopsy in the early diagnosis of cervical lesions.Methods：Among 640 cases with abnormal cervical smear of TCT,320 cases were examined for HR-HPV by hybrid capture Ⅱ(HC-Ⅱ),372 cases of them received colposcopy with biopsy,272 cases received both HPV-DNA testing and colposcopy with biopsy.Results：①The examination of HR-HPV could lower the false feminine gender in TCT, and with increase of the grade of cervical cytology,the incidence increases in the patients with positive high risk of HPV( P0.05).②The pathology diagnosis of cervical lesions was obviously higher than that of TCT(P0.01).Significant differences of CIN incidence and the degree of CIN in HR-HPV positive cases and HR-HPV negative cases（P＜0.05).HPV infection of biopsy in HR-HPV positive cases was higher than that in HR-HPV negative cases（P＜0.01).③Colposcopy with biopsy could reduce the missed diagnosis of