高危型人乳头状瘤病毒16,18型DNA检测在宫颈病变筛查中的应用价值

摘要

Objective To evaluate the detective value of high-risk human papillomavirus (HPV) genotype 16 and 18 (HPV16, 18) in screening cervical lesions. Methods By histological biopsy, 209 cases were cancer and percancerous lesions [cervical intraepithelial neoplasia (CIN) Ⅰ, CIN Ⅱ, CIN Ⅲ and invasive cervical cancer], and 296 cases were inflammation, polyp and other benign lesions. HPV16,18 DNA and liquid-based cytology were used to detect the cases with cancer and percancerous lesions by histological biopsy. Comparing the results of the 2 methods, HPV16,18 infectious rates, sensitivity, specificity and negative predictive value were statistically analyzed. Results Of 209 palients with cancer and precancerous lesions,158 cases were positive of HPV16.18, and 128 cases were positive of liquid-based cytology [ low-grade squamous intraepithelial lesion (LSIL), atypical squamuus cells, cannot exclude a high-grade squamous intraepithelial lesion ( ASC-H), high-grade squamous intraepithelial lesion (HSIL) and squamous cell carcinoma ]. Among the 296 patients with benign lesions, 43 cases were positive of HPV 16,18, and 2 cases were positive of liquid-based cytology. The results of cancer and precancerous lesions showed thai the positive rate of HPV16, 18 DNA was higher than that of liquid-based cytology (X2 = 12.69,P< 0.01). The sensitivity, specificity and negative predictive value of HPV16,18 DNA were 75.6% , 85.5% and 83.2% respectively, and 61.2% , 99.3% and 78.4% of liquid-based cytology. The HPV16.18 positive rate of CIN II was obviously higher than that of CIN I (X2 =6.69, P <0.05). Conclusions The occurrence of cervical cancer and percancerous lesions is closely related to HPV16.18 infection. Compared with liquid-based cytology, HPV16.18 DNA in cervical cancer and percancerous lesions has a higher sensitivity, lower specificity and higher negative predictive value. HPV16,18 DNA has an important clinical value for screening cervical benign lesions, and it is better than liquid-based cytology.%目的 评价高危型人乳头状瘤病毒16,18型(HPV16,18) DNA检测在宫颈病变筛查中的价值.方法 收集209例病理组织学结果为癌及癌前病变[宫颈上皮内瘤变(CIN)Ⅰ、CINⅡ、CINⅢ、宫颈浸润癌]和296例病理组织学为良性病变(炎症、息肉等),并同时做了液基细胞学检查、HPV16,18 DNA检测的病例,统计比较HPV16,18 DNA检测与液基细胞学检查对癌及癌前病变的敏感性、特异性及阴性预测值；比较不同病变程度分类患者中HPV16,18的检出率.结果 209例癌及癌前病变患者中HPV16,18阳性158例,液基细胞学阳性[低级别鳞状上皮内病变(LSIL)、不除外高级别鳞状上皮细胞(ASC-H)、高级别鳞状上皮内病变(HSIL),鳞状细胞癌]128例.296例宫颈良性病变患者HPV16,18阳性43例,液基细胞学阳性2例.HPV16,18 DNA检测对癌及癌前病变的敏感性为75.6％,液基细胞学为61.2％,两者比较差异有统计学意义(x2=12.69,P＜0.01),HPV16,18 DNA对癌及癌前病变的检出率明显高于液基细胞学.HPV16,18 DNA检测特异性为85.5％,阴性预测值为83.2％；液基细胞学特异性为99.3％,阴性预测值为78.4％;CINⅡ病变的HPV阳性检出率明显高于CINⅠ(x2=6.69,P＜0.05).结论 高危型HPV16,18感染与宫颈癌及宫颈癌前病变的发生、发展密切相关,HPV16,18 DNA检测对癌前病变和宫颈癌的敏感性高于液基细胞学、特异性低于液基细胞学,对宫颈炎、息肉等良性病变的阴性预测值高于液基细胞学,检测HPV16,18 DNA有着重要的临床价值.