本文關(guān)鍵詞： 宮頸腫瘤 多相篩查 DNA探針 HPV 細(xì)胞診斷學(xué)　出處：《腫瘤》2015年05期 　論文類型：期刊論文

【摘要】：目的:評價采用高危型人乳頭瘤病毒(high-risk human papillomavirus,HR-HPV)檢測法進(jìn)行宮頸癌初篩后幾種分流方法的效果及應(yīng)用價值。方法 :重新分析2003年在中國山西省襄垣縣開展的以人群為基礎(chǔ)的子宮頸癌篩查橫斷面研究的資料,最終納入研究人群為1 788名婦女。所有篩查對象均進(jìn)行了薄層液基細(xì)胞學(xué)(liquid-based cytology,LBC)、HR-HPV第二代雜交捕獲(hybrid capture 2,HC2)法(可進(jìn)行HPV初篩和高、低病毒載量分析)和醋酸染色肉眼觀察法(visual inspection with acetic acid,VIA)檢測,對結(jié)果異常者進(jìn)行陰道鏡檢查,鏡檢陽性時行活組織檢查并得出最終的病理學(xué)診斷結(jié)果。本次研究模擬HPV檢測為基礎(chǔ)的宮頸癌篩查方案,采用HPV-HC2法初篩,然后以LBC、VIA、HPV-HC2高病毒載量和HPV-HC2低病毒載量4種篩查方法分流,比較各種方案識別宮頸高級別鱗狀上皮內(nèi)病變(high-grade squamous intraepithelial lesion,HSIL)及浸潤癌的敏感度、特異度和陰道鏡轉(zhuǎn)診率等指標(biāo),以受試者工作特征(receiver operator characteristic,ROC)曲線下面積綜合分析各篩查方案的應(yīng)用價值(α校正=0.012 5)。結(jié)果 :以HPV-HC2檢測作為初篩方法,陰道鏡轉(zhuǎn)診率為18.1%,其檢出HSIL及浸潤癌的敏感度和特異度分別達(dá)到95.7%和85.0%,而陽性預(yù)測值僅為20.4%。使用LBC、VIA和HPV-HC2低病毒載量分流后,陰道鏡轉(zhuǎn)診率分別降低為8.7%、4.5%和9.8%,特異度分別提高到94.3%、97.5%和93.1%,陽性預(yù)測值分別提高到37.2%、46.9%和32.0%,敏感度分別降低至84.1%、55.1%和81.2%。HPV初篩與其聯(lián)合LBC分流和HPV低病毒載量分流相比,兩組間曲線下面積的差異均無統(tǒng)計學(xué)意義(P值均0.012 5),而與其聯(lián)合VIA分流和HPV高病毒載量比較,兩組間曲線下面積差異均具有統(tǒng)計學(xué)意義(P值均0.001)。結(jié)論 :從經(jīng)濟(jì)性和適應(yīng)性考慮,在資源有限、欠發(fā)達(dá)的地區(qū),將HPV DNA載量值提高到≥10 pg/m L作為篩查標(biāo)準(zhǔn)來進(jìn)行宮頸癌篩查是可行的,效果較好。在發(fā)達(dá)地區(qū),可廣泛推行HR-HPV初篩加細(xì)胞學(xué)分流。HR-HPV初篩后以VIA作為分流技術(shù)的宮頸癌篩查方案在農(nóng)村地區(qū)是可行的,但操作醫(yī)生的技能尚需培訓(xùn)和提高。
[Abstract]:Objective: To evaluate the high-risk human papillomavirus (high-risk human, papillomavirus, HR-HPV) detection method of screening method for cervical cancer after several shunt effect and application value. Methods: re analysis of 2003 in Xiangyuan County of Shanxi province to carry out Chinese population-based cervical cancer screening cross-sectional study data included in the final analysis the crowd was 1788 women. All screening subjects were ThinPrep cytology test (liquid-based, cytology, LBC) HR-HPV second generation hybrid capture (hybrid capture 2, HC2 (HPV) method of screening and high and low viral load analysis) and observation (visual inspection with acetic acid staining eye acetic acid. VIA) detection, abnormal results of colposcopy, biopsy examination was positive and the final pathological diagnosis results. This study simulated HPV based detection of cervical cancer Screening programs, using the method of HPV-HC2 screening, and then to LBC, VIA, HPV-HC2 shunt high viral load and low HPV-HC2 viral load of 4 screening methods, comparison of various schemes to identify high grade cervical squamous intraepithelial lesions (high-grade squamous, intraepithelial lesion, HSIL) and infiltration of cancer sensitivity, specificity and colposcopy to diagnosis rate and other indicators, the receiver operating characteristic (receiver operator, characteristic, ROC) and area under the curve of comprehensive application value of each screening program (alpha correction =0.012 5). Results: the HPV-HC2 test as a screening method, colposcopy referral rate was 18.1%, the detection of HSIL and invasive carcinoma of the sensitive and specific specificity were respectively 95.7% and 85%, and positive predictive value of LBC is only 20.4%., VIA and HPV-HC2 low viral load diversion, colposcopy referral rates were reduced to 8.7%, 4.5% and 9.8% respectively, the specificity increased to 94.3%, 97.5% and 93. 1%, the positive predictive value were increased to 37.2%, 46.9% and 32% respectively, the sensitivity is reduced to 84.1%, 55.1% and 81.2%.HPV screening and combined with LBC and HPV shunt shunt low viral load compared differences between the two groups, the area under the curve were not statistically significant (P < 0.0125), compared with the combined VIA shunt and HPV high viral load, the area under the curve between the two groups, the differences were statistically significant (P < 0.001). Conclusion: from the consideration of economy and adaptability, with limited resources, underdeveloped areas, the HPV DNA load value increased to more than 10 pg/m L as the standard to screening for cervical cancer screening it is feasible and effective. In developed areas, can be widely implemented with cytology triage.HR-HPV screening with VIA as a screening method of cervical carcinoma and shunt technology in rural areas is feasible to screen early HR-HPV, but the operation skill of doctors need training and improvement.

【作者單位】： 重慶醫(yī)科大學(xué)放射醫(yī)學(xué)教研室;中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院腫瘤醫(yī)院/腫瘤研究所流行病室;
【分類號】：R737.33

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本文編號：1534122