【摘要】：目的分析LCT(liquid-based cervical cytology)和HR-HPV(high-risk human papillomavirus)與陰道鏡下宮頸活檢組織病理學(xué)診斷結(jié)果,探討LCT和HR-HPV對(duì)宮頸上皮內(nèi)瘤變的診斷價(jià)值。方法對(duì)2013年1月~2014年1月在青島大學(xué)附屬醫(yī)院本部院區(qū)門(mén)診行LCT檢查的20479例患者的臨床資料進(jìn)行回顧性分析,選取行HR-HPV檢測(cè)及陰道鏡下宮頸活檢的1534例患者作為研究對(duì)象,比較LCT、HR-HPV檢測(cè)與陰道鏡下宮頸活檢對(duì)宮頸上皮內(nèi)瘤變的檢出率。細(xì)胞學(xué)診斷應(yīng)用2001版TBS分級(jí)系統(tǒng),以未明確意義的不典型鱗狀細(xì)胞(atypical squamous cell of undetermined significance,ASC-US)及其以上病變作為陽(yáng)性診斷。以組織病理學(xué)結(jié)果作為診斷的金標(biāo)準(zhǔn)。結(jié)果1.20479例LCT檢查結(jié)果示未見(jiàn)上皮內(nèi)病變或惡性病變(NILM)19151例占93.52%,ASC-US及以上級(jí)別病變1328例,陽(yáng)性檢出率為6.48%(1328/20479)。LCT結(jié)果為ASC-US、LSIL、ASC-H、HSIL、宮頸癌中CINI及以上宮頸病變的檢出率分別為43.55%(334/767)、51.91%(95/183)、83.19%(99/119)、91.88%(181/197)、100%(5/5),經(jīng)卡方檢驗(yàn),ASC-US與LSIL、ASC-H與HSIL差別無(wú)顯著意義(P0.05),ASC-H、HSIL均高于ASC-US及LSIL,差別有顯著意義(P0.05)。2.ASC-US、LSIL、ASC-H、HSIL、宮頸癌中HR-HPV的陽(yáng)性率分別為77.44%、68.31%、84.87%、96.45%、100%。在LCT各陽(yáng)性結(jié)果中HR-HPV的陽(yáng)性率逐漸增高,差別有顯著意義(P0.05)3.HR-HPV陽(yáng)性組與陰性組比較,高級(jí)別宮頸上皮內(nèi)瘤變的檢出率分別為44.33%、10.16%,差別有非常顯著意義(P0.01)。4.ASC-US中HPV陽(yáng)性者宮頸高級(jí)別上皮內(nèi)瘤變及宮頸癌的檢出率為26.60%(158/594)明顯高于HPV陰性者4.05%(7/173),差別有非常顯著意義(P0.01)。HPV陰性者無(wú)宮頸癌的檢出。5.LSIL中HPV陽(yáng)性者宮頸高級(jí)別上皮內(nèi)瘤變及宮頸癌的檢出率為33.60%(42/125)明顯高于HPV陰性者13.79%(8/58),差別有顯著意義(P0.05)。6.263例液基細(xì)胞學(xué)陰性、HR-HPV陽(yáng)性者行陰道鏡下宮頸活檢病理結(jié)果為宮頸高級(jí)別上皮內(nèi)瘤變及宮頸癌44例,檢出率為16.73%(44/263)。結(jié)論1.LCT及HR-HPV是檢測(cè)宮頸病變的有效篩查方法,二者聯(lián)合檢測(cè)的診斷準(zhǔn)確性更高。2.HR-HPV檢測(cè)對(duì)細(xì)胞學(xué)診斷為ASC-US的患者有重要的分流價(jià)值。3.細(xì)胞學(xué)陰性、HR-HPV陽(yáng)性的女性有患宮頸高級(jí)別上皮內(nèi)瘤變及宮頸癌的風(fēng)險(xiǎn),對(duì)此類(lèi)患者行陰道鏡下宮頸活檢可以減少漏診。
[Abstract]:Objective to analyze the pathological diagnosis results of LCT (liquid-based cervical cytology) and HR-HPV (high-risk human papillomavirus) and cervical biopsy under colposcopy) and to explore the value of LCT and HR-HPV in the diagnosis of cervical intraepithelial neoplasia. Methods the clinical data of 20479 patients with LCT from January 2013 to January 2014 were analyzed retrospectively. 1534 patients who underwent HR-HPV examination and cervical biopsy under colposcopy were selected as the study objects. To compare the detection rate of HR-HPV with cervical biopsy under colposcopy for cervical intraepithelial neoplasia. 2001 TBS grading system was used for cytological diagnosis. The atypical squamous cell (atypical squamous cell of undetermined significance ASC-US) and above lesions were used as positive diagnosis. Histopathological results were taken as the golden criteria for diagnosis. Results the results of LCT in 1.20479 cases showed that there were no intraepithelial lesions or malignant lesions in 19151 cases (93.52%). 1328 cases had ASC-US or above grade lesions. 闃蟲(chóng)，

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