新疆巴楚縣宮頸癌篩查及篩查策略的研究
發(fā)布時(shí)間：2018-08-04 10:39
【摘要】：目的：通過對新疆巴楚縣維吾爾族婦女宮頸癌的篩查，了解篩查地區(qū)婦女子宮頸癌早診現(xiàn)狀及被調(diào)查人員的基本信息，系統(tǒng)評價(jià)多種子宮頸癌篩查方法，探索適合于新疆農(nóng)村這樣經(jīng)濟(jì)水平低的地區(qū)的子宮頸癌篩查方案和策略；評價(jià)高危型人乳頭狀瘤病毒DNA酶切信號放大法（Cervista HR HPV DNA）檢測HR-HPV在預(yù)測維吾爾族婦女宮頸病變的價(jià)值。方法：對巴楚縣6個(gè)鄉(xiāng)3個(gè)鎮(zhèn)20-65歲的已婚婦女5045人作為調(diào)查對象，自2014年3月1日至2014年6月15日期間，采用訪談方式進(jìn)行婦女基本信息(年齡、職業(yè)、學(xué)歷等)的問卷調(diào)查、婦科檢查、care HPV檢測、薄層制片技術(shù)細(xì)胞學(xué)檢查（TCT）檢測、醋酸染色肉眼觀察法（VIA）、碘染色肉眼觀察法（VILI）。care HPV陽性、TCT結(jié)果為ASC-US及以上病變者、VIA/VILI陽性，其中一項(xiàng)陽性行陰道鏡下宮頸活檢。首先對巴楚縣維吾爾族婦女宮頸癌篩查結(jié)果進(jìn)行初步分析；其次以病理組織學(xué)結(jié)果為金標(biāo)準(zhǔn)，計(jì)算各種篩查方法的靈敏度(Se)、特異度(Se)、ROC曲線下面積(AUC)等系統(tǒng)評價(jià)各種篩查方法；模擬組合形成幾種子宮頸癌篩查方案，對篩查方案進(jìn)行評價(jià)，綜合分析可行性及影響因素，探索適于新疆經(jīng)濟(jì)落后農(nóng)村的宮頸癌篩查策略；最后對373例新疆巴楚縣調(diào)查現(xiàn)場的維吾爾族婦女進(jìn)行Cervista HR HPV DNA檢測的臨床驗(yàn)證及評價(jià)其對維吾爾族婦女宮頸病變的預(yù)測價(jià)值。結(jié)果：1.本研究應(yīng)篩查人數(shù)為5000，實(shí)際篩查人數(shù)為5045人現(xiàn)場完成問卷調(diào)查并參加子宮頸癌的篩查，完成率100.9%，篩查對象的受教育程度普遍較低，小學(xué)及以下的文化程度占63.5%，調(diào)查對象最小年齡20歲，最大年齡65歲，平均年齡為39.47士9.73歲，查出宮頸癌11例，查出CINII及以上病例為67例，檢出率為1.33%，早診率為85.1%，早治率為73.7%。HPV陽性檢出率為9.93%。35歲以上的婦女CINⅡ級以上病變的發(fā)生率明顯增高，而30歲以下婦女CINⅡ級以上病變的發(fā)生率低。HPV感染率從40-45歲以后陽性率呈逐漸增高趨勢。2.篩查方法的總體特性:VIA/VILI的Se和Sp分別為53.2%和68.7%；TCT的Se和Sp分別為65.6%和85.0%。隨著病理級別的增高，TCT檢查陽性率也呈增高趨勢，差異有統(tǒng)計(jì)學(xué)意義；HPV檢測的Se和Sp分別為85.1%和42.8%，隨著病理級別的增高，HPV檢測結(jié)果的陽性率也在逐漸增高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。陰道鏡檢查的Se和Sp分別為94.2%和77.5%。各篩查方法中，陰道鏡靈敏度最高（94.2%），靈敏度其次的為HPV（85.1%），TCT的靈敏度為65.6%，VIA/VILI的靈敏度最低為53.2%。特異度最高的為TCT檢查（85.0%）。3.將各種篩查方法模擬組合形成三類子宮頸癌篩查方案，第一類HPV與TCT組合的三種方案。HPV初篩TCT分流的曲線下面積（比較HPV與TCT同時(shí)檢測、TCT初篩HPV分流）最大（0.794）；第二類方案中，單獨(dú)以HPV DNA檢測技術(shù)作為初篩，Se、Sp分別為85.1%和42.8，單獨(dú)TCT初篩Se、Sp分別為65.6%和85.0%；第三類方案中，單獨(dú)VIA/VILI初篩、VIA/VILI初篩HPV分流方案、VIA/VILI初篩TCT分流方案Se、Sp分別為53.2%、68.7%和40.9%、96.9%和35.1%、99.06%，VIA/VILI初篩HPV分流方案的ROC曲線下面積最大�？傮w比較各種組合方案，HPV初篩TCT分流的篩查方案ROC曲線下面積最大。4.5045例篩查人群中373例維吾爾族婦女行Cervista HR HPV檢測，HR-HPV感染率隨細(xì)胞學(xué)診斷級別、病理級別升高而升高，差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。373例樣本中A9組陽性率在病理陽性及細(xì)胞學(xué)陽性各個(gè)組中均較A5/A6組、A7組感染率高，差別有統(tǒng)計(jì)學(xué)意義（P 0.05）。結(jié)論：1.新疆巴楚縣維吾爾族婦女的CINⅡ級以上病變的檢出率為1.33%，HPV感染率（9.93%）低于中國其他宮頸癌高發(fā)地區(qū)，35歲以上的婦女CINⅡ級以上病變的發(fā)生率明顯增高，對宮頸病變的篩查應(yīng)在大于30歲的有性生活的女性較為合適，重點(diǎn)是35歲以上年齡段的婦女。2.陰道鏡檢查診斷價(jià)值好于其余3種方法，可作為宮頸癌篩查的首選方法，但需要專業(yè)的技術(shù)人員，在農(nóng)村基層推廣困難；TCT檢測由于對專業(yè)人員及設(shè)施要求高，在農(nóng)村基層很難推廣；care HPV檢測宮頸病變的靈敏度較高僅次于陰道鏡檢查，由于快速、簡便、易行、低廉，能夠作為一種有效地初篩方法用于農(nóng)村和欠發(fā)達(dá)地區(qū)子宮頸癌的預(yù)防；肉眼觀察(VIA/VILI)適用于欠發(fā)達(dá)地區(qū)農(nóng)村基層宮頸癌篩查。3.HPV初篩TCT分流方法在各種組合方案中對于宮頸癌篩查最有價(jià)值。但由于新疆經(jīng)濟(jì)落后的農(nóng)村地區(qū)醫(yī)療衛(wèi)生資源缺乏，也可選用VIA/VILI初篩care HPV分流的篩查方法。4.Cervista HRHPV DNA檢測與care HPV檢測具有較好的一致性，，可用于臨床檢測HPV高危亞型，可作為一種care HPV檢測及TCT檢查的靈敏分流方法應(yīng)用于大規(guī)模宮頸癌篩查及普查。HR-HPV感染組中，A9組對維吾爾族婦女CIN及宮頸癌的預(yù)測有很高的價(jià)值。
[Abstract]:Objective: through the screening of cervical cancer of Uygur women in Bachu County, Xinjiang, the status of the early diagnosis of cervical cancer and the basic information of the investigators in the screening area were understood. The screening methods of various cervical cancer were systematically evaluated, and the screening scheme and strategy of cervical cancer suitable for the low economic level in the rural areas of Xinjiang were explored. High risk human papillomavirus DNA HPV DNA (Cervista HR HPV DNA) was used to detect the value of HR-HPV in the prediction of cervical lesions in Uygur women. Methods: 5045 married women aged 20-65 years old in 6 townships in Bachu county were investigated. From March 1, 2014 to June 15, 2014, interviews were conducted to carry out women based groups. A questionnaire of this information (age, occupation, education, etc.), gynecologic examination, care HPV test, TLC cytology examination (TCT), acetic acid staining naked eye observation (VIA), iodine staining naked eye observation (VILI).Care HPV positive, TCT results for ASC-US and above lesions, VIA/VILI positive, one of the positive cervical biopsy under colposcopy First of all, the results of cervical cancer screening for Uygur women in Bachu county were first analyzed. Secondly, the sensitivity of various screening methods (Se), specificity (Se), area under ROC curve (AUC) and other screening methods were evaluated with the results of histopathology. The case was evaluated, the feasibility and the influencing factors were synthetically analyzed, and the cervical cancer screening strategy suitable for the backward rural areas in Xinjiang was explored. The Cervista HR HPV DNA detection of Uygur women in the 373 Uygur women in Bachu County, Xinjiang was tested and evaluated. The results were as follows: 1. The number of screening people in this study was 5000. The actual screening number of 5045 people completed the questionnaire survey and participated in the screening of cervical cancer, the completion rate was 100.9%, the education level of the screening subjects was generally low, the education level of the primary school and the following was 63.5%, the minimum age was 20 years and the maximum age was 65 years, the average age was 39.47 9.73 years old. In 11 cases of cervical cancer, 67 cases of CINII and above were found, the detection rate was 1.33%, the rate of early diagnosis was 85.1%. The incidence of 73.7%.HPV positive rate was higher than that of women above 9.93%.35 years old, and the incidence of low.HPV infection rate of the lower.HPV infection rate in women under 30 years of age of 30 years old was from 40-45 years old. The overall characteristics of the increasing trend.2. screening method: the Se and Sp of VIA/VILI were 53.2% and 68.7%, respectively, and Se and Sp of TCT were 65.6% and 85.0%., respectively, with the increase of pathological grade, and the positive rate of TCT examination also increased, the difference was statistically significant; HPV Se and Sp were 85.1% and 42.8% respectively. The positive rate of the fruit was also increasing, the difference was statistically significant (P0.05). The colposcopy Se and Sp were 94.2% and 77.5%. respectively, the colposcopy sensitivity was the highest (94.2%), the sensitivity followed HPV (85.1%), the sensitivity of TCT was 65.6%, and the lowest sensitivity of VIA/VILI was TCT examination (85%).3.. Various screening methods were combined to form three types of cervical cancer screening program, and the first class of HPV and TCT combination of the three schemes for.HPV initial screening of TCT shunt curve area (compared HPV and TCT simultaneous detection, TCT initial sieving HPV shunt) maximum (0.794); in the second class, HPV DNA detection technique was used as the initial screening, Se, Sp was 85.1% and 42.8, respectively, Sp, respectively, respectively. The single TCT screening Se and Sp were 65.6% and 85% respectively. In the third classes, the initial screening of VIA/VILI, the initial sieve HPV diversion scheme, the VIA/VILI initial sieve TCT shunt scheme Se, Sp respectively 53.2%, 68.7% and 40.9%, 96.9% and 35.1%, 99.06%, VIA/VILI screening HPV shunt scheme 373 Uygur women in the.4.5045 screening program under the flow screening program ROC curve were detected by Cervista HR HPV. The rate of HR-HPV infection increased with the level of cytological diagnosis and pathological grade, and the difference was statistically significant (P 0.05). The positive rate of A9 group in.373 case samples was higher than A5 in all groups of pathological positive and cytological positive groups. In group /A6, the infection rate of group A7 was high, and the difference was statistically significant (P 0.05). Conclusion: 1. Uygur women in Bachu County, Xinjiang, was 1.33%, and HPV infection rate (9.93%) was lower than that of other high incidence areas of cervical cancer in China. The incidence of CIN II in women above 35 years old was significantly higher, and the screening of cervical lesions should be screened. Women with sexual life greater than 30 years of age are more appropriate. The emphasis is on the value of.2. colposcopy for women over 35 years of age, better than the rest of the 3 methods, which can serve as the first choice for screening for cervical cancer, but requires professional technicians to promote difficulties in rural grass-roots level; TCT tests are high in requirements for professionals and facilities and in agriculture. The grass-roots level of the village is difficult to popularize. The sensitivity of care HPV to the detection of cervical lesions is higher than the colposcopy, because it is fast, simple, easy and cheap. It can be used as an effective screening method for the prevention of cervical cancer in rural and underdeveloped areas, and VIA/VILI is suitable for the screening of cervical cancer in rural grass-roots level in underdeveloped areas.3.HPV. The primary screening TCT shunt method is of the most valuable for screening cervical cancer in various combinations. However, because of the lack of medical and health resources in the rural areas of Xinjiang's backward economy, the screening method of VIA/VILI initial screening care HPV shunt can also be selected..4.Cervista HRHPV DNA detection has good consistency with care HPV detection, which can be used for clinical detection of HPV high. The risk subtype can be used as a sensitive shunt method for care HPV detection and TCT examination in large scale cervical cancer screening and screening of.HR-HPV infection groups. The A9 group is of high value for the prediction of CIN and cervical cancer in Uygur women.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R737.33
本文編號：2163677
[Abstract]:Objective: through the screening of cervical cancer of Uygur women in Bachu County, Xinjiang, the status of the early diagnosis of cervical cancer and the basic information of the investigators in the screening area were understood. The screening methods of various cervical cancer were systematically evaluated, and the screening scheme and strategy of cervical cancer suitable for the low economic level in the rural areas of Xinjiang were explored. High risk human papillomavirus DNA HPV DNA (Cervista HR HPV DNA) was used to detect the value of HR-HPV in the prediction of cervical lesions in Uygur women. Methods: 5045 married women aged 20-65 years old in 6 townships in Bachu county were investigated. From March 1, 2014 to June 15, 2014, interviews were conducted to carry out women based groups. A questionnaire of this information (age, occupation, education, etc.), gynecologic examination, care HPV test, TLC cytology examination (TCT), acetic acid staining naked eye observation (VIA), iodine staining naked eye observation (VILI).Care HPV positive, TCT results for ASC-US and above lesions, VIA/VILI positive, one of the positive cervical biopsy under colposcopy First of all, the results of cervical cancer screening for Uygur women in Bachu county were first analyzed. Secondly, the sensitivity of various screening methods (Se), specificity (Se), area under ROC curve (AUC) and other screening methods were evaluated with the results of histopathology. The case was evaluated, the feasibility and the influencing factors were synthetically analyzed, and the cervical cancer screening strategy suitable for the backward rural areas in Xinjiang was explored. The Cervista HR HPV DNA detection of Uygur women in the 373 Uygur women in Bachu County, Xinjiang was tested and evaluated. The results were as follows: 1. The number of screening people in this study was 5000. The actual screening number of 5045 people completed the questionnaire survey and participated in the screening of cervical cancer, the completion rate was 100.9%, the education level of the screening subjects was generally low, the education level of the primary school and the following was 63.5%, the minimum age was 20 years and the maximum age was 65 years, the average age was 39.47 9.73 years old. In 11 cases of cervical cancer, 67 cases of CINII and above were found, the detection rate was 1.33%, the rate of early diagnosis was 85.1%. The incidence of 73.7%.HPV positive rate was higher than that of women above 9.93%.35 years old, and the incidence of low.HPV infection rate of the lower.HPV infection rate in women under 30 years of age of 30 years old was from 40-45 years old. The overall characteristics of the increasing trend.2. screening method: the Se and Sp of VIA/VILI were 53.2% and 68.7%, respectively, and Se and Sp of TCT were 65.6% and 85.0%., respectively, with the increase of pathological grade, and the positive rate of TCT examination also increased, the difference was statistically significant; HPV Se and Sp were 85.1% and 42.8% respectively. The positive rate of the fruit was also increasing, the difference was statistically significant (P0.05). The colposcopy Se and Sp were 94.2% and 77.5%. respectively, the colposcopy sensitivity was the highest (94.2%), the sensitivity followed HPV (85.1%), the sensitivity of TCT was 65.6%, and the lowest sensitivity of VIA/VILI was TCT examination (85%).3.. Various screening methods were combined to form three types of cervical cancer screening program, and the first class of HPV and TCT combination of the three schemes for.HPV initial screening of TCT shunt curve area (compared HPV and TCT simultaneous detection, TCT initial sieving HPV shunt) maximum (0.794); in the second class, HPV DNA detection technique was used as the initial screening, Se, Sp was 85.1% and 42.8, respectively, Sp, respectively, respectively. The single TCT screening Se and Sp were 65.6% and 85% respectively. In the third classes, the initial screening of VIA/VILI, the initial sieve HPV diversion scheme, the VIA/VILI initial sieve TCT shunt scheme Se, Sp respectively 53.2%, 68.7% and 40.9%, 96.9% and 35.1%, 99.06%, VIA/VILI screening HPV shunt scheme 373 Uygur women in the.4.5045 screening program under the flow screening program ROC curve were detected by Cervista HR HPV. The rate of HR-HPV infection increased with the level of cytological diagnosis and pathological grade, and the difference was statistically significant (P 0.05). The positive rate of A9 group in.373 case samples was higher than A5 in all groups of pathological positive and cytological positive groups. In group /A6, the infection rate of group A7 was high, and the difference was statistically significant (P 0.05). Conclusion: 1. Uygur women in Bachu County, Xinjiang, was 1.33%, and HPV infection rate (9.93%) was lower than that of other high incidence areas of cervical cancer in China. The incidence of CIN II in women above 35 years old was significantly higher, and the screening of cervical lesions should be screened. Women with sexual life greater than 30 years of age are more appropriate. The emphasis is on the value of.2. colposcopy for women over 35 years of age, better than the rest of the 3 methods, which can serve as the first choice for screening for cervical cancer, but requires professional technicians to promote difficulties in rural grass-roots level; TCT tests are high in requirements for professionals and facilities and in agriculture. The grass-roots level of the village is difficult to popularize. The sensitivity of care HPV to the detection of cervical lesions is higher than the colposcopy, because it is fast, simple, easy and cheap. It can be used as an effective screening method for the prevention of cervical cancer in rural and underdeveloped areas, and VIA/VILI is suitable for the screening of cervical cancer in rural grass-roots level in underdeveloped areas.3.HPV. The primary screening TCT shunt method is of the most valuable for screening cervical cancer in various combinations. However, because of the lack of medical and health resources in the rural areas of Xinjiang's backward economy, the screening method of VIA/VILI initial screening care HPV shunt can also be selected..4.Cervista HRHPV DNA detection has good consistency with care HPV detection, which can be used for clinical detection of HPV high. The risk subtype can be used as a sensitive shunt method for care HPV detection and TCT examination in large scale cervical cancer screening and screening of.HR-HPV infection groups. The A9 group is of high value for the prediction of CIN and cervical cancer in Uygur women.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R737.33
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 李麗;瑪依努爾·尼亞孜;陳鳳;朱開春;劉新偉;熱孜亞·買買提孜;孫振柱;趙麗霞;張?jiān)?潘秦鏡;劉新伏;武燕萍;喬友林;;新疆維吾爾族女性HPV感染狀況及其分布特征研究[J];癌癥進(jìn)展;2010年02期
2 曾轉(zhuǎn)萍,陳鳳,劉彬,黃曼妮,張洵,潘秦鏡,趙芳輝,戎壽德,喬友林;山西省宮頸癌高發(fā)區(qū)宮頸癌的年齡分布[J];廣東藥學(xué)院學(xué)報(bào);2005年01期
3 肖克林;王丁;周克元;;HC2法在宮頸癌篩查中的應(yīng)用現(xiàn)狀[J];國際檢驗(yàn)醫(yī)學(xué)雜志;2008年04期
4 剛小青;張菊新;;液基細(xì)胞學(xué)、HPV檢測及hTERC基因檢測在宮頸癌篩查中的應(yīng)用價(jià)值[J];國際婦產(chǎn)科學(xué)雜志;2011年06期
5 高天楊;王秋艷;齊爽;;宮頸癌患者年輕化與人乳頭瘤病毒感染增加的關(guān)系[J];黑龍江醫(yī)學(xué);2008年03期
6 瞿曉怡;王凌云;高榮興;;液基薄層細(xì)胞學(xué)篩查宮頸癌及癌前病變的研究[J];臨床腫瘤學(xué)雜志;2009年02期
7 阮建波;康東平;陳冬萍;梁艷芳;吳秋良;毛玲芝;;多重HPV感染與宮頸病變的臨床分析[J];熱帶醫(yī)學(xué)雜志;2011年04期
8 李翎;羅紅敏;陳琳;王春英;;HPV16E6/E7基因及蛋白表達(dá)與宮頸癌的相關(guān)性研究[J];山東醫(yī)藥;2006年08期
9 李華;百合尼莎·阿不都熱西提;張?zhí)K琴;古扎麗努爾·阿不力孜;;喀什維吾爾族婦女宮頸癌與HLA-DRB1*15和HLA-DRB1*04的關(guān)系[J];復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版);2010年05期
10 周艷秋;張禮婕;烏蘭娜;劉志紅;吳瑞芳;;深圳市3567例體檢婦女篩查宮頸癌結(jié)果分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2007年04期
相關(guān)博士學(xué)位論文 前1條
1 趙方輝;子宮頸癌篩查方法及策略的研究[D];北京協(xié)和醫(yī)學(xué)院;2010年
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