高危HPV和TCT在宮頸高級別病變診斷與治療中的作用研究
發(fā)布時間：2018-09-16 20:26
【摘要】：目的本研究旨在探討HPV分型檢測與TCT檢查在宮頸高級別病變診斷與治療中的作用;探索HPV52/58亞型能否作為轉(zhuǎn)診陰道鏡的指標(biāo);HPV分型(16/18/52/58)及TCT檢查結(jié)果能否作為預(yù)測宮頸錐切術(shù)后病變升級及病變殘留的客觀指標(biāo),從而為宮頸高級別病變的精準(zhǔn)診斷與治療提供客觀依據(jù)。方法選取2010年1月1日至2016年4月31日就診于天津市第一中心醫(yī)院婦科門診的臨床宮頸細(xì)胞學(xué)、HPV檢測結(jié)果與病理資料完整的患者249例,HPV檢測方法為導(dǎo)流雜交技術(shù)。結(jié)果1.本組患者HPV感染率90.76%,單一高危HPV感染率為64.65%,多重高危HPV感染率為22.49%。高危HPV感染前5位分別為HPV16、58、52、18、33。2.20-30歲組HPV感染率最高(97.30%);其次為41-50歲組(92.59%)。3.本組患者中CINⅠ45例、CINⅡ-Ⅲ(包括原位癌)194例、宮頸浸潤癌2例。宮頸高級別病變組HPV16/18感染高于宮頸低級別病變組(X~2=9.001,p0.05);宮頸高級別病變組其他HR-HPV感染低于宮頸低級別病變組(X~2=6.773,p0.05);宮頸高級別病變組HPV52/58感染高于宮頸低級別病變組(X~2=5.530,p0.05)。4.TCT結(jié)果異常者中,術(shù)后病理診斷為CINⅠ45例、CINⅡ61例、CINⅢ(包括原位癌)133例、宮頸浸潤癌2例。TCT結(jié)果在宮頸各級別病變之間的差異有統(tǒng)計學(xué)意義(X~2=30.311,p0.05)。5.TCT為HSIL者,其宮頸高級別病變發(fā)生率高于LSIL者(X~2=18.186,p0.05)。HSIL預(yù)測宮頸高級別病變的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值分別為97.53%、75.37%、43.89%、94.29%。6.術(shù)前HPV16/18感染、HPV52/58感染、其他HR-HPV感染者,HPV16/18者宮頸高級別病變發(fā)生率高于其他HR-HPV者(X~2=5.282,p0.05);HPV52/58者與HPV16/18及其他HR-HPV者間差異無統(tǒng)計學(xué)意義(X~2=0.051,p0.05;X~2=3.551,p0.05)。HPV16/18預(yù)測宮頸高級別病變的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值分別為86.09%、21.74%、84.62%、55.56%。7.TCT為HSIL者,其錐切術(shù)后切緣陽性發(fā)生率高于LSIL者(X~2=8.129,p0.01)。HSIL預(yù)測錐切術(shù)后切緣陽性的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值分別為14.12%、3.62%、70.59%、64.56%。8.HPV16/18、HPV52/58、其他HR-HPV感染者,三組術(shù)后切緣陽性發(fā)生率之間差異無統(tǒng)計學(xué)意義(X~2=1.025,p0.05)。9.TCT為HSIL者,其錐切術(shù)后病理級別增加發(fā)生率高于LSIL者(X~2=6.074,p0.05)。HSIL預(yù)測錐切術(shù)后病理級別增加的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值分別為21.18%、90.58%、58.06%、65.10%。10.HPV16/18、HPV52/58、其他HR-HPV感染者,其錐切術(shù)后病理級別增加發(fā)生率之間差異無統(tǒng)計學(xué)意義(X~2=0.861,p0.05)。結(jié)論1.HPV感染率隨宮頸病變級別升高而增加。2.HPV感染率及感染亞型分布有地區(qū)差異,本地區(qū)各級別宮頸病變中以HPV16/18/52/58感染為主;HPV16/18可作為轉(zhuǎn)診陰道鏡的指標(biāo),但HPV52/58尚不能作為轉(zhuǎn)診陰道鏡的指標(biāo)。3.HPV感染年齡分布有兩個高峰,20-30歲的年輕女性HPV感染率最高,41-50歲圍絕經(jīng)期女性出現(xiàn)第二個高峰。4.HSIL預(yù)測宮頸高級別病變的敏感性及特異性均優(yōu)于不同型別的高危HPV感染;HSIL預(yù)測錐切術(shù)后切緣陽性和病理級別增加的敏感性均優(yōu)于不同型別的高危HPV感染。因此,在宮頸病變的診斷與治療中,應(yīng)更加重視宮頸細(xì)胞學(xué)檢查結(jié)果,特別是HSIL者。
[Abstract]:Objective To explore the role of HPV typing test and TCT in the diagnosis and treatment of high-grade cervical lesions, to explore whether HPV 52/58 subtype can be used as a referral colposcopy indicator, HPV typing (16/18/52/58) and TCT results can be used as objective indicators to predict the cervical lesion escalation and residual lesions after conization. Methods From January 1, 2010 to April 31, 2016, 249 patients with complete HPV test results and pathological data were enrolled in the gynecological clinic of Tianjin First Central Hospital. The HPV test method was used as a guided hybridization technique. Results 1. The HPV infection rate was 9. HPV infection rate was 0.76%, single high-risk HPV infection rate was 64.65%, multiple high-risk HPV infection rate was 22.49%. The top five high-risk HPV infection groups were HPV 16,58,52,18,33.2.20-30 years old group (97.30%), followed by 41-50 years old group (92.59%).3. CIN I 45 cases, CIN II-III (including carcinoma in situ) 194 cases, cervical invasive carcinoma 2 cases. HPV16/18 infection was higher than low-grade cervical lesion group (X~2=9.001, p0.05); other HR-HPV infection in high-grade cervical lesion group was lower than low-grade cervical lesion group (X~2=6.773, p0.05); HPV52/58 infection in high-grade cervical lesion group was higher than low-grade cervical lesion group (X~2=5.530, p0.05). 4. TCT results were abnormal, postoperative pathological diagnosis was CIN I 45 cases, CIN 0.05. The results of TCT were statistically significant (X~2=30.311, p0.05). 5. The incidence of high-grade cervical lesions in HSIL patients was higher than that in LSIL patients (X~2=18.186, p0.05). HSIL predicted high-grade cervical lesions with sensitivity, specificity, positive predictive value, negative predictive value. Preoperative HPV16/18 infection, HPV52/58 infection, other HR-HPV infection, HPV16/18 cervical high-grade lesion incidence was higher than other HR-HPV infection (X~2 = 5.282, p0.05); HPV52/58 and HPV16/18 and other HR-HPV had no significant difference (X~2 = 0.051, p0.05; X~2 = 3.551, p0.05). The sensitivity, specificity, positive predictive value and negative predictive value were 86.09%, 21.74%, 84.62% and 55.56% respectively. 7. The incidence of positive margin after conization in HSIL patients was higher than that in LSIL patients (X~2=8.129, P 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of HSIL in predicting positive margin after conization were 1. There was no significant difference in the incidence of positive incision margins among the three groups (X~2=1.025, P 0.05). 9. TCT was HSIL, and the incidence of increased pathological grade after conization was higher than that of LSIL (X~2=6.074, P 0.05). HSIL was more sensitive and specific in predicting the increase of pathological grade after conization. There was no significant difference in the incidence of pathological grade increase among the patients with 10.HPV 16/18, HPV 52/58 and other HR-HPV infection (X~2=0.861, p0.05). Conclusion 1. HPV infection rate increased with the increase of cervical lesion grade. 2. HPV infection rate and distribution of infection subtypes. HPV16/18/52/58 infection was the main infection in cervical lesions of different levels in the region; HPV16/18 could be used as a referral colposcopy index, but HPV52/58 could not be used as a referral colposcopy index. 3. HPV infection age distribution had two peaks, 20-30 years old young women HPV infection rate was the highest, 41-50 years old perimenopausal women appeared the second high. The sensitivity and specificity of HSIL in predicting high-grade cervical lesions were superior to that of different types of high-risk HPV infection; the sensitivity of HSIL in predicting positive margins and increased pathological grade after conization was superior to that of different types of high-risk HPV infection. Therefore, more attention should be paid to the results of cervical cytology in the diagnosis and treatment of cervical lesions. Don't be HSIL.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33
本文編號：2244700
[Abstract]:Objective To explore the role of HPV typing test and TCT in the diagnosis and treatment of high-grade cervical lesions, to explore whether HPV 52/58 subtype can be used as a referral colposcopy indicator, HPV typing (16/18/52/58) and TCT results can be used as objective indicators to predict the cervical lesion escalation and residual lesions after conization. Methods From January 1, 2010 to April 31, 2016, 249 patients with complete HPV test results and pathological data were enrolled in the gynecological clinic of Tianjin First Central Hospital. The HPV test method was used as a guided hybridization technique. Results 1. The HPV infection rate was 9. HPV infection rate was 0.76%, single high-risk HPV infection rate was 64.65%, multiple high-risk HPV infection rate was 22.49%. The top five high-risk HPV infection groups were HPV 16,58,52,18,33.2.20-30 years old group (97.30%), followed by 41-50 years old group (92.59%).3. CIN I 45 cases, CIN II-III (including carcinoma in situ) 194 cases, cervical invasive carcinoma 2 cases. HPV16/18 infection was higher than low-grade cervical lesion group (X~2=9.001, p0.05); other HR-HPV infection in high-grade cervical lesion group was lower than low-grade cervical lesion group (X~2=6.773, p0.05); HPV52/58 infection in high-grade cervical lesion group was higher than low-grade cervical lesion group (X~2=5.530, p0.05). 4. TCT results were abnormal, postoperative pathological diagnosis was CIN I 45 cases, CIN 0.05. The results of TCT were statistically significant (X~2=30.311, p0.05). 5. The incidence of high-grade cervical lesions in HSIL patients was higher than that in LSIL patients (X~2=18.186, p0.05). HSIL predicted high-grade cervical lesions with sensitivity, specificity, positive predictive value, negative predictive value. Preoperative HPV16/18 infection, HPV52/58 infection, other HR-HPV infection, HPV16/18 cervical high-grade lesion incidence was higher than other HR-HPV infection (X~2 = 5.282, p0.05); HPV52/58 and HPV16/18 and other HR-HPV had no significant difference (X~2 = 0.051, p0.05; X~2 = 3.551, p0.05). The sensitivity, specificity, positive predictive value and negative predictive value were 86.09%, 21.74%, 84.62% and 55.56% respectively. 7. The incidence of positive margin after conization in HSIL patients was higher than that in LSIL patients (X~2=8.129, P 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of HSIL in predicting positive margin after conization were 1. There was no significant difference in the incidence of positive incision margins among the three groups (X~2=1.025, P 0.05). 9. TCT was HSIL, and the incidence of increased pathological grade after conization was higher than that of LSIL (X~2=6.074, P 0.05). HSIL was more sensitive and specific in predicting the increase of pathological grade after conization. There was no significant difference in the incidence of pathological grade increase among the patients with 10.HPV 16/18, HPV 52/58 and other HR-HPV infection (X~2=0.861, p0.05). Conclusion 1. HPV infection rate increased with the increase of cervical lesion grade. 2. HPV infection rate and distribution of infection subtypes. HPV16/18/52/58 infection was the main infection in cervical lesions of different levels in the region; HPV16/18 could be used as a referral colposcopy index, but HPV52/58 could not be used as a referral colposcopy index. 3. HPV infection age distribution had two peaks, 20-30 years old young women HPV infection rate was the highest, 41-50 years old perimenopausal women appeared the second high. The sensitivity and specificity of HSIL in predicting high-grade cervical lesions were superior to that of different types of high-risk HPV infection; the sensitivity of HSIL in predicting positive margins and increased pathological grade after conization was superior to that of different types of high-risk HPV infection. Therefore, more attention should be paid to the results of cervical cytology in the diagnosis and treatment of cervical lesions. Don't be HSIL.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 王秋紅;杜桂清;鄧桂霞;喬婷婷;聶艷絨;馬丹琦;;宮頸上皮內(nèi)瘤變患者活檢與錐切術(shù)后病理結(jié)果比較[J];貴陽醫(yī)學(xué)院學(xué)報;2016年02期
2 張靖;高波;康峗;馬智靜;李啟明;;中國女性宮頸人乳頭瘤病毒感染型別分布區(qū)域性特征的Meta分析[J];中華微生物學(xué)和免疫學(xué)雜志;2014年12期
3 吳緒峰;曾蓉;高晗;蔡鴻寧;;宮頸錐切術(shù)后全子宮切除的CINⅢ患者病灶殘留相關(guān)因素分析[J];腫瘤防治研究;2014年06期
4 李壽俊;許國章;易波;陳奕;賀天鋒;;宮頸癌高危人乳頭瘤病毒型別分布的Meta分析[J];浙江預(yù)防醫(yī)學(xué);2014年05期
5 舒焰紅;錢德英;吳越;岑堅敏;陳觀娣;陽麗;李志剛;;即查即治策略處理宮頸高度鱗狀上皮內(nèi)病變的臨床價值[J];實用醫(yī)學(xué)雜志;2013年03期
6 岑堯;張翠英;張雅麗;侯建華;;中國女性人乳頭瘤病毒感染狀況及高危型別分布的Meta分析[J];癌癥進(jìn)展;2013年01期
7 吳瑾;賈英;唐良萏;;人乳頭狀瘤病毒檢測對宮頸上皮內(nèi)瘤樣病變Ⅱ～Ⅲ LEEP術(shù)后切緣陽性的預(yù)后評估[J];重慶醫(yī)科大學(xué)學(xué)報;2012年07期
8 張東紅;林美珊;;人乳頭瘤病毒在國人宮頸病變中感染及型別分布特征的Meta分析[J];中國全科醫(yī)學(xué);2010年12期
9 李霓;代敏;;中國婦女人乳頭狀瘤病毒感染的多中心橫斷面研究[J];中華疾病控制雜志;2008年05期
10 樊慶泊,Tay Sun Kuie,沈鏗;子宮頸環(huán)形電切術(shù)在子宮頸上皮內(nèi)瘤變治療中的價值[J];中華婦產(chǎn)科雜志;2001年05期
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