【摘要】：目的：1.利用細胞DNA定量分析技術,常規(guī)細胞學檢查及宮頸HPV檢測在一定人群中開展宮頸癌篩查,研究不同篩查方式的靈敏度和特異度,以評價其在宮頸癌及癌前病變篩查診斷中的應用,找出適合宮頸癌篩查的最適用方法；2.評價DNA定量分析技術用于ASCUS分流中價值；3.評價DNA異倍體和HPV感染之間的相關性,以明確二者在宮頸病變中的關系。 方法：1.隨機選取2012年6月——2013年5月在昆明醫(yī)科大學第一附屬醫(yī)院婦科門診就診的,無宮頸脫落細胞學取材禁忌癥的3418位患者為研究對象,分別進行細胞DNA定量分析、常規(guī)細胞學檢查,對細胞DNA定量分析有≥3個異倍體細胞或(和)細胞學診斷高于低度鱗狀上皮內病變的行宮頸HPV檢測及宮頸活檢,以宮頸活檢結果為金標準,進行雙盲對照研究及統(tǒng)計學分析；2.篩選本院就診的宮頸癌篩查常規(guī)細胞學檢查結果為ASCUS的126例患者,根據(jù)DNA倍體檢測分為實驗活檢組和實驗非活檢組,對兩組患者分別進行陰道鏡下活檢,以宮頸活檢為金標準進行統(tǒng)計學分析；3.篩取有HPV感染的病例,將其檢查結果與DNA結果進行對比,找出兩者的相關性。 結果：1.共有211名婦女做了宮頸組織活檢及病理檢查,以宮頸活檢病理結果為金標準,以組織學診斷CIN2及以上級別病變?yōu)殛栃蚤撝?計算出細胞DNA定量分析技術的靈敏度為89.6%,特異度為71.4%,約登指數(shù)為0.610；常規(guī)細胞學檢查的靈敏度為71.8%,特異度為78.9%,約登指數(shù)為0.507；宮頸HPV檢查的靈敏度為92.7%,特異度為84.2%,約登指數(shù)為0.769,DNA定量分析技術與常規(guī)細胞學相比,DNA靈敏度增高,約登指數(shù)較大2.對于常規(guī)細胞學檢查為ASCUS的126例患者,在陰道鏡下行宮頸活檢,ASCUS伴有DNA倍體異常者,CINII及以上病變的風險增高。若以篩查CIN及以上級別病變?yōu)槟繕?DNA倍體定量分析的靈敏度為83.1%,特異度為69.4%,約登指數(shù)為0.525；若以篩查CINII及以上為目標DNA倍體定量分析的靈敏度為85.4%,特異度為83.3%,約登指數(shù)為0.687。3.211例行HR-HPV檢測的病例中,HR-HPV感染的檢出率隨著宮頸病變級別的升高而增加,在112例HR-HPV感染病例中,100例(89.3%)DNA倍體分析為陽性；在176例倍體分析陽性的病例中,100例(43.4%)檢出有HR-HPV感染,兩者行統(tǒng)計學分析具有差異性。 結論：1.DNA定量分析技術與常規(guī)細胞學相比,明顯的提高了靈敏性且其真實性較好,而HPV檢測技術的靈敏性和特異性均較高,可以作為宮頸癌篩查的有效手段,與細胞學聯(lián)合應用可以最大限度的減少漏診率,提高篩查的效率。 2.DNA倍體分析為篩查ASCUS提供了一種客觀、敏感的方法,有利于ASCUS中CINII及以上病變的檢出,能為常規(guī)細胞學為ASCUS的患者提供合理的分流。 3.HPV的持續(xù)感染與DNA異倍體的形成有一定的聯(lián)系,但并不是必需的因素,DNA定量分析技術與宮頸HPV檢測可以提高宮頸病變的檢出率。
[Abstract]:Objective: 1. The sensitivity and specificity of different screening methods were studied by quantitative analysis of cell DNA, routine cytological examination and cervical HPV detection in a certain population. In order to evaluate its application in the screening diagnosis of cervical cancer and precancerous lesions, find out the most suitable method for cervical cancer screening. 2. Evaluate the value of DNA quantitative analysis technique in ASCUS shunt. 3. To evaluate the correlation between DNA aneuploidy and HPV infection in cervical lesions. Method 1: 1. From June 2012 to May 2013, 3418 patients with no contraindication of cervical exfoliation cytology were selected from gynecological outpatient clinic of the first affiliated Hospital of Kunming Medical University as the study objects. The quantitative analysis of cell DNA was performed respectively. Routine cytological examination showed that the quantitative analysis of cell DNA was more than 3 aneuploidy cells or (and) cytology, which was higher than that of low grade squamous intraepithelial lesions. The cervical HPV detection and cervical biopsy were performed, and the results of cervical biopsy were regarded as the gold standard. Double blind control study and statistical analysis; 2. According to DNA ploidy test, 126 patients with ASCUS were divided into experimental biopsy group and experimental non-biopsy group. The cervical biopsy was used as the gold standard for statistical analysis. 3. The results of HPV infection were compared with those of DNA, and the correlation between them was found. Results: 1. A total of 211 women underwent cervical biopsy and pathological examination. The sensitivity of quantitative analysis of cellular DNA was 89.6, taking the pathological results of cervical biopsy as gold standard and histologic diagnosis of lesions of CIN2 and above as positive threshold. The specificity was 71.4 and the Yorden index was 0.610; The sensitivity of routine cytology was 71.8%, the specificity was 78.9, and the Yorden index was 0.507; The sensitivity and specificity of cervical HPV examination were 92.7% and 84.2% respectively. Compared with conventional cytology, the sensitivity of DNA was higher and the Yorden index was higher than that of conventional cytology. Cervical biopsy was performed under colposcopy in 126 patients with conventional cytologic examination of ASCUS. ASCUS with DNA ploidy was associated with increased risk of CINII and above lesions. The sensitivity of quantitative analysis of DNA ploidy was 83.1, the specificity was 69.4, and the Yorden index was 0.525. If the sensitivity of quantitative analysis of DNA ploidy is 85.4, the specificity is 83.3, and the Yorden index is 0.687.3.211, the sensitivity of quantitative analysis of DNA ploidy is 85.4, the specificity is 83.3, and the Yorden index is 0.687.3.211. The detection rate of HR-HPV infection increased with the increase of cervical lesion grade. Among 112 cases of HR-HPV infection, 100 cases (89.3%) were positive for DNA ploidy analysis. Among 176 cases with positive ploidy analysis, 100 cases (43.4%) were found to have HR-HPV infection. Conclusion: compared with conventional cytology, 1.DNA quantitative analysis technique can improve the sensitivity and its authenticity, while the sensitivity and specificity of HPV detection technique are higher, so it can be used as an effective method for cervical cancer screening. Combined with cytology can minimize the rate of missed diagnosis and improve the efficiency of screening. 2.DNA ploidy analysis provides an objective and sensitive method for screening ASCUS, which is beneficial to the detection of CINII and above lesions in ASCUS, and can provide reasonable shunt for patients with ASCUS by routine cytology. The persistent infection of 3.HPV is related to the formation of DNA aneuploidy, but it is not a necessary factor. DNA quantitative analysis and cervical HPV detection can improve the detection rate of cervical lesions.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

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