【摘要】：宮頸癌的早期病變，即宮頸上皮內(nèi)瘤變（cervical intraepithelial neoplasia，CIN），是一個宮頸癌前細(xì)胞病變的循序漸進(jìn)的過程。近年來的研究表明，CIN的早期發(fā)現(xiàn)與治療可以有效的預(yù)防宮頸癌。人乳頭瘤病毒（human papilloma virus,HPV）的持續(xù)感染可以誘發(fā)CIN，進(jìn)而導(dǎo)致宮頸癌。 現(xiàn)在臨床應(yīng)用比較廣泛的宮頸病變篩查方法包括：HPV分型檢測、液基薄層細(xì)胞學(xué)檢測、陰道鏡檢查及陰道鏡下組織活檢等，這些方法在早期篩查中各有優(yōu)劣。如何組合這些方法使篩查更快速準(zhǔn)確有待進(jìn)一步研究。 目的： 1．本文通過對在大連婦產(chǎn)醫(yī)院門診婦女HPV感染情況進(jìn)行流行病學(xué)特征分析，初步了解HPV多重感染情況，HPV基因型和不同年齡的分布，為以后HPV疫苗的研制提供本地的流行病學(xué)依據(jù)； 2．研究HPV及其高危型與各級別宮頸病變的相關(guān)性； 3．研究TCT和HPV分型檢測以及二者聯(lián)合檢測在宮頸病變篩查中的應(yīng)用價(jià)值。 方法：收集大連婦產(chǎn)醫(yī)院7355例做HPV分型檢測和TCT檢查的患者，分析感染HPV的型別和年齡分布特征。再以其中做陰道鏡檢查及活檢的患者340例為研究對象，以病理診斷作為金標(biāo)準(zhǔn)，將TCT和HPV結(jié)果的單獨(dú)應(yīng)用及兩種方案聯(lián)合應(yīng)用與組織學(xué)診斷結(jié)果作分析。 結(jié)果： 1．在7355名患者中，HPV陽性1957人，總感染率為26.6%，21種型別均有檢出，感染率最高的型別是HPV16(16.3%)，感染率最低的型別是HPV43(0.2%)，高危型中檢出率前四位的依次為16(16.3%)、58(12.9%)、18(12.4%)、53(10.3%)。HPV感染率最高的是15-19歲年齡組。檢出高危型例數(shù)在各年齡所占比例最高的是35-39歲年齡組。HPV感染以單一感染為主，感染率為21.2%，多重感染率為5.4%。 2．340例不同年齡組患者中，低級病變率最高的是20-24年齡組（87.0%），高級病變率最高的是≥55年齡組（58.3%）。HPV感染率為62.6%(213/340)，其中高危型陽性率40.3%(137/340)，HPV的多重感染率31.9%(68/213)。在高級別病變中高危型以HPV16為主，占42.1%，，之后依次為18、58、52、31、33型，高級別病變組患者中這些高危型HPV的檢出率顯著高于炎癥組和低級別病變組（P0.05）。 3．將340例病理學(xué)結(jié)果高級別病變?yōu)殛栃裕图墑e病變?yōu)殛幮�，其中HPV高危型為陽性，低危型和陰性定為陰性，TCT結(jié)果≥LISL為陽性，≤ASC-H為陰性。TCT檢測宮頸病變的靈敏度：71.0%，特異度：76.8%，陽性預(yù)測值：58.5%，陰性預(yù)測值：85.2%，誤診率：23.2%，漏診率：29.0%。HPV檢測宮頸病變的靈敏度：74.8%，特異度：75.5%，陽性預(yù)測值：58.4%，陰性預(yù)測值：86.7%，誤診率為：24.5%，漏診率為：25.2%。診斷宮頸病變聯(lián)合檢測方案1以TCT陽性和（或）HPV陽性為陽性，二者都陰性為陰性，靈敏度：97.2%，特異度：13.3%，陽性預(yù)測值：34.0%，陰性預(yù)測值：91.2%，誤診率：86.7%，漏診率：2.8%。方案2以TCT陰性和（或）HPV陰性為陰性，二者都陽性為陽性，靈敏度：56.1%，特異度：93.1%，陽性預(yù)測值：78.9%，陰性預(yù)測值：82.2%誤診率：6.9%，漏診率：43.9%。 結(jié)論： 1. HPV總感染率26.6%，21種型別均有檢出，其中16型感染率最高其次為58型。感染年齡高峰出現(xiàn)在青年期，以低危型感染為主，中年高危型HPV感染達(dá)到高峰。 2.不同年齡組中宮頸病變率不同，隨年齡增加高級病變發(fā)生率增加。HPV在宮頸病變中感染率較高，并隨著病變程度的增加，HPV感染率特別是高危型HPV感染率升高。 3.聯(lián)合檢測方案1可明顯提高靈敏度、陰性預(yù)測值，降低漏診率，在篩查和陰性排除方面優(yōu)于單獨(dú)應(yīng)用HPV檢測或TCT方法。方案2可明顯提高特異度、陽性預(yù)測值，降低誤診率，在定位疑似病例方面優(yōu)于單獨(dú)檢測。
[Abstract]:The early stage of cervical cancer, that is, cervical intraepithelial neoplasia (CIN), is a step-by-step process of pre-cervical cancer. Recent studies have shown that early detection and treatment of CIN can be effective in the prevention of cervical cancer. The persistent infection of human papillomavirus (HPV) can induce CIN and lead to cervical cancer. There are now a wide range of cervical lesions screening methods for clinical applications, including HPV type detection, liquid-based thin-layer cytology, colposcopy and colposcope biopsy, which are excellent in early screening Poor. How to combine these methods allows for more rapid and accurate screening to be further developed To study. Objective: To study the incidence of HPV infection and the distribution of HPV genotypes and different ages in the clinic of women and women in Dalian, and to provide a local flow for the development of the later HPV vaccine. Pathologic basis; 2. Study of HPV and its high-risk and various levels Correlation of cervical lesions; 3. Study on the detection of TCT and HPV typing and the combination of the two in the detection of cervical disease Application value in variable screening. Methods: 7355 patients with HPV type detection and TCT examination were collected in Dalian Maternity Hospital, and the infection of HP was analyzed. The type and age distribution of V were characterized by the study of 340 cases of patients with colposcopy and biopsy, and the application of TCT and HPV as the gold standard and the combination of the two schemes. and the organization The results of this study were as follows: 1. In the 7355 patients, the HPV positive in 1957, the total infection rate of 26. 6% and the 21 types were detected. The highest infection rate was HPV16 (16. 3%), the lowest infection rate was HPV43 (0.2%), the first four in the high-risk type were 16 (16. 3%), 58 (12. 9%), 18 (12.4%), 53 (10.3%). HPV The highest staining rate is the age group of 15-19 years. The number of high-risk patients in all ages The highest proportion is the age group of 35-39. HPV infection is dominated by a single infection, and the infection rate is 2. 1. 2%, the multiple infection rate was 5. 4%. Of the 340 patients with different age groups, the highest rate of low-grade lesions was the 20-24 age group (87.0%). The highest rate of high-grade lesions was in the 55 age group (58.3%). The infection rate of HPV was 62.6% (213/ 340), of which the high-risk positive rate was 40.3% (137/ 340), and the HPV was much higher. The prevalence of high-risk HPV was significantly higher in the high-risk group than in the high-risk group (42.1%), followed by 18, 58, 52, 31, 33 and high-level lesions. In the group of inflammation and low-grade lesions (P0.05). 3. The high-level lesions of 340 cases were positive and the low-grade lesions were negative, with the HPV high-risk being positive, low-risk and negative, and the TCT-junction The sensitivity of TCT in the detection of cervical lesions was 71.0%, specificity: 76.8%, positive predictive value: 52.5%, negative predictive value: 85.2%, misdiagnosis rate: 22.8%, and specificity: 77.5%.%, positive predictive value: 58.4%, negative predictive value: 86.7%, misdiagnosed The positive predictive value was 97.2%, specificity: 13. 3%, positive predictive value: 34. 0%, negative predictive value: 91.2%. The misdiagnosis rate was 86.7%, the rate of missed diagnosis was 2.8%. The negative of the negative and/ or HPV negative of the scheme 2 was positive, the sensitivity was 56.1%, the specificity was 93.1%, the positive predictive value was 78.9%, the negative predictive value was 88.2.% Misdiagnosis Results: 1. The total infection rate of HPV was 26. 6% and 21 species. The type of infection was the highest, followed by 58. The peak in the age of the infection was in the blue period. The high-risk HPV infection of middle-aged and middle-aged patients with low-risk-type infection has reached the peak. In the age group, the rate of cervical lesion was different, and the incidence of high-grade lesions increased with age. The infection rate of HPV in the cervical lesion was high, and with the course of the lesion the increase of the degree, the HPV infection rate, especially the high-risk HPV infection rate, 3. the joint detection scheme 1 can obviously improve the sensitivity, the negative predictive value, and reduce the missed diagnosis rate, in that aspect of screening and negative elimination, the HPV detection or the TCT method is better than that of a single application. the scheme 2 can obviously improve the specificity,
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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