高危型人乳頭瘤病毒檢測(cè)對(duì)宮頸癌前病變篩查的臨床價(jià)值
發(fā)布時(shí)間：2019-07-04 18:01
【摘要】：目的：宮頸癌是最常見(jiàn)的婦科惡性腫瘤，其發(fā)病率居女性惡性腫瘤的第2位。據(jù)世界范圍統(tǒng)計(jì)，每年約有46.6萬(wàn)宮頸癌新發(fā)病例，其中80%發(fā)生在發(fā)展中國(guó)家。而每年我國(guó)宮頸癌新發(fā)病例有13萬(wàn)人，高居世界第二位。且患者趨向年輕化，年齡在35歲以下的宮頸癌患者占三分之一，上海疾控中心對(duì)上海子宮頸癌的流行趨勢(shì)分析研究顯示，35歲以下發(fā)病的女性比例從1970年不足2％增加到2006年超過(guò)10％。 目前認(rèn)為宮頸癌的發(fā)生、發(fā)展是由量變到質(zhì)變，由漸變到突變的長(zhǎng)期過(guò)程，且有報(bào)道顯示，宮頸癌前病變的治愈率高達(dá)98%。故有效的篩查及恰當(dāng)?shù)母深A(yù)，能阻斷其向?qū)m頸癌的進(jìn)展，從而降低宮頸癌的發(fā)病率和死亡率。 近40年來(lái)由于宮頸細(xì)胞學(xué)篩查宮頸癌在臨床上的普遍應(yīng)用，使宮頸癌前病變及宮頸癌得以早期發(fā)現(xiàn)和治療，宮頸癌的發(fā)病率和死亡率已有明顯下降。大量的流行病學(xué)研究和病原學(xué)研究已經(jīng)明確了高危型人乳頭瘤病毒(high risk human papillomavirus，HR-HPV)持續(xù)感染為宮頸癌前病變和宮頸癌發(fā)生的根本原因，故HPV檢測(cè)可作為篩查宮頸癌前病變及宮頸癌的重要手段之一。但目前我國(guó)HPV檢測(cè)在臨床工作中尚未得到廣泛應(yīng)用，現(xiàn)階段臨床廣泛應(yīng)用的篩查宮頸病變的主要方法仍是宮頸液基細(xì)胞學(xué)（Liquid based cytolog，TCT），TCT受很多主觀因素影響。本實(shí)驗(yàn)通過(guò)對(duì)比研究HPV、TCT及HPV聯(lián)合TCT篩查宮頸癌前病變及宮頸癌的檢出率，為臨床篩查宮頸癌提供更為有價(jià)值的篩查方法，從而做到對(duì)宮頸癌的早期發(fā)現(xiàn)、早期干預(yù)，降低其發(fā)生率和死亡率。研究HPV分型與宮頸癌前病變的相關(guān)性，為臨床隨訪及療效監(jiān)測(cè)提供參考。 方法： 選擇2013年6月到2013年12月就診于河北醫(yī)科大學(xué)第二醫(yī)院婦產(chǎn)科門診有性生活的女性7622例，隨機(jī)分組，，其中6387例采用HPV檢測(cè)（Cobas4800）進(jìn)行宮頸癌前病變篩查，HPV16或18陽(yáng)性者部分行TCT，TCT陽(yáng)性者（按照TBS分類法報(bào)告，不能明確意義的非典型鱗狀上皮細(xì)胞即ASC-US及以上者判斷為陽(yáng)性）行陰道鏡，陰性者嚴(yán)密隨訪。部分直接行陰道鏡檢查。HPV其他12種高危型陽(yáng)性者行TCT，TCT結(jié)果回報(bào)陽(yáng)性者行陰道鏡檢查，陰性者亦嚴(yán)密隨訪。1235例使用TCT進(jìn)行宮頸癌前病變的篩查，報(bào)告陽(yáng)性者，部分行陰道鏡檢查的同時(shí)行HPV檢測(cè)。部分直接行陰道鏡檢查。陰道鏡檢查必要時(shí)取宮頸活組織檢查，以組織病理學(xué)診斷作為金標(biāo)準(zhǔn)(鏡下未取活檢者視為慢性宮頸炎)。 結(jié)果： 1HPV感染者年齡平均為37.33±10.37歲，大部分集中于29-44.25歲，而文獻(xiàn)報(bào)道HPV感染高峰年齡為17-33歲。CIN患者平均年齡為37.95±10.54歲，其中大部分集中于29-44歲之間，TCT陽(yáng)性者平均年齡為39.98±17.508歲，高峰年齡為29-47歲，HPV陽(yáng)性、CIN陽(yáng)性及TCT陽(yáng)性者年齡分布無(wú)統(tǒng)計(jì)學(xué)意義（X2=4.68，P=0.0960.05），故認(rèn)為三者年齡分布無(wú)明顯區(qū)別。 26387例HPV檢測(cè)的患者中，HPV陽(yáng)性者701例，陽(yáng)性率為10.97%。其中HPV16陽(yáng)性者179例，占25.53%，HPV18陽(yáng)性者38例，占5.42%，其他12種高危型HPV陽(yáng)性者402例，占57.34%，混合感染者82例，占11.69%。其中HPV16和HPV18陽(yáng)性者中16例未行TCT而直接行陰道鏡檢查，鏡下取活檢11例，慢性宮頸炎者（包括鏡下未取活檢者）10例，CINI1例，CINII1例，CINIII4例，即HPV檢測(cè)對(duì)宮頸癌前病變檢出率為37.5%（6/16）。其余685例HPV陽(yáng)性者均行TCT，TCT陽(yáng)性者277例，陰性者408例，陰道鏡下取宮頸活組織送病理者有208例，其中慢性宮頸炎61例，CINI53例，CINII55例，CINIII36例，宮頸癌3例，HPV聯(lián)合TCT對(duì)宮頸癌前病變的檢出率為53.06%（147/277）。1235例采用TCT篩查宮頸癌前病變的患者中，TCT陽(yáng)性169例，陰道鏡宮頸活組織檢查136例，其中慢性宮頸炎者92例，CINI25例，CINII13例，CINIII6例，TCT對(duì)宮頸病變的檢出率為26.03%（44/169）。經(jīng)統(tǒng)計(jì)學(xué)分析HPV與HPV聯(lián)合TCT檢測(cè)宮頸高度病變的檢出率無(wú)統(tǒng)計(jì)學(xué)意義（P=0.10.05），即HPV篩查宮頸病變與HPV聯(lián)合TCT篩查宮頸病變的檢出率無(wú)明顯差異。HPV聯(lián)合TCT與TCT單獨(dú)篩查宮頸癌前病變的檢出率有統(tǒng)計(jì)學(xué)差異（P=0.000.05），即HPV聯(lián)合TCT篩查宮頸病變檢出率較TCT單獨(dú)篩查宮頸癌前病變檢出率高。 3陰道鏡宮頸活檢病理為CINI患者59例，其中HPV16陽(yáng)性10例，占16.94%，HPV18陽(yáng)性4例，占6.78%，其余12種陽(yáng)性36例，占61.01%，混合感染9例，占15.25%。CINII患者者57例，其中HPV16陽(yáng)性19例，占33.33%，HPV18陽(yáng)性6例，占10.52%，其余12種陽(yáng)性19例，占33.33%，混合感染13例，占22.80%。CINIII患者40例，其中HPV16陽(yáng)性20例，占50%，HPV18陽(yáng)性5例，占12.5%，其余12種陽(yáng)性3例，占7.5%，混合感染12例，占30%。三組中HPV感染亞型分布有統(tǒng)計(jì)學(xué)差異（P0.05）。其中CINI組較CINII和CINIII組HPV16、18陽(yáng)性率低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。CINII和CINIII組中HPV16、18陽(yáng)性率無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。 結(jié)論： 1HPV聯(lián)合TCT對(duì)宮頸癌前病變篩查，可明顯提高其檢出率，降低漏診率。故臨床應(yīng)用HPV聯(lián)合TCT對(duì)宮頸癌前病變及宮頸癌進(jìn)行篩查，可更好的對(duì)宮頸癌進(jìn)行早期發(fā)現(xiàn)、早期干預(yù)，從而進(jìn)一步降低宮頸癌的發(fā)病率和死亡率。有效預(yù)防宮頸癌的發(fā)生。 2CINI主要與HPV其余12種感染有關(guān)，CINII和CINIII主要與HPV16、18有關(guān)。宮頸病變及宮頸癌主要與HPV16、18有關(guān)。
[Abstract]:Objective: Cervical cancer is the most common gynecological malignant tumor, and the incidence of cervical cancer is the second place of female malignant tumor. According to the world-wide statistics, approximately 46.6 million new cases of cervical cancer are reported annually, of which 80 per cent are in developing countries. In each year, there are 1.3 million new cases of cervical cancer in China and the second in the world. The prevalence of cervical cancer in Shanghai showed that the proportion of women under 35 years of age increased from less than 2% in 1970 to more than 10% in 2006. At present, the development of cervical cancer is considered to be changed from quantitative to qualitative change, from gradual change to the long-term process of mutation, and it is reported that the cure rate of precancerous lesion of cervical cancer is as high as 98. %. Therefore, effective screening and appropriate intervention can block the progression of cervical cancer, thereby reducing the incidence and death of cervical cancer. The rate of cervical cancer and the early detection and treatment of cervical cancer and the incidence and mortality of cervical cancer have been known in the past 40 years due to the widespread use of cervical cytology in the screening of cervical cancer. A significant number of epidemiological studies and etiological studies have identified the underlying causes of high risk human papillomavirus (HR-HPV) infection for pre-cervical and cervical cancer, and the detection of HPV can be an important hand in the screening of precancerous lesions and cervical cancer. However, at present, the detection of HPV in our country has not been widely used in the clinical work, and the main method for screening cervical lesions in the present stage is still the liquid-based cytology (TCT), and the TCT is subject to many subjective factors. In this experiment, the positive rate of HPV, TCT and HPV combined with TCT in the screening of pre-cervical cancer and cervical cancer was compared, and a more valuable screening method was provided for the clinical screening of cervical cancer, so that the early detection, early intervention and the reduction of the incidence of cervical cancer were achieved. Mortality. The correlation between HPV types and pre-cervical lesions was studied and the clinical follow-up and efficacy monitoring were provided. for reference Methods: From June,2013 to December,2013, there were 7622 women who had sex life in the second hospital of Hebei Medical University, and the random group, of which,6387 cases were screened by HPV detection (Cobas4800), and HPV16 or 18 was positive. the partial row of TCT and TCT positive (according to the TBS classification report, the atypical squamous epithelial cells that cannot be clearly defined, that is, the ASC-US and the above are judged to be positive) are the colposcope, Strict follow-up of the negative. The colposcopy was examined by colposcopy colposcopy. The results of TCT and TCT in the other 12 high-risk positive cases of HPV were examined by colposcopy and the negative was closely followed up.1235 cases of pre-cervical cancer were screened with TCT, the positive and partial colposcopy were the same. Time line HPV detection. Partial straight The colposcopy was examined by the colposcopy. The colposcopy was examined for the biopsy of the cervix when necessary to organize the pathological diagnosis as a gold standard (the biopsy was not taken under the microscope). Chronic Results: The average age of HPV-infected persons was 37.33-10.37 years, most of which were in the age of 29-44.25 years. The peak age was 17-33 years. The average age of CIN was 37.95 to 10.54 years, and most of them were between 29 and 44 years. The average age of the patients with TCT was 39.98 and 17.508 years. The peak age was 29-47 years. The positive rate of HPV, the positive of CIN and the age distribution of the patients with TCT were not of statistical significance (X2 = 4.68, P = 0.0960.05), it is considered that There was no significant difference among the three age distributions. Among the 26387 patients with HPV, HPV-positive 70 In 1 case, the positive rate was 10.97%. Of these,179 cases (25.53%) of HPV16 were positive (5.42%), and 402 (57.34%) of the other 12 high-risk HPV-positive cases (57.34%). Among the patients with HPV16 and HPV18,16 of HPV16 and HPV18 were examined by colposcopy,11 cases of biopsy,11 cases of chronic cervicitis (including non-biopsy under the microscope),11 cases of CINI,1 case of CINI, and 4 cases of CINIII4. The rate was 37.5% (6/16). The remaining 685 cases of HPV positive were TCT,277 cases of TCT,408 cases of negative, and 208 cases of cervical biopsy under colposcopy, including 61 cases of chronic cervicitis,53 cases of CINI,55 cases of CINI, CI The positive rate of cervical cancer was 53.06% (147/277) in NIII36 and 3 cases of cervical cancer. In 1235 cases of pre-cervical cancer with cervical cancer were screened by TCT,169 cases of TCT were positive,136 cases were examined by colposcopy and cervical biopsy. Among them,92 cases of chronic cervicitis,25 cases of CINI,13 cases of CINI,6 cases of CINI and 2 cases of cervical lesions were detected by TCT. 6.03% (44/169). The detection rate of HPV and HPV combined with TCT in the detection of cervical height was not significant (P = 0.05). There was no significant difference in the detection rate of cervical lesions. The detection rate of HPV combined with TCT and TCT alone was different (P = 0.0005), that is, the detection rate of HPV combined with TCT was higher than that of TCT. The positive rate of HPV16 in cervical carcinoma was higher than that of the patients with CINII. The positive rate of HPV16 was 16.94%, HPV18 was positive in 4 cases (6.78%), the remaining 12 were positive (61.01%), mixed infection (9 cases) (15.25%) and CINII (33.33%). The positive of V18 in 6 cases (10.52%), the remaining 12 (33.33%), mixed infection (13 cases) (22.80%), CINIII (40 cases), HPV16 positive 20 cases (50%), HPV18 positive 5 cases (12.5%) and the remaining 12 positive cases (7%). 5%, mixed infection in 12 cases, accounting for 30%. HPV infection in three groups There was a significant difference in the distribution of HPV16 and 18 in CINII and CINIII groups (P0.05). sex-rate-free Statistical difference (P0.05). Conclusion:1 HPV combined with TCT in the treatment of cervical cancer The detection rate of the cervical cancer can be obviously improved and the missed diagnosis rate can be obviously improved, so that the clinical application of the HPV combined with the TCT can screen the precancerous lesion and the cervical cancer of the cervical cancer, and the early detection and the early intervention of the cervical cancer can be better performed. Thereby further reducing the cervical cancer. The incidence and mortality of cervical cancer can be effectively prevented. CINI is mainly related to the remaining 12 types of HPV infection. I and CINIII are mainly related to HPV16 and 18.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
本文編號(hào)：2510107
[Abstract]:Objective: Cervical cancer is the most common gynecological malignant tumor, and the incidence of cervical cancer is the second place of female malignant tumor. According to the world-wide statistics, approximately 46.6 million new cases of cervical cancer are reported annually, of which 80 per cent are in developing countries. In each year, there are 1.3 million new cases of cervical cancer in China and the second in the world. The prevalence of cervical cancer in Shanghai showed that the proportion of women under 35 years of age increased from less than 2% in 1970 to more than 10% in 2006. At present, the development of cervical cancer is considered to be changed from quantitative to qualitative change, from gradual change to the long-term process of mutation, and it is reported that the cure rate of precancerous lesion of cervical cancer is as high as 98. %. Therefore, effective screening and appropriate intervention can block the progression of cervical cancer, thereby reducing the incidence and death of cervical cancer. The rate of cervical cancer and the early detection and treatment of cervical cancer and the incidence and mortality of cervical cancer have been known in the past 40 years due to the widespread use of cervical cytology in the screening of cervical cancer. A significant number of epidemiological studies and etiological studies have identified the underlying causes of high risk human papillomavirus (HR-HPV) infection for pre-cervical and cervical cancer, and the detection of HPV can be an important hand in the screening of precancerous lesions and cervical cancer. However, at present, the detection of HPV in our country has not been widely used in the clinical work, and the main method for screening cervical lesions in the present stage is still the liquid-based cytology (TCT), and the TCT is subject to many subjective factors. In this experiment, the positive rate of HPV, TCT and HPV combined with TCT in the screening of pre-cervical cancer and cervical cancer was compared, and a more valuable screening method was provided for the clinical screening of cervical cancer, so that the early detection, early intervention and the reduction of the incidence of cervical cancer were achieved. Mortality. The correlation between HPV types and pre-cervical lesions was studied and the clinical follow-up and efficacy monitoring were provided. for reference Methods: From June,2013 to December,2013, there were 7622 women who had sex life in the second hospital of Hebei Medical University, and the random group, of which,6387 cases were screened by HPV detection (Cobas4800), and HPV16 or 18 was positive. the partial row of TCT and TCT positive (according to the TBS classification report, the atypical squamous epithelial cells that cannot be clearly defined, that is, the ASC-US and the above are judged to be positive) are the colposcope, Strict follow-up of the negative. The colposcopy was examined by colposcopy colposcopy. The results of TCT and TCT in the other 12 high-risk positive cases of HPV were examined by colposcopy and the negative was closely followed up.1235 cases of pre-cervical cancer were screened with TCT, the positive and partial colposcopy were the same. Time line HPV detection. Partial straight The colposcopy was examined by the colposcopy. The colposcopy was examined for the biopsy of the cervix when necessary to organize the pathological diagnosis as a gold standard (the biopsy was not taken under the microscope). Chronic Results: The average age of HPV-infected persons was 37.33-10.37 years, most of which were in the age of 29-44.25 years. The peak age was 17-33 years. The average age of CIN was 37.95 to 10.54 years, and most of them were between 29 and 44 years. The average age of the patients with TCT was 39.98 and 17.508 years. The peak age was 29-47 years. The positive rate of HPV, the positive of CIN and the age distribution of the patients with TCT were not of statistical significance (X2 = 4.68, P = 0.0960.05), it is considered that There was no significant difference among the three age distributions. Among the 26387 patients with HPV, HPV-positive 70 In 1 case, the positive rate was 10.97%. Of these,179 cases (25.53%) of HPV16 were positive (5.42%), and 402 (57.34%) of the other 12 high-risk HPV-positive cases (57.34%). Among the patients with HPV16 and HPV18,16 of HPV16 and HPV18 were examined by colposcopy,11 cases of biopsy,11 cases of chronic cervicitis (including non-biopsy under the microscope),11 cases of CINI,1 case of CINI, and 4 cases of CINIII4. The rate was 37.5% (6/16). The remaining 685 cases of HPV positive were TCT,277 cases of TCT,408 cases of negative, and 208 cases of cervical biopsy under colposcopy, including 61 cases of chronic cervicitis,53 cases of CINI,55 cases of CINI, CI The positive rate of cervical cancer was 53.06% (147/277) in NIII36 and 3 cases of cervical cancer. In 1235 cases of pre-cervical cancer with cervical cancer were screened by TCT,169 cases of TCT were positive,136 cases were examined by colposcopy and cervical biopsy. Among them,92 cases of chronic cervicitis,25 cases of CINI,13 cases of CINI,6 cases of CINI and 2 cases of cervical lesions were detected by TCT. 6.03% (44/169). The detection rate of HPV and HPV combined with TCT in the detection of cervical height was not significant (P = 0.05). There was no significant difference in the detection rate of cervical lesions. The detection rate of HPV combined with TCT and TCT alone was different (P = 0.0005), that is, the detection rate of HPV combined with TCT was higher than that of TCT. The positive rate of HPV16 in cervical carcinoma was higher than that of the patients with CINII. The positive rate of HPV16 was 16.94%, HPV18 was positive in 4 cases (6.78%), the remaining 12 were positive (61.01%), mixed infection (9 cases) (15.25%) and CINII (33.33%). The positive of V18 in 6 cases (10.52%), the remaining 12 (33.33%), mixed infection (13 cases) (22.80%), CINIII (40 cases), HPV16 positive 20 cases (50%), HPV18 positive 5 cases (12.5%) and the remaining 12 positive cases (7%). 5%, mixed infection in 12 cases, accounting for 30%. HPV infection in three groups There was a significant difference in the distribution of HPV16 and 18 in CINII and CINIII groups (P0.05). sex-rate-free Statistical difference (P0.05). Conclusion:1 HPV combined with TCT in the treatment of cervical cancer The detection rate of the cervical cancer can be obviously improved and the missed diagnosis rate can be obviously improved, so that the clinical application of the HPV combined with the TCT can screen the precancerous lesion and the cervical cancer of the cervical cancer, and the early detection and the early intervention of the cervical cancer can be better performed. Thereby further reducing the cervical cancer. The incidence and mortality of cervical cancer can be effectively prevented. CINI is mainly related to the remaining 12 types of HPV infection. I and CINIII are mainly related to HPV16 and 18.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33
【引證文獻(xiàn)】
相關(guān)期刊論文 前4條
1 魏麗麗;李春霞;;篩查宮頸癌中三種篩查方法的臨床應(yīng)用價(jià)值比較[J];甘肅科技;2017年13期
2 鐘碧如;;腫瘤標(biāo)志物檢測(cè)聯(lián)合TCT檢測(cè)與HPVDNA檢測(cè)在診斷宮頸癌及癌前病變中的意義[J];中國(guó)實(shí)用醫(yī)藥;2017年19期
3 雷永革;曹巧林;譚秋梅;;陰道局部T淋巴細(xì)胞的免疫指標(biāo)變化與宮頸病變關(guān)系研究[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2017年03期
4 王麗娜;任艷;牟路萌;杜景云;王遠(yuǎn)志;王鵬雁;;新疆北疆部分地區(qū)HPV的流行情況及高危型HPV 16、18與宮頸病變的關(guān)系[J];石河子大學(xué)學(xué)報(bào)(自然科學(xué)版);2016年01期
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1 隋旭;HPV E6和p53的相互作用對(duì)WEE1異構(gòu)體的影響[D];昆明理工大學(xué);2016年
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