發(fā)布時(shí)間：2018-04-10 10:18

  選題：宮頸癌篩查　視角：高危型人乳頭狀瘤病毒　引自：《吉林大學(xué)》2017年碩士論文

【摘要】：背景與目的:宮頸癌(Cervical Cancer,CC)的發(fā)病率在發(fā)展中國家女性惡性腫瘤中排名第二位[1],中國每年死于宮頸癌的人數(shù)近5萬,近年來宮頸癌的發(fā)病率呈年輕化趨勢(shì),但其發(fā)生發(fā)展是一個(gè)較為漫長(zhǎng)的過程,從癌前病變到出現(xiàn)早期癌、浸潤(rùn)癌是一個(gè)持續(xù)進(jìn)展的過程,需10-15年時(shí)間[2]。因此,宮頸癌篩查是降低宮頸癌的發(fā)病率和死亡率的關(guān)鍵。宮頸癌的篩查方法有液基細(xì)胞學(xué)檢查(Thinprep Cytologic Test,TCT)、人乳頭瘤病毒(Human Papilloma Virus,HPV)檢測(cè)及二者聯(lián)合篩查。本研究旨在探討TCT、HPV檢測(cè)及二者聯(lián)合篩查在宮頸癌前病變中的篩查價(jià)值。資料與方法:1.研究對(duì)象:選取2015年1月-2016年1月于吉林大學(xué)第一醫(yī)院進(jìn)行TCT及HPV檢測(cè)的患者9756例,排除伴有急性生殖道炎癥、宮頸錐切、子宮切除病史及盆腔放射治療病史的患者,選取其中1025例進(jìn)行陰道鏡下宮頸活檢的患者為研究對(duì)象,年齡19-84歲,知情同意。2.研究方法2.1 TCT檢查受檢者三天內(nèi)禁止性生活、陰道沖洗及陰道內(nèi)用藥。檢查者將液基細(xì)胞采集專用毛刷置入宮頸內(nèi),于宮頸鱗柱狀交界部位同一方向旋轉(zhuǎn)5圈,立即放入細(xì)胞保存液中漂洗。應(yīng)用新柏氏全自動(dòng)細(xì)胞制片機(jī)制片。細(xì)胞學(xué)診斷采用TBS分級(jí)系統(tǒng)(2006):未見上皮內(nèi)病變細(xì)胞或惡性細(xì)胞(NILM);細(xì)胞學(xué)異常診斷包括意義不明確的宮頸不典型鱗狀細(xì)胞(ASC-US)、不能排除高級(jí)別鱗狀上皮內(nèi)病變的宮頸不典型鱗狀細(xì)胞(ASC-H)、低度鱗狀上皮內(nèi)病變(LSIL)、高度鱗狀上皮內(nèi)病變(HSIL)、宮頸鱗狀細(xì)胞癌(SCC)、不典型腺上皮細(xì)胞(AGC)和腺癌。結(jié)果判斷標(biāo)準(zhǔn):TCT檢查結(jié)果為NILM判定為陰性結(jié)果,其余均判定為陽性結(jié)果。2.2 HPV檢測(cè)檢查者用棉簽拭去宮頸及宮頸周圍的粘液,將取樣器置入宮頸外口1-1.5cm,順時(shí)針方向旋轉(zhuǎn)3圈,將收集的標(biāo)本及取樣器保存于專用試管中。采用第二代雜交捕獲實(shí)驗(yàn)(HC2)方法,可檢測(cè)l6、18、31、33、35、39、45、51、52、56、58、59、68型13種高危型HPV。結(jié)果判斷標(biāo)準(zhǔn):標(biāo)本中HPV-DNA的負(fù)荷量≥1.0ng/L為陽性結(jié)果。3.統(tǒng)計(jì)學(xué)方法采用SPSS13.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,各組計(jì)數(shù)資料之間比較采用χ2檢驗(yàn),取P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.以陰道鏡下宮頸活檢組織病理學(xué)檢查結(jié)果作為診斷標(biāo)準(zhǔn),組織病理學(xué)診斷正�；蜓装Y患者的高危型HPV感染陽性率與LSIL、HSIL及CC患者的高危型HPV感染陽性率比較具有統(tǒng)計(jì)學(xué)差異(χ2=211.77,P=0.0000)。2.TCT檢查結(jié)果級(jí)別越高,篩查假陰性率越低,各組患者間比較有統(tǒng)計(jì)學(xué)意義(χ2=11.00 P=0.0117)。隨著TCT檢查結(jié)果級(jí)別的升高,組織病理學(xué)級(jí)別升高(χ2趨勢(shì)=691.22,P=0.0000)。3.TCT檢查聯(lián)合HPV檢測(cè)的靈敏度明顯高于單獨(dú)TCT檢查或HPV檢測(cè)。結(jié)論:1.高危型HPV感染與宮頸癌前病變及宮頸癌有關(guān),TCT檢查結(jié)果級(jí)別越高,篩查假陰性率越低,需予以足夠重視。2.宮頸癌的高發(fā)年齡提前。3.TCT聯(lián)合HPV篩查能降低宮頸癌篩查的假陰性率,是最為理想的宮頸癌前病變篩查方法。
[Abstract]:Background & objective: the incidence of cervical cancer (CCC) is the second most common among women in developing countries [1]. The number of cervical cancer deaths in China is nearly 50 000 every year. The incidence of cervical cancer is younger in recent years.However, its occurrence and development is a long process, from precancerous lesion to early stage cancer, invasive cancer is a continuous progress process, it takes 10-15 years [2].Therefore, cervical cancer screening is the key to reduce the incidence and mortality of cervical cancer.The screening methods of cervical cancer include liquid based cytology, human Papilloma Cytologic test, and combined screening of human papillomavirus (HPV) and human papillomavirus (HPV).The purpose of this study was to investigate the value of TCTH HPV detection and combined screening in cervical precancerous lesions.Data and methods: 1.Participants: 9756 patients with TCT and HPV were selected from January 2015 to January 2016 in the first Hospital of Jilin University to exclude patients with acute genital tract inflammation, cervical conization, hysterectomy and pelvic radiation therapy.1025 of them, aged 19 to 84, were selected for cervical biopsy under colposcopy, with informed consent.Methods 2. 1 TCT test subjects were not allowed to have sex, vaginal irrigation and intravaginal medication for 3 days.The special brush was placed into the cervix and rotated in the same direction at the columnar junction of the cervix and then rinsed in the cell preservation solution.New Burr's automatic cell film was used to prepare the film.Cytological diagnosis was performed using the TBS grading system / 2006: no intraepithelial lesion or malignant cells were found. Cytological abnormalities included atypical squamous cells of the cervix with unclear significance, which could not be excluded from high-grade squamous intraepithelial lesions of the cervix.Atypical squamous cell carcinoma (ASC-HN), low grade squamous intraepithelial lesion (LSILA), high squamous intraepithelial lesion (HSIL), cervical squamous cell carcinoma (SCC), atypical glandular epithelial cell (AGC) and adenocarcinoma.Results the results of NILM were determined to be negative by NILM, and the others were determined to be positive by using cotton swabs to wipe the mucus of the cervix and the surrounding cervix. The sampler was inserted into the outer cervix of the cervix for1-1.5 cm and rotated three times clockwise.The collected specimen and sampler are stored in a special test tube.The second generation hybridization capture assay (HC2) was used to detect 13 high risk types of HPVs.Results: the load of HPV-DNA 鈮，

本文編號(hào)：1730800