本文選題：液基細(xì)胞學(xué)檢查 + 人乳頭瘤病毒��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2016年碩士論文

【摘要】：背景宮頸癌是婦科疾病中常見的源于宮頸鱗-柱交接部的惡性腫瘤,嚴(yán)重威脅女性的生活質(zhì)量。全球每年新發(fā)宮頸癌患者約52.9萬人,其中85%均在發(fā)展中國(guó)家[1]。人乳頭瘤病毒(HPV)持續(xù)感染與宮頸癌的發(fā)生發(fā)展緊密相關(guān),HPV有100多種亞型,可分為高危型HPV(HR—HPV)與低危型HPV(LR-HPV)。目前,我國(guó)在宮頸癌的防治上引進(jìn)了一系列的方法,如HPV分型檢測(cè)、HPV L1殼蛋白檢測(cè)及HPV疫苗、宮頸細(xì)胞學(xué)檢查等。近年來,各國(guó)學(xué)者都在努力尋求更有價(jià)值的篩查方法,能夠更好的指導(dǎo)臨床醫(yī)生診治宮頸病變。目的探討HPV L1殼蛋白檢測(cè)、宮頸液基薄層細(xì)胞學(xué)檢查(TCT)、HPV分型檢測(cè)在宮頸病變篩查的臨床意義,以期得到更好的篩查方法來指導(dǎo)臨床上的分流管理與治療。方法收集在新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院婦科門診2014年7月-2015年6月期間因體檢或發(fā)現(xiàn)宮頸異常就診的1052例女性,均進(jìn)行TCT檢查和HPV分型檢測(cè),對(duì)TCT結(jié)果陽性、高危型HPV(HR-HPV)陽性或兩者均陽性患者進(jìn)行陰道鏡檢查及陰道鏡下子宮頸活檢術(shù),同時(shí)對(duì)TCT結(jié)果陽性患者采用免疫細(xì)胞化學(xué)的方法檢測(cè)HPV L1殼蛋白的表達(dá)。結(jié)果156例TCT結(jié)果異常中,意義未明確的非典型鱗狀上皮細(xì)胞(ASCUS)、低度鱗狀上皮內(nèi)病變(LSIL)、高度鱗狀上皮內(nèi)病變(HSIL)、鱗狀細(xì)胞癌(SCC)的HR-HPV陽性率,分別為19.1%(13/68)、35.3%(18/51)、77.8%(21/27)、100%(10/10)。HR-HPV在TCT結(jié)果為高級(jí)別宮頸上皮內(nèi)瘤變中的陽性率較高。LR-HPV陽性主要見于低級(jí)別宮頸上皮內(nèi)瘤變。TCT異常結(jié)果中ASCUS、LSIL、HSIL、SCC在病理組織學(xué)CIN及以上陽性率分別為54.4%(37/68),60.8%(31/51),85.2%(23/27),10/10。TCT結(jié)果為低級(jí)別宮頸病變與組織病理學(xué)結(jié)果符合率低于高級(jí)別宮頸病變(χ~2=49.762,P0.001)。隨著細(xì)胞學(xué)診斷結(jié)果越嚴(yán)重,與病理組織學(xué)結(jié)果越符合。在262例組織病理學(xué)結(jié)果中,TCT(+)和HR-HPV(+)者中宮頸病變檢出率顯著高于TCT、HR-HPV單一陽性者的檢出率(χ~2=50.095,P0.001;χ~2=72.034,P0.001),兩兩比較差異有統(tǒng)計(jì)學(xué)意義。TCT聯(lián)合HPV檢測(cè)在CINⅢ及以上病例中雙陽性檢出率最高,在SCC中達(dá)到了100%。不同組織病理學(xué)結(jié)果中,HPV L1殼蛋白在低級(jí)別宮頸病變表達(dá)率高于高級(jí)別宮頸病變(χ~2=22.75,P0.001)。隨著組織病理學(xué)結(jié)果越嚴(yán)重,HPV L1殼蛋白陽性表達(dá)率越低。研究對(duì)象以35歲為界,35歲以下年齡組的HPV L1殼蛋白陽性表達(dá)率高于35歲以上,差異有統(tǒng)計(jì)學(xué)意義(χ~2=18.203,P0.001)。結(jié)論HR-HPV在TCT結(jié)果為高級(jí)別宮頸上皮內(nèi)瘤變中的陽性率較高,LR-HPV主要見于低級(jí)別宮頸上皮內(nèi)瘤變。TCT聯(lián)合HPV分型檢測(cè)診斷宮頸病變的檢出率高于兩者單一陽性的檢出率,可以作為臨床上宮頸病變的篩查方法。HPV L1殼蛋白檢測(cè)的陽性率隨著宮頸病變程度加重及年齡增長(zhǎng)逐漸下降,有望成為預(yù)測(cè)宮頸癌前病變進(jìn)展趨勢(shì)的生物學(xué)標(biāo)志物,對(duì)臨床宮頸病變的篩查具有一定的指導(dǎo)意義。
[Abstract]:Background Cervical cancer is a common malignant tumor from cervix squamous-column junction in gynecological diseases, which is a serious threat to the quality of life of women.There are about 529000 new cases of cervical cancer in the world every year, of which 85% are in developing countries.The persistent infection of human papillomavirus (HPV) is closely related to the occurrence and development of cervical cancer. There are more than 100 subtypes of HPV, which can be divided into high-risk HPV-HR-HPVs and low-risk HPV-LR-HPVs.At present, China has introduced a series of methods in the prevention and treatment of cervical cancer, such as HPV typing detection of HPVL1 shell protein and HPV vaccine, cervical cytology, and so on.In recent years, scholars all over the world are trying to find more valuable screening methods, which can better guide clinicians in the diagnosis and treatment of cervical diseases.Objective to investigate the clinical significance of HPV L1 shell protein detection and cervical liquid-based thin layer cytology in screening cervical lesions in order to obtain a better screening method to guide clinical shunt management and treatment.Methods from July 2014 to June 2015, 1052 women in gynecological outpatient department of the first affiliated Hospital of Xinxiang Medical College were examined by TCT and HPV typing, and the results of TCT were positive.Patients with high risk HPV-HR-HPV-positive or both were examined by colposcopy and cervical biopsy under colposcopy. The expression of HPV L1 shell protein was detected by immunocytochemistry in patients with positive TCT results.Results the positive rates of HR-HPV in atypical squamous epithelial cells with no clear significance, low grade squamous intraepithelial lesions, high squamous intraepithelial lesions and squamous cell carcinoma were found in 156 cases with abnormal TCT results.The positive rate of HR-HPV in high grade cervical intraepithelial neoplasia was higher. LR-HPV positive rate was mainly found in low grade cervical intraepithelial neoplasia. TCT abnormality. The positive rate of ASCUSLSILHSILILSCC in histopathological CIN and above were 54.44% 3768 / 60.8% 31 / 51T, respectively. The results showed that the positive rate of HR-HPV was 85.22% 23272727% and 1010.10% TCT, respectively.The coincidence rate between low grade cervical lesions and histopathological results was lower than that of high grade cervical lesions (蠂 2 / 49.762 P 0.001).The more serious the cytological diagnosis, the more consistent with the histopathological results.The detection rate of cervical lesions in 262 cases with histopathological findings was significantly higher than that in patients with single positive HR-HPV of TCTT (50.095U, P 0.001); 蠂 2 (72.034) (P 0.001). The difference was statistically significant. The positive rate of TCT combined with HPV was the highest in patients with CIN 鈪，

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