摘要
目的评估阴道镜和高危型HPV-DNA检测及两种方法联合在宫颈病变筛查中的应用价值。方法采用HPV-DNA检测、阴道镜检查结合Reid评分系统及镜下多点活检对196例超薄液基细胞学检查(TCT)阴性(炎症反应性细胞改变)的接触性阴道出血症状患者进行分流诊断。结果 196例患者中,阴道镜检查阳性率(Reid评分≥1分)达31.6%(62/196);高危型HPV-DNA阳性率达33.2%(65/196);宫颈活检诊断为宫颈病变率31.1%(61/196),且随着活检病变程度加重,阴道镜Reid评分(rp=0.713,P<0.001)和高危型HPV-DNA检测阳性率(rp=0.538,P<0.001)逐渐上升。以宫颈组织病理学检查结果为确诊标准,阴道镜、高危型HPV-DNA检测及两方法联合诊断宫颈病变的灵敏度、特异度、阳性预测值及阴性预测值分别为72.1%、88.1%、73.3%、87.5%;68.9%、83.0%、64.6%、85.5%;90.2%、92.6%、84.6%、95.4%。结论接触性阴道出血患者即使TCT阴性仍然存在一定的宫颈癌前病变及癌变风险,联合应用阴道镜和高危型HPV-DNA检测有助于建立良好的分流诊断,降低漏诊率和过度诊断率。
Objective To investigate the diagnosis value and clinical significance high risk HPV-DNA detection and colpos- copy in screening of cervical atypical lesions. Methods HPV-DNA detection, colposeopy combined with Reid scoring system and endoscopic multiple biopsy were performed in 196 participants with negative result（ inflammatory response of ceils） of ThinPrep liquid based cytology test and symptoms of vaginal contact bleeding. Results In 196 cases,by cytology,the positive rate was 31.6% （62/196） ;By high-risk HPV-DNA detection, the positive rate was 33.2% （65/196）. The positive rate of endoscopic mul- tiple biopsy detection was 61/196 （ 31.1% ）. with the severity of cervical biopsy lesions, the degree of colposcopy Reid score （ rp = 0.713, P 〈 0. 001 ） and high-risk HPV-DNA positive rate （ rp = 0.538, P 〈 0. 001 ） gradually increased. Taking biopsy pathology results as standard, the sensitivity, specificity, positive predictive values and negative predictive values of cytology were 72.1%, 88.1% ,73.3% and 87.5% ,respectively;and of high risk HPV-DNA detection were 68.9% ,83.0% ,64.6% and 85.5% ,re- spectively;Additionally,these assessment indicators were 90.2% ,92.6% ,84.6% and 95.4% by combined of the two above- mentioned screening methods. Conclusion There are still some cervical precancerous lesions and cancer risk in patient with symptoms of vaginal contact bleeding Even if the ThinPrep cytologic test was negative. Combined colposcopy and high-risk HPV- DNA testing can help establish a good diversion diagnosis, and reduce the rate of misdiagnosis and over-diagnosis.
出处
《中华全科医学》
2013年第6期854-855,975,共3页
Chinese Journal of General Practice
关键词
宫颈疾病
阴道镜
筛查
Cervical disease
Colposcopy
Screening
