摘要
目的 探讨人类乳头状瘤病毒（human papillomavirus,HPV）基因分型检测在宫颈病变诊断中的临床应用价值.方法 选取2010年1月至2012年12月在北京大学第一医院妇产科就诊的1715例患者作为研究对象,所有患者均行宫颈脱落细胞学检查、HPV分型检测及阴道镜检查下行多点活检,并最终经组织病理学检查诊断为宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）.分析HPV分型检查在宫颈癌筛查诊断中临床应用价值.结果 1715例CIN患者HPV检出率排名前五位的依次是HPV16、58、52、33、31;CIN2＋（包括CIN2/CIN3/原位腺癌/宫颈癌,以下简称CIN2＋）患者中前五位依次是HPVI6、58、33、52、31;其中CIN2＋中细胞学未见上皮内病变细胞和恶性细胞（negative for intraepithelial lesion or malignancy,NILM）患者中,Logistic回归分析结果显示HPV16、33和18型阳性致CIN2＋风险性较大,回归系数OR分别为5.031（P=0.000）、2.375 （P=0.000）和1.598（P =0.027）.宫颈脱落细胞学为非典型鳞状上皮细胞（atypical squamous cells of undetermined significance,ASCUS）,伴随HPV16、58型阳性,发生CIN2＋风险性较大,回归系数OR分别为5.139（P=0.000）和2.096（P=0.025）.宫颈脱落细胞学为低度鳞状上皮内病变（low squamous intraepithelial lesion,LSIL）,伴随HPV16、33、52型CIN2＋风险性较大,回归系数OR分别为5.774（P =0.000）、3.368（P =0.000）和1.747（P=0.034）.结论 HPV分型检测在宫颈癌筛查中具有重要作用,是指导细胞学阴性、ASCUS和LSIL患者临床处理时的重要参考指标,尤其是当HPV16型阳性时.
Objective To evaluate the clinical value of HPV genotyping in diagnosis of cervical lesions.Methods Totally 1715 patients seen in Department of Obstetrics and Gynecology,Peking University First Hospital from January 2010 to December 2012 were chosen to be evaluated.All the patients experienced cervical Liquid-based cytology test,HPV genotyping and multiple punch biopsy during colposcopy and they were confirmed of cervical intraepithelial neoplasia （CIN） through histopathological examination.The clinical efficacy of HPV genotyping was evaluated.Results HPV 16,58,52,33 and 31 were the first five types detected in all of the 1715 patients.The first five types detected in the patients with CIN2 ＋ （including CIN2/CIN3/adenocarcinoma in situ/cervical cancer） were HPV 16,58,33,52 and 31.Logistic regression analysis showed that in the CIN2 ＋ patients who were negative for intraepithelial lesion or malignancy （NILM）,those with positive HPV 16,33 and 18 had higher risk of CIN2 ＋,with the regression coefficient OR 5.031 （P =0.000）,2.375 （P =0.000） and 1.598 （P =0.027）.The cervical liquid-based cytology showed that there was a higher risk of CIN2 ＋ for atypical squamous cells of undetermined significance （ASCUS） with positive HPV 16 and 18,and the regression coefficients OR were 5.139 （P =0.000） and 2.096 （P =0.025）,respectively ; and the low-grade squamous intraepithelial lesion （LSIL） with positive HPV 16,33 and 52 had higher risk of CIN2 ＋,the regression coefficients OR were 5.774（P =0.000）,3.368（P =0.000） and 1.747（P =0.034）.Conclusion HPV genotyping is significantly useful for cervical screening.It is an important parameter for directing the clinical treatment in ASCUS and LSIL patients with negative cytology results,especially HPV 16 positive patients need to be further evaluated.
出处
《中华实验和临床病毒学杂志》
CAS
CSCD
2014年第6期429-432,共4页
Chinese Journal of Experimental and Clinical Virology
