目的：评价高危型人乳头瘤病毒（HPV DNA）与液基细胞学检测（TCT）在宫颈疾病筛查中的应用价值。方法收集2012年10月—2013年12月某院妇科宫颈病变就诊患者的标本进行 HPV DNA 分型和 TCT 检测，阳性者进行阴道镜病理学检测，比较各 TCT 组、不同病变类型患者 HPV DNA 阳性率，比较 TCT 和 HPV DNA 检测的灵敏度和特异性，二者单独与联合检测的差异。结果HPV DNA 阳性率为28．07％（1045／3723），以高危型（HR）－HPV 为主，阳性率为21．57％（803例），最常见的 HR-HPV DNA 基因型为 HPV16、58、52、18型。各年龄组 HR－HPV 阳性率比较，差异有统计学意义（χ2＝31．74，P ＜0．001），其中20～30岁年龄组阳性率最高。TCT阳性率为13．46%（501例），共971例患者进行病理检测，293例病理诊断阳性。按 TCT 和不同病变类型分组，将HR-HPV DNA 阳性率进行趋势χ2检验，结果均显示随病变程度增加，HR-HPV 阳性率呈增高趋势（均 P ＜0．01）。以病理诊断作为金标准，HR-HPV DNA 和 TCT 灵敏度分别为90．44％（265／293）、85．32％（250／293），两者联合检测灵敏度为95．90％。病理阳性者中，TCT 和 HPV DNA 检出率分别为85．32％、90．44％，联合检测检出率为95．90％，3组比较，差异有统计学意义（χ2＝18．185，P ＜0．001）。其中联合检测检出率高于单独使用 TCT、HPV DNA。结论HPV DNA 检测对宫颈癌筛查是一个有益的补充，HPV DNA 联合 TCT 检测可以最大限度地降低漏诊率。%Objective To evaluate the application value of high-risk human papillomavirus (HR-HPV)DNA de-tection and ThinPrep liquid-based cytology testing(TCT)in cervical disease screening.Methods Cervical specimens of women with cervical lesions in a hospital between October 2012 and December 2013 were taken and performed hu-man papillomavirus DNA genotyping (HPV DNA)and ThinPrep liquid-based cytology testing(TCT).Positive pa-tients were performed colposcopy pathological detection.HPV DNA positive rates among different TCT groups, and different cervical lesion groups were compared,the sensitivity and specificity of TCT and HPV DNA detection, as well as differences between separate and joint detection were also compared.Results The positive rate of HPV DNA was 28.07% (1 045/3 723),most were HR-HPV (21 .57%,n=803),the major HR-HPV genotypes were HPV 16,58,52,and 18 type.HR-HPV positive rates were statistically different among different age groups(χ2 =31 .74,P <0.001 ),positive rate was highest in 20 -30 year old age group .Positive rate of TCT was 13.46%(n=501),a total of 971 patients were performed pathological detection,293 were positive.Patients were divided according to different TCT and different lesion type,χ2 testing of HR-HPV DNA positive rate showed that positive rate of HR-HPV had a increasing tendency with the increase in severity of diseases(all P <0.01).Pathological de- tection was as a gold standard ,the sensitivity of HR-HPV DNA and TCT was 90.44%(265/293)and 85.32%(250/293)respectively,the sensitivity of joint HR-HPV DNA detection and TCT was 95.90%.In positive patho-logical group,the detection rate of TCT and HR-HPV DNA was 85.32% and 90.44%,respectively,joint detec-tion rate was 95.90%,the difference among three groups was significant (χ2 =18.185,P <0.001).Joint detection rate was higher than separate detection rate of TCT or HPV DNA.Conclusion HPV DNA detection is a useful supplement for cervical cancer screening,HPV DNA detection combined with TCT can reduce the misdiagnosis rate.
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