高危型人乳头瘤病毒检测初筛宫颈癌后几种分流方法的效果评价

发布时间：2018-02-25 15:32

本文关键词： 宫颈肿瘤多相筛查 DNA探针 HPV 细胞诊断学　出处：《肿瘤》2015年05期 　论文类型：期刊论文

【摘要】：目的:评价采用高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)检测法进行宫颈癌初筛后几种分流方法的效果及应用价值。方法 :重新分析2003年在中国山西省襄垣县开展的以人群为基础的子宫颈癌筛查横断面研究的资料,最终纳入研究人群为1 788名妇女。所有筛查对象均进行了薄层液基细胞学(liquid-based cytology,LBC)、HR-HPV第二代杂交捕获(hybrid capture 2,HC2)法(可进行HPV初筛和高、低病毒载量分析)和醋酸染色肉眼观察法(visual inspection with acetic acid,VIA)检测,对结果异常者进行阴道镜检查,镜检阳性时行活组织检查并得出最终的病理学诊断结果。本次研究模拟HPV检测为基础的宫颈癌筛查方案,采用HPV-HC2法初筛,然后以LBC、VIA、HPV-HC2高病毒载量和HPV-HC2低病毒载量4种筛查方法分流,比较各种方案识别宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及浸润癌的敏感度、特异度和阴道镜转诊率等指标,以受试者工作特征(receiver operator characteristic,ROC)曲线下面积综合分析各筛查方案的应用价值(α校正=0.012 5)。结果 :以HPV-HC2检测作为初筛方法,阴道镜转诊率为18.1%,其检出HSIL及浸润癌的敏感度和特异度分别达到95.7%和85.0%,而阳性预测值仅为20.4%。使用LBC、VIA和HPV-HC2低病毒载量分流后,阴道镜转诊率分别降低为8.7%、4.5%和9.8%,特异度分别提高到94.3%、97.5%和93.1%,阳性预测值分别提高到37.2%、46.9%和32.0%,敏感度分别降低至84.1%、55.1%和81.2%。HPV初筛与其联合LBC分流和HPV低病毒载量分流相比,两组间曲线下面积的差异均无统计学意义(P值均0.012 5),而与其联合VIA分流和HPV高病毒载量比较,两组间曲线下面积差异均具有统计学意义(P值均0.001)。结论 :从经济性和适应性考虑,在资源有限、欠发达的地区,将HPV DNA载量值提高到≥10 pg/m L作为筛查标准来进行宫颈癌筛查是可行的,效果较好。在发达地区,可广泛推行HR-HPV初筛加细胞学分流。HR-HPV初筛后以VIA作为分流技术的宫颈癌筛查方案在农村地区是可行的,但操作医生的技能尚需培训和提高。
[Abstract]:Objective: To evaluate the high-risk human papillomavirus (high-risk human, papillomavirus, HR-HPV) detection method of screening method for cervical cancer after several shunt effect and application value. Methods: re analysis of 2003 in Xiangyuan County of Shanxi province to carry out Chinese population-based cervical cancer screening cross-sectional study data included in the final analysis the crowd was 1788 women. All screening subjects were ThinPrep cytology test (liquid-based, cytology, LBC) HR-HPV second generation hybrid capture (hybrid capture 2, HC2 (HPV) method of screening and high and low viral load analysis) and observation (visual inspection with acetic acid staining eye acetic acid. VIA) detection, abnormal results of colposcopy, biopsy examination was positive and the final pathological diagnosis results. This study simulated HPV based detection of cervical cancer Screening programs, using the method of HPV-HC2 screening, and then to LBC, VIA, HPV-HC2 shunt high viral load and low HPV-HC2 viral load of 4 screening methods, comparison of various schemes to identify high grade cervical squamous intraepithelial lesions (high-grade squamous, intraepithelial lesion, HSIL) and infiltration of cancer sensitivity, specificity and colposcopy to diagnosis rate and other indicators, the receiver operating characteristic (receiver operator, characteristic, ROC) and area under the curve of comprehensive application value of each screening program (alpha correction =0.012 5). Results: the HPV-HC2 test as a screening method, colposcopy referral rate was 18.1%, the detection of HSIL and invasive carcinoma of the sensitive and specific specificity were respectively 95.7% and 85%, and positive predictive value of LBC is only 20.4%., VIA and HPV-HC2 low viral load diversion, colposcopy referral rates were reduced to 8.7%, 4.5% and 9.8% respectively, the specificity increased to 94.3%, 97.5% and 93. 1%, the positive predictive value were increased to 37.2%, 46.9% and 32% respectively, the sensitivity is reduced to 84.1%, 55.1% and 81.2%.HPV screening and combined with LBC and HPV shunt shunt low viral load compared differences between the two groups, the area under the curve were not statistically significant (P < 0.0125), compared with the combined VIA shunt and HPV high viral load, the area under the curve between the two groups, the differences were statistically significant (P < 0.001). Conclusion: from the consideration of economy and adaptability, with limited resources, underdeveloped areas, the HPV DNA load value increased to more than 10 pg/m L as the standard to screening for cervical cancer screening it is feasible and effective. In developed areas, can be widely implemented with cytology triage.HR-HPV screening with VIA as a screening method of cervical carcinoma and shunt technology in rural areas is feasible to screen early HR-HPV, but the operation skill of doctors need training and improvement.

【作者单位】：重庆医科大学放射医学教研室;中国医学科学院北京协和医学院肿瘤医院/肿瘤研究所流行病室;
【分类号】：R737.33

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