新疆巴楚县宫颈癌筛查及筛查策略的研究

发布时间：2018-08-04 10:39

【摘要】：目的：通过对新疆巴楚县维吾尔族妇女宫颈癌的筛查，了解筛查地区妇女子宫颈癌早诊现状及被调查人员的基本信息，系统评价多种子宫颈癌筛查方法，探索适合于新疆农村这样经济水平低的地区的子宫颈癌筛查方案和策略；评价高危型人乳头状瘤病毒DNA酶切信号放大法（Cervista HR HPV DNA）检测HR-HPV在预测维吾尔族妇女宫颈病变的价值。方法：对巴楚县6个乡3个镇20-65岁的已婚妇女5045人作为调查对象，自2014年3月1日至2014年6月15日期间，采用访谈方式进行妇女基本信息(年龄、职业、学历等)的问卷调查、妇科检查、care HPV检测、薄层制片技术细胞学检查（TCT）检测、醋酸染色肉眼观察法（VIA）、碘染色肉眼观察法（VILI）。care HPV阳性、TCT结果为ASC-US及以上病变者、VIA/VILI阳性，其中一项阳性行阴道镜下宫颈活检。首先对巴楚县维吾尔族妇女宫颈癌筛查结果进行初步分析；其次以病理组织学结果为金标准，计算各种筛查方法的灵敏度(Se)、特异度(Se)、ROC曲线下面积(AUC)等系统评价各种筛查方法；模拟组合形成几种子宫颈癌筛查方案，对筛查方案进行评价，综合分析可行性及影响因素，探索适于新疆经济落后农村的宫颈癌筛查策略；最后对373例新疆巴楚县调查现场的维吾尔族妇女进行Cervista HR HPV DNA检测的临床验证及评价其对维吾尔族妇女宫颈病变的预测价值。结果：1.本研究应筛查人数为5000，实际筛查人数为5045人现场完成问卷调查并参加子宫颈癌的筛查，完成率100.9%，筛查对象的受教育程度普遍较低，小学及以下的文化程度占63.5%，调查对象最小年龄20岁，最大年龄65岁，平均年龄为39.47士9.73岁，查出宫颈癌11例，查出CINII及以上病例为67例，检出率为1.33%，早诊率为85.1%，早治率为73.7%。HPV阳性检出率为9.93%。35岁以上的妇女CINⅡ级以上病变的发生率明显增高，而30岁以下妇女CINⅡ级以上病变的发生率低。HPV感染率从40-45岁以后阳性率呈逐渐增高趋势。2.筛查方法的总体特性:VIA/VILI的Se和Sp分别为53.2%和68.7%；TCT的Se和Sp分别为65.6%和85.0%。随着病理级别的增高，TCT检查阳性率也呈增高趋势，差异有统计学意义；HPV检测的Se和Sp分别为85.1%和42.8%，随着病理级别的增高，HPV检测结果的阳性率也在逐渐增高，差异有统计学意义（P0.05）。阴道镜检查的Se和Sp分别为94.2%和77.5%。各筛查方法中，阴道镜灵敏度最高（94.2%），灵敏度其次的为HPV（85.1%），TCT的灵敏度为65.6%，VIA/VILI的灵敏度最低为53.2%。特异度最高的为TCT检查（85.0%）。3.将各种筛查方法模拟组合形成三类子宫颈癌筛查方案，第一类HPV与TCT组合的三种方案。HPV初筛TCT分流的曲线下面积（比较HPV与TCT同时检测、TCT初筛HPV分流）最大（0.794）；第二类方案中，单独以HPV DNA检测技术作为初筛，Se、Sp分别为85.1%和42.8，单独TCT初筛Se、Sp分别为65.6%和85.0%；第三类方案中，单独VIA/VILI初筛、VIA/VILI初筛HPV分流方案、VIA/VILI初筛TCT分流方案Se、Sp分别为53.2%、68.7%和40.9%、96.9%和35.1%、99.06%，VIA/VILI初筛HPV分流方案的ROC曲线下面积最大。总体比较各种组合方案，HPV初筛TCT分流的筛查方案ROC曲线下面积最大。4.5045例筛查人群中373例维吾尔族妇女行Cervista HR HPV检测，HR-HPV感染率随细胞学诊断级别、病理级别升高而升高，差异有统计学意义（P 0.05）。373例样本中A9组阳性率在病理阳性及细胞学阳性各个组中均较A5/A6组、A7组感染率高，差别有统计学意义（P 0.05）。结论：1.新疆巴楚县维吾尔族妇女的CINⅡ级以上病变的检出率为1.33%，HPV感染率（9.93%）低于中国其他宫颈癌高发地区，35岁以上的妇女CINⅡ级以上病变的发生率明显增高，对宫颈病变的筛查应在大于30岁的有性生活的女性较为合适，重点是35岁以上年龄段的妇女。2.阴道镜检查诊断价值好于其余3种方法，可作为宫颈癌筛查的首选方法，但需要专业的技术人员，在农村基层推广困难；TCT检测由于对专业人员及设施要求高，在农村基层很难推广；care HPV检测宫颈病变的灵敏度较高仅次于阴道镜检查，由于快速、简便、易行、低廉，能够作为一种有效地初筛方法用于农村和欠发达地区子宫颈癌的预防；肉眼观察(VIA/VILI)适用于欠发达地区农村基层宫颈癌筛查。3.HPV初筛TCT分流方法在各种组合方案中对于宫颈癌筛查最有价值。但由于新疆经济落后的农村地区医疗卫生资源缺乏，也可选用VIA/VILI初筛care HPV分流的筛查方法。4.Cervista HRHPV DNA检测与care HPV检测具有较好的一致性，，可用于临床检测HPV高危亚型，可作为一种care HPV检测及TCT检查的灵敏分流方法应用于大规模宫颈癌筛查及普查。HR-HPV感染组中，A9组对维吾尔族妇女CIN及宫颈癌的预测有很高的价值。
[Abstract]:Objective: through the screening of cervical cancer of Uygur women in Bachu County, Xinjiang, the status of the early diagnosis of cervical cancer and the basic information of the investigators in the screening area were understood. The screening methods of various cervical cancer were systematically evaluated, and the screening scheme and strategy of cervical cancer suitable for the low economic level in the rural areas of Xinjiang were explored. High risk human papillomavirus DNA HPV DNA (Cervista HR HPV DNA) was used to detect the value of HR-HPV in the prediction of cervical lesions in Uygur women. Methods: 5045 married women aged 20-65 years old in 6 townships in Bachu county were investigated. From March 1, 2014 to June 15, 2014, interviews were conducted to carry out women based groups. A questionnaire of this information (age, occupation, education, etc.), gynecologic examination, care HPV test, TLC cytology examination (TCT), acetic acid staining naked eye observation (VIA), iodine staining naked eye observation (VILI).Care HPV positive, TCT results for ASC-US and above lesions, VIA/VILI positive, one of the positive cervical biopsy under colposcopy First of all, the results of cervical cancer screening for Uygur women in Bachu county were first analyzed. Secondly, the sensitivity of various screening methods (Se), specificity (Se), area under ROC curve (AUC) and other screening methods were evaluated with the results of histopathology. The case was evaluated, the feasibility and the influencing factors were synthetically analyzed, and the cervical cancer screening strategy suitable for the backward rural areas in Xinjiang was explored. The Cervista HR HPV DNA detection of Uygur women in the 373 Uygur women in Bachu County, Xinjiang was tested and evaluated. The results were as follows: 1. The number of screening people in this study was 5000. The actual screening number of 5045 people completed the questionnaire survey and participated in the screening of cervical cancer, the completion rate was 100.9%, the education level of the screening subjects was generally low, the education level of the primary school and the following was 63.5%, the minimum age was 20 years and the maximum age was 65 years, the average age was 39.47 9.73 years old. In 11 cases of cervical cancer, 67 cases of CINII and above were found, the detection rate was 1.33%, the rate of early diagnosis was 85.1%. The incidence of 73.7%.HPV positive rate was higher than that of women above 9.93%.35 years old, and the incidence of low.HPV infection rate of the lower.HPV infection rate in women under 30 years of age of 30 years old was from 40-45 years old. The overall characteristics of the increasing trend.2. screening method: the Se and Sp of VIA/VILI were 53.2% and 68.7%, respectively, and Se and Sp of TCT were 65.6% and 85.0%., respectively, with the increase of pathological grade, and the positive rate of TCT examination also increased, the difference was statistically significant; HPV Se and Sp were 85.1% and 42.8% respectively. The positive rate of the fruit was also increasing, the difference was statistically significant (P0.05). The colposcopy Se and Sp were 94.2% and 77.5%. respectively, the colposcopy sensitivity was the highest (94.2%), the sensitivity followed HPV (85.1%), the sensitivity of TCT was 65.6%, and the lowest sensitivity of VIA/VILI was TCT examination (85%).3.. Various screening methods were combined to form three types of cervical cancer screening program, and the first class of HPV and TCT combination of the three schemes for.HPV initial screening of TCT shunt curve area (compared HPV and TCT simultaneous detection, TCT initial sieving HPV shunt) maximum (0.794); in the second class, HPV DNA detection technique was used as the initial screening, Se, Sp was 85.1% and 42.8, respectively, Sp, respectively, respectively. The single TCT screening Se and Sp were 65.6% and 85% respectively. In the third classes, the initial screening of VIA/VILI, the initial sieve HPV diversion scheme, the VIA/VILI initial sieve TCT shunt scheme Se, Sp respectively 53.2%, 68.7% and 40.9%, 96.9% and 35.1%, 99.06%, VIA/VILI screening HPV shunt scheme 373 Uygur women in the.4.5045 screening program under the flow screening program ROC curve were detected by Cervista HR HPV. The rate of HR-HPV infection increased with the level of cytological diagnosis and pathological grade, and the difference was statistically significant (P 0.05). The positive rate of A9 group in.373 case samples was higher than A5 in all groups of pathological positive and cytological positive groups. In group /A6, the infection rate of group A7 was high, and the difference was statistically significant (P 0.05). Conclusion: 1. Uygur women in Bachu County, Xinjiang, was 1.33%, and HPV infection rate (9.93%) was lower than that of other high incidence areas of cervical cancer in China. The incidence of CIN II in women above 35 years old was significantly higher, and the screening of cervical lesions should be screened. Women with sexual life greater than 30 years of age are more appropriate. The emphasis is on the value of.2. colposcopy for women over 35 years of age, better than the rest of the 3 methods, which can serve as the first choice for screening for cervical cancer, but requires professional technicians to promote difficulties in rural grass-roots level; TCT tests are high in requirements for professionals and facilities and in agriculture. The grass-roots level of the village is difficult to popularize. The sensitivity of care HPV to the detection of cervical lesions is higher than the colposcopy, because it is fast, simple, easy and cheap. It can be used as an effective screening method for the prevention of cervical cancer in rural and underdeveloped areas, and VIA/VILI is suitable for the screening of cervical cancer in rural grass-roots level in underdeveloped areas.3.HPV. The primary screening TCT shunt method is of the most valuable for screening cervical cancer in various combinations. However, because of the lack of medical and health resources in the rural areas of Xinjiang's backward economy, the screening method of VIA/VILI initial screening care HPV shunt can also be selected..4.Cervista HRHPV DNA detection has good consistency with care HPV detection, which can be used for clinical detection of HPV high. The risk subtype can be used as a sensitive shunt method for care HPV detection and TCT examination in large scale cervical cancer screening and screening of.HR-HPV infection groups. The A9 group is of high value for the prediction of CIN and cervical cancer in Uygur women.
【学位授予单位】：新疆医科大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R737.33

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