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高危HPV和TCT在宫颈高级别病变诊断与治疗中的作用研究

发布时间:2018-09-16 20:26
【摘要】:目的本研究旨在探讨HPV分型检测与TCT检查在宫颈高级别病变诊断与治疗中的作用;探索HPV52/58亚型能否作为转诊阴道镜的指标;HPV分型(16/18/52/58)及TCT检查结果能否作为预测宫颈锥切术后病变升级及病变残留的客观指标,从而为宫颈高级别病变的精准诊断与治疗提供客观依据。方法选取2010年1月1日至2016年4月31日就诊于天津市第一中心医院妇科门诊的临床宫颈细胞学、HPV检测结果与病理资料完整的患者249例,HPV检测方法为导流杂交技术。结果1.本组患者HPV感染率90.76%,单一高危HPV感染率为64.65%,多重高危HPV感染率为22.49%。高危HPV感染前5位分别为HPV16、58、52、18、33。2.20-30岁组HPV感染率最高(97.30%);其次为41-50岁组(92.59%)。3.本组患者中CINⅠ45例、CINⅡ-Ⅲ(包括原位癌)194例、宫颈浸润癌2例。宫颈高级别病变组HPV16/18感染高于宫颈低级别病变组(X~2=9.001,p0.05);宫颈高级别病变组其他HR-HPV感染低于宫颈低级别病变组(X~2=6.773,p0.05);宫颈高级别病变组HPV52/58感染高于宫颈低级别病变组(X~2=5.530,p0.05)。4.TCT结果异常者中,术后病理诊断为CINⅠ45例、CINⅡ61例、CINⅢ(包括原位癌)133例、宫颈浸润癌2例。TCT结果在宫颈各级别病变之间的差异有统计学意义(X~2=30.311,p0.05)。5.TCT为HSIL者,其宫颈高级别病变发生率高于LSIL者(X~2=18.186,p0.05)。HSIL预测宫颈高级别病变的敏感性、特异性、阳性预测值、阴性预测值分别为97.53%、75.37%、43.89%、94.29%。6.术前HPV16/18感染、HPV52/58感染、其他HR-HPV感染者,HPV16/18者宫颈高级别病变发生率高于其他HR-HPV者(X~2=5.282,p0.05);HPV52/58者与HPV16/18及其他HR-HPV者间差异无统计学意义(X~2=0.051,p0.05;X~2=3.551,p0.05)。HPV16/18预测宫颈高级别病变的敏感性、特异性、阳性预测值、阴性预测值分别为86.09%、21.74%、84.62%、55.56%。7.TCT为HSIL者,其锥切术后切缘阳性发生率高于LSIL者(X~2=8.129,p0.01)。HSIL预测锥切术后切缘阳性的敏感性、特异性、阳性预测值、阴性预测值分别为14.12%、3.62%、70.59%、64.56%。8.HPV16/18、HPV52/58、其他HR-HPV感染者,三组术后切缘阳性发生率之间差异无统计学意义(X~2=1.025,p0.05)。9.TCT为HSIL者,其锥切术后病理级别增加发生率高于LSIL者(X~2=6.074,p0.05)。HSIL预测锥切术后病理级别增加的敏感性、特异性、阳性预测值、阴性预测值分别为21.18%、90.58%、58.06%、65.10%。10.HPV16/18、HPV52/58、其他HR-HPV感染者,其锥切术后病理级别增加发生率之间差异无统计学意义(X~2=0.861,p0.05)。结论1.HPV感染率随宫颈病变级别升高而增加。2.HPV感染率及感染亚型分布有地区差异,本地区各级别宫颈病变中以HPV16/18/52/58感染为主;HPV16/18可作为转诊阴道镜的指标,但HPV52/58尚不能作为转诊阴道镜的指标。3.HPV感染年龄分布有两个高峰,20-30岁的年轻女性HPV感染率最高,41-50岁围绝经期女性出现第二个高峰。4.HSIL预测宫颈高级别病变的敏感性及特异性均优于不同型别的高危HPV感染;HSIL预测锥切术后切缘阳性和病理级别增加的敏感性均优于不同型别的高危HPV感染。因此,在宫颈病变的诊断与治疗中,应更加重视宫颈细胞学检查结果,特别是HSIL者。
[Abstract]:Objective To explore the role of HPV typing test and TCT in the diagnosis and treatment of high-grade cervical lesions, to explore whether HPV 52/58 subtype can be used as a referral colposcopy indicator, HPV typing (16/18/52/58) and TCT results can be used as objective indicators to predict the cervical lesion escalation and residual lesions after conization. Methods From January 1, 2010 to April 31, 2016, 249 patients with complete HPV test results and pathological data were enrolled in the gynecological clinic of Tianjin First Central Hospital. The HPV test method was used as a guided hybridization technique. Results 1. The HPV infection rate was 9. HPV infection rate was 0.76%, single high-risk HPV infection rate was 64.65%, multiple high-risk HPV infection rate was 22.49%. The top five high-risk HPV infection groups were HPV 16,58,52,18,33.2.20-30 years old group (97.30%), followed by 41-50 years old group (92.59%).3. CIN I 45 cases, CIN II-III (including carcinoma in situ) 194 cases, cervical invasive carcinoma 2 cases. HPV16/18 infection was higher than low-grade cervical lesion group (X~2=9.001, p0.05); other HR-HPV infection in high-grade cervical lesion group was lower than low-grade cervical lesion group (X~2=6.773, p0.05); HPV52/58 infection in high-grade cervical lesion group was higher than low-grade cervical lesion group (X~2=5.530, p0.05). 4. TCT results were abnormal, postoperative pathological diagnosis was CIN I 45 cases, CIN 0.05. The results of TCT were statistically significant (X~2=30.311, p0.05). 5. The incidence of high-grade cervical lesions in HSIL patients was higher than that in LSIL patients (X~2=18.186, p0.05). HSIL predicted high-grade cervical lesions with sensitivity, specificity, positive predictive value, negative predictive value. Preoperative HPV16/18 infection, HPV52/58 infection, other HR-HPV infection, HPV16/18 cervical high-grade lesion incidence was higher than other HR-HPV infection (X~2 = 5.282, p0.05); HPV52/58 and HPV16/18 and other HR-HPV had no significant difference (X~2 = 0.051, p0.05; X~2 = 3.551, p0.05). The sensitivity, specificity, positive predictive value and negative predictive value were 86.09%, 21.74%, 84.62% and 55.56% respectively. 7. The incidence of positive margin after conization in HSIL patients was higher than that in LSIL patients (X~2=8.129, P 0.01). The sensitivity, specificity, positive predictive value and negative predictive value of HSIL in predicting positive margin after conization were 1. There was no significant difference in the incidence of positive incision margins among the three groups (X~2=1.025, P 0.05). 9. TCT was HSIL, and the incidence of increased pathological grade after conization was higher than that of LSIL (X~2=6.074, P 0.05). HSIL was more sensitive and specific in predicting the increase of pathological grade after conization. There was no significant difference in the incidence of pathological grade increase among the patients with 10.HPV 16/18, HPV 52/58 and other HR-HPV infection (X~2=0.861, p0.05). Conclusion 1. HPV infection rate increased with the increase of cervical lesion grade. 2. HPV infection rate and distribution of infection subtypes. HPV16/18/52/58 infection was the main infection in cervical lesions of different levels in the region; HPV16/18 could be used as a referral colposcopy index, but HPV52/58 could not be used as a referral colposcopy index. 3. HPV infection age distribution had two peaks, 20-30 years old young women HPV infection rate was the highest, 41-50 years old perimenopausal women appeared the second high. The sensitivity and specificity of HSIL in predicting high-grade cervical lesions were superior to that of different types of high-risk HPV infection; the sensitivity of HSIL in predicting positive margins and increased pathological grade after conization was superior to that of different types of high-risk HPV infection. Therefore, more attention should be paid to the results of cervical cytology in the diagnosis and treatment of cervical lesions. Don't be HSIL.
【学位授予单位】:天津医科大学
【学位级别】:硕士
【学位授予年份】:2017
【分类号】:R737.33

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