细胞DNA分析技术及宫颈HPV检测在宫颈癌筛查中的应用
发布时间:2018-12-17 14:30
【摘要】:目的:1.利用细胞DNA定量分析技术,常规细胞学检查及宫颈HPV检测在一定人群中开展宫颈癌筛查,研究不同筛查方式的灵敏度和特异度,以评价其在宫颈癌及癌前病变筛查诊断中的应用,找出适合宫颈癌筛查的最适用方法;2.评价DNA定量分析技术用于ASCUS分流中价值;3.评价DNA异倍体和HPV感染之间的相关性,以明确二者在宫颈病变中的关系。 方法:1.随机选取2012年6月——2013年5月在昆明医科大学第一附属医院妇科门诊就诊的,无宫颈脱落细胞学取材禁忌症的3418位患者为研究对象,分别进行细胞DNA定量分析、常规细胞学检查,对细胞DNA定量分析有≥3个异倍体细胞或(和)细胞学诊断高于低度鳞状上皮内病变的行宫颈HPV检测及宫颈活检,以宫颈活检结果为金标准,进行双盲对照研究及统计学分析;2.筛选本院就诊的宫颈癌筛查常规细胞学检查结果为ASCUS的126例患者,根据DNA倍体检测分为实验活检组和实验非活检组,对两组患者分别进行阴道镜下活检,以宫颈活检为金标准进行统计学分析;3.筛取有HPV感染的病例,将其检查结果与DNA结果进行对比,找出两者的相关性。 结果:1.共有211名妇女做了宫颈组织活检及病理检查,以宫颈活检病理结果为金标准,以组织学诊断CIN2及以上级别病变为阳性阈值,计算出细胞DNA定量分析技术的灵敏度为89.6%,特异度为71.4%,约登指数为0.610;常规细胞学检查的灵敏度为71.8%,特异度为78.9%,约登指数为0.507;宫颈HPV检查的灵敏度为92.7%,特异度为84.2%,约登指数为0.769,DNA定量分析技术与常规细胞学相比,DNA灵敏度增高,约登指数较大2.对于常规细胞学检查为ASCUS的126例患者,在阴道镜下行宫颈活检,ASCUS伴有DNA倍体异常者,CINII及以上病变的风险增高。若以筛查CIN及以上级别病变为目标,DNA倍体定量分析的灵敏度为83.1%,特异度为69.4%,约登指数为0.525;若以筛查CINII及以上为目标DNA倍体定量分析的灵敏度为85.4%,特异度为83.3%,约登指数为0.687。3.211例行HR-HPV检测的病例中,HR-HPV感染的检出率随着宫颈病变级别的升高而增加,在112例HR-HPV感染病例中,100例(89.3%)DNA倍体分析为阳性;在176例倍体分析阳性的病例中,100例(43.4%)检出有HR-HPV感染,两者行统计学分析具有差异性。 结论:1.DNA定量分析技术与常规细胞学相比,明显的提高了灵敏性且其真实性较好,而HPV检测技术的灵敏性和特异性均较高,可以作为宫颈癌筛查的有效手段,与细胞学联合应用可以最大限度的减少漏诊率,提高筛查的效率。 2.DNA倍体分析为筛查ASCUS提供了一种客观、敏感的方法,有利于ASCUS中CINII及以上病变的检出,能为常规细胞学为ASCUS的患者提供合理的分流。 3.HPV的持续感染与DNA异倍体的形成有一定的联系,但并不是必需的因素,DNA定量分析技术与宫颈HPV检测可以提高宫颈病变的检出率。
[Abstract]:Objective: 1. The sensitivity and specificity of different screening methods were studied by quantitative analysis of cell DNA, routine cytological examination and cervical HPV detection in a certain population. In order to evaluate its application in the screening diagnosis of cervical cancer and precancerous lesions, find out the most suitable method for cervical cancer screening. 2. Evaluate the value of DNA quantitative analysis technique in ASCUS shunt. 3. To evaluate the correlation between DNA aneuploidy and HPV infection in cervical lesions. Method 1: 1. From June 2012 to May 2013, 3418 patients with no contraindication of cervical exfoliation cytology were selected from gynecological outpatient clinic of the first affiliated Hospital of Kunming Medical University as the study objects. The quantitative analysis of cell DNA was performed respectively. Routine cytological examination showed that the quantitative analysis of cell DNA was more than 3 aneuploidy cells or (and) cytology, which was higher than that of low grade squamous intraepithelial lesions. The cervical HPV detection and cervical biopsy were performed, and the results of cervical biopsy were regarded as the gold standard. Double blind control study and statistical analysis; 2. According to DNA ploidy test, 126 patients with ASCUS were divided into experimental biopsy group and experimental non-biopsy group. The cervical biopsy was used as the gold standard for statistical analysis. 3. The results of HPV infection were compared with those of DNA, and the correlation between them was found. Results: 1. A total of 211 women underwent cervical biopsy and pathological examination. The sensitivity of quantitative analysis of cellular DNA was 89.6, taking the pathological results of cervical biopsy as gold standard and histologic diagnosis of lesions of CIN2 and above as positive threshold. The specificity was 71.4 and the Yorden index was 0.610; The sensitivity of routine cytology was 71.8%, the specificity was 78.9, and the Yorden index was 0.507; The sensitivity and specificity of cervical HPV examination were 92.7% and 84.2% respectively. Compared with conventional cytology, the sensitivity of DNA was higher and the Yorden index was higher than that of conventional cytology. Cervical biopsy was performed under colposcopy in 126 patients with conventional cytologic examination of ASCUS. ASCUS with DNA ploidy was associated with increased risk of CINII and above lesions. The sensitivity of quantitative analysis of DNA ploidy was 83.1, the specificity was 69.4, and the Yorden index was 0.525. If the sensitivity of quantitative analysis of DNA ploidy is 85.4, the specificity is 83.3, and the Yorden index is 0.687.3.211, the sensitivity of quantitative analysis of DNA ploidy is 85.4, the specificity is 83.3, and the Yorden index is 0.687.3.211. The detection rate of HR-HPV infection increased with the increase of cervical lesion grade. Among 112 cases of HR-HPV infection, 100 cases (89.3%) were positive for DNA ploidy analysis. Among 176 cases with positive ploidy analysis, 100 cases (43.4%) were found to have HR-HPV infection. Conclusion: compared with conventional cytology, 1.DNA quantitative analysis technique can improve the sensitivity and its authenticity, while the sensitivity and specificity of HPV detection technique are higher, so it can be used as an effective method for cervical cancer screening. Combined with cytology can minimize the rate of missed diagnosis and improve the efficiency of screening. 2.DNA ploidy analysis provides an objective and sensitive method for screening ASCUS, which is beneficial to the detection of CINII and above lesions in ASCUS, and can provide reasonable shunt for patients with ASCUS by routine cytology. The persistent infection of 3.HPV is related to the formation of DNA aneuploidy, but it is not a necessary factor. DNA quantitative analysis and cervical HPV detection can improve the detection rate of cervical lesions.
【学位授予单位】:昆明医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R737.33
本文编号:2384324
[Abstract]:Objective: 1. The sensitivity and specificity of different screening methods were studied by quantitative analysis of cell DNA, routine cytological examination and cervical HPV detection in a certain population. In order to evaluate its application in the screening diagnosis of cervical cancer and precancerous lesions, find out the most suitable method for cervical cancer screening. 2. Evaluate the value of DNA quantitative analysis technique in ASCUS shunt. 3. To evaluate the correlation between DNA aneuploidy and HPV infection in cervical lesions. Method 1: 1. From June 2012 to May 2013, 3418 patients with no contraindication of cervical exfoliation cytology were selected from gynecological outpatient clinic of the first affiliated Hospital of Kunming Medical University as the study objects. The quantitative analysis of cell DNA was performed respectively. Routine cytological examination showed that the quantitative analysis of cell DNA was more than 3 aneuploidy cells or (and) cytology, which was higher than that of low grade squamous intraepithelial lesions. The cervical HPV detection and cervical biopsy were performed, and the results of cervical biopsy were regarded as the gold standard. Double blind control study and statistical analysis; 2. According to DNA ploidy test, 126 patients with ASCUS were divided into experimental biopsy group and experimental non-biopsy group. The cervical biopsy was used as the gold standard for statistical analysis. 3. The results of HPV infection were compared with those of DNA, and the correlation between them was found. Results: 1. A total of 211 women underwent cervical biopsy and pathological examination. The sensitivity of quantitative analysis of cellular DNA was 89.6, taking the pathological results of cervical biopsy as gold standard and histologic diagnosis of lesions of CIN2 and above as positive threshold. The specificity was 71.4 and the Yorden index was 0.610; The sensitivity of routine cytology was 71.8%, the specificity was 78.9, and the Yorden index was 0.507; The sensitivity and specificity of cervical HPV examination were 92.7% and 84.2% respectively. Compared with conventional cytology, the sensitivity of DNA was higher and the Yorden index was higher than that of conventional cytology. Cervical biopsy was performed under colposcopy in 126 patients with conventional cytologic examination of ASCUS. ASCUS with DNA ploidy was associated with increased risk of CINII and above lesions. The sensitivity of quantitative analysis of DNA ploidy was 83.1, the specificity was 69.4, and the Yorden index was 0.525. If the sensitivity of quantitative analysis of DNA ploidy is 85.4, the specificity is 83.3, and the Yorden index is 0.687.3.211, the sensitivity of quantitative analysis of DNA ploidy is 85.4, the specificity is 83.3, and the Yorden index is 0.687.3.211. The detection rate of HR-HPV infection increased with the increase of cervical lesion grade. Among 112 cases of HR-HPV infection, 100 cases (89.3%) were positive for DNA ploidy analysis. Among 176 cases with positive ploidy analysis, 100 cases (43.4%) were found to have HR-HPV infection. Conclusion: compared with conventional cytology, 1.DNA quantitative analysis technique can improve the sensitivity and its authenticity, while the sensitivity and specificity of HPV detection technique are higher, so it can be used as an effective method for cervical cancer screening. Combined with cytology can minimize the rate of missed diagnosis and improve the efficiency of screening. 2.DNA ploidy analysis provides an objective and sensitive method for screening ASCUS, which is beneficial to the detection of CINII and above lesions in ASCUS, and can provide reasonable shunt for patients with ASCUS by routine cytology. The persistent infection of 3.HPV is related to the formation of DNA aneuploidy, but it is not a necessary factor. DNA quantitative analysis and cervical HPV detection can improve the detection rate of cervical lesions.
【学位授予单位】:昆明医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R737.33
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