TCT、HPV检测在宫颈癌前病变中的筛查价值

发布时间：2018-04-10 10:18

  选题：宫颈癌筛查　视角：高危型人乳头状瘤病毒　引自：《吉林大学》2017年硕士论文

【摘要】：背景与目的:宫颈癌(Cervical Cancer,CC)的发病率在发展中国家女性恶性肿瘤中排名第二位[1],中国每年死于宫颈癌的人数近5万,近年来宫颈癌的发病率呈年轻化趋势,但其发生发展是一个较为漫长的过程,从癌前病变到出现早期癌、浸润癌是一个持续进展的过程,需10-15年时间[2]。因此,宫颈癌筛查是降低宫颈癌的发病率和死亡率的关键。宫颈癌的筛查方法有液基细胞学检查(Thinprep Cytologic Test,TCT)、人乳头瘤病毒(Human Papilloma Virus,HPV)检测及二者联合筛查。本研究旨在探讨TCT、HPV检测及二者联合筛查在宫颈癌前病变中的筛查价值。资料与方法:1.研究对象:选取2015年1月-2016年1月于吉林大学第一医院进行TCT及HPV检测的患者9756例,排除伴有急性生殖道炎症、宫颈锥切、子宫切除病史及盆腔放射治疗病史的患者,选取其中1025例进行阴道镜下宫颈活检的患者为研究对象,年龄19-84岁,知情同意。2.研究方法2.1 TCT检查受检者三天内禁止性生活、阴道冲洗及阴道内用药。检查者将液基细胞采集专用毛刷置入宫颈内,于宫颈鳞柱状交界部位同一方向旋转5圈,立即放入细胞保存液中漂洗。应用新柏氏全自动细胞制片机制片。细胞学诊断采用TBS分级系统(2006):未见上皮内病变细胞或恶性细胞(NILM);细胞学异常诊断包括意义不明确的宫颈不典型鳞状细胞(ASC-US)、不能排除高级别鳞状上皮内病变的宫颈不典型鳞状细胞(ASC-H)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、宫颈鳞状细胞癌(SCC)、不典型腺上皮细胞(AGC)和腺癌。结果判断标准:TCT检查结果为NILM判定为阴性结果,其余均判定为阳性结果。2.2 HPV检测检查者用棉签拭去宫颈及宫颈周围的粘液,将取样器置入宫颈外口1-1.5cm,顺时针方向旋转3圈,将收集的标本及取样器保存于专用试管中。采用第二代杂交捕获实验(HC2)方法,可检测l6、18、31、33、35、39、45、51、52、56、58、59、68型13种高危型HPV。结果判断标准:标本中HPV-DNA的负荷量≥1.0ng/L为阳性结果。3.统计学方法采用SPSS13.0统计学软件进行数据分析,各组计数资料之间比较采用χ2检验,取P0.05为差异有统计学意义。结果:1.以阴道镜下宫颈活检组织病理学检查结果作为诊断标准,组织病理学诊断正常或炎症患者的高危型HPV感染阳性率与LSIL、HSIL及CC患者的高危型HPV感染阳性率比较具有统计学差异(χ2=211.77,P=0.0000)。2.TCT检查结果级别越高,筛查假阴性率越低,各组患者间比较有统计学意义(χ2=11.00 P=0.0117)。随着TCT检查结果级别的升高,组织病理学级别升高(χ2趋势=691.22,P=0.0000)。3.TCT检查联合HPV检测的灵敏度明显高于单独TCT检查或HPV检测。结论:1.高危型HPV感染与宫颈癌前病变及宫颈癌有关,TCT检查结果级别越高,筛查假阴性率越低,需予以足够重视。2.宫颈癌的高发年龄提前。3.TCT联合HPV筛查能降低宫颈癌筛查的假阴性率,是最为理想的宫颈癌前病变筛查方法。
[Abstract]:Background & objective: the incidence of cervical cancer (CCC) is the second most common among women in developing countries [1]. The number of cervical cancer deaths in China is nearly 50 000 every year. The incidence of cervical cancer is younger in recent years.However, its occurrence and development is a long process, from precancerous lesion to early stage cancer, invasive cancer is a continuous progress process, it takes 10-15 years [2].Therefore, cervical cancer screening is the key to reduce the incidence and mortality of cervical cancer.The screening methods of cervical cancer include liquid based cytology, human Papilloma Cytologic test, and combined screening of human papillomavirus (HPV) and human papillomavirus (HPV).The purpose of this study was to investigate the value of TCTH HPV detection and combined screening in cervical precancerous lesions.Data and methods: 1.Participants: 9756 patients with TCT and HPV were selected from January 2015 to January 2016 in the first Hospital of Jilin University to exclude patients with acute genital tract inflammation, cervical conization, hysterectomy and pelvic radiation therapy.1025 of them, aged 19 to 84, were selected for cervical biopsy under colposcopy, with informed consent.Methods 2. 1 TCT test subjects were not allowed to have sex, vaginal irrigation and intravaginal medication for 3 days.The special brush was placed into the cervix and rotated in the same direction at the columnar junction of the cervix and then rinsed in the cell preservation solution.New Burr's automatic cell film was used to prepare the film.Cytological diagnosis was performed using the TBS grading system / 2006: no intraepithelial lesion or malignant cells were found. Cytological abnormalities included atypical squamous cells of the cervix with unclear significance, which could not be excluded from high-grade squamous intraepithelial lesions of the cervix.Atypical squamous cell carcinoma (ASC-HN), low grade squamous intraepithelial lesion (LSILA), high squamous intraepithelial lesion (HSIL), cervical squamous cell carcinoma (SCC), atypical glandular epithelial cell (AGC) and adenocarcinoma.Results the results of NILM were determined to be negative by NILM, and the others were determined to be positive by using cotton swabs to wipe the mucus of the cervix and the surrounding cervix. The sampler was inserted into the outer cervix of the cervix for1-1.5 cm and rotated three times clockwise.The collected specimen and sampler are stored in a special test tube.The second generation hybridization capture assay (HC2) was used to detect 13 high risk types of HPVs.Results: the load of HPV-DNA 鈮，

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