HPVL1壳蛋白检测、宫颈细胞学检查、HPV检测诊断宫颈病变的临床价值

发布时间：2018-04-19 01:31

  本文选题：液基细胞学检查 + 人乳头瘤病毒　； 参考：《新乡医学院》2016年硕士论文

【摘要】：背景宫颈癌是妇科疾病中常见的源于宫颈鳞-柱交接部的恶性肿瘤,严重威胁女性的生活质量。全球每年新发宫颈癌患者约52.9万人,其中85%均在发展中国家[1]。人乳头瘤病毒(HPV)持续感染与宫颈癌的发生发展紧密相关,HPV有100多种亚型,可分为高危型HPV(HR—HPV)与低危型HPV(LR-HPV)。目前,我国在宫颈癌的防治上引进了一系列的方法,如HPV分型检测、HPV L1壳蛋白检测及HPV疫苗、宫颈细胞学检查等。近年来,各国学者都在努力寻求更有价值的筛查方法,能够更好的指导临床医生诊治宫颈病变。目的探讨HPV L1壳蛋白检测、宫颈液基薄层细胞学检查(TCT)、HPV分型检测在宫颈病变筛查的临床意义,以期得到更好的筛查方法来指导临床上的分流管理与治疗。方法收集在新乡医学院第一附属医院妇科门诊2014年7月-2015年6月期间因体检或发现宫颈异常就诊的1052例女性,均进行TCT检查和HPV分型检测,对TCT结果阳性、高危型HPV(HR-HPV)阳性或两者均阳性患者进行阴道镜检查及阴道镜下子宫颈活检术,同时对TCT结果阳性患者采用免疫细胞化学的方法检测HPV L1壳蛋白的表达。结果156例TCT结果异常中,意义未明确的非典型鳞状上皮细胞(ASCUS)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、鳞状细胞癌(SCC)的HR-HPV阳性率,分别为19.1%(13/68)、35.3%(18/51)、77.8%(21/27)、100%(10/10)。HR-HPV在TCT结果为高级别宫颈上皮内瘤变中的阳性率较高。LR-HPV阳性主要见于低级别宫颈上皮内瘤变。TCT异常结果中ASCUS、LSIL、HSIL、SCC在病理组织学CIN及以上阳性率分别为54.4%(37/68),60.8%(31/51),85.2%(23/27),10/10。TCT结果为低级别宫颈病变与组织病理学结果符合率低于高级别宫颈病变(χ~2=49.762,P0.001)。随着细胞学诊断结果越严重,与病理组织学结果越符合。在262例组织病理学结果中,TCT(+)和HR-HPV(+)者中宫颈病变检出率显著高于TCT、HR-HPV单一阳性者的检出率(χ~2=50.095,P0.001;χ~2=72.034,P0.001),两两比较差异有统计学意义。TCT联合HPV检测在CINⅢ及以上病例中双阳性检出率最高,在SCC中达到了100%。不同组织病理学结果中,HPV L1壳蛋白在低级别宫颈病变表达率高于高级别宫颈病变(χ~2=22.75,P0.001)。随着组织病理学结果越严重,HPV L1壳蛋白阳性表达率越低。研究对象以35岁为界,35岁以下年龄组的HPV L1壳蛋白阳性表达率高于35岁以上,差异有统计学意义(χ~2=18.203,P0.001)。结论HR-HPV在TCT结果为高级别宫颈上皮内瘤变中的阳性率较高,LR-HPV主要见于低级别宫颈上皮内瘤变。TCT联合HPV分型检测诊断宫颈病变的检出率高于两者单一阳性的检出率,可以作为临床上宫颈病变的筛查方法。HPV L1壳蛋白检测的阳性率随着宫颈病变程度加重及年龄增长逐渐下降,有望成为预测宫颈癌前病变进展趋势的生物学标志物,对临床宫颈病变的筛查具有一定的指导意义。
[Abstract]:Background Cervical cancer is a common malignant tumor from cervix squamous-column junction in gynecological diseases, which is a serious threat to the quality of life of women.There are about 529000 new cases of cervical cancer in the world every year, of which 85% are in developing countries.The persistent infection of human papillomavirus (HPV) is closely related to the occurrence and development of cervical cancer. There are more than 100 subtypes of HPV, which can be divided into high-risk HPV-HR-HPVs and low-risk HPV-LR-HPVs.At present, China has introduced a series of methods in the prevention and treatment of cervical cancer, such as HPV typing detection of HPVL1 shell protein and HPV vaccine, cervical cytology, and so on.In recent years, scholars all over the world are trying to find more valuable screening methods, which can better guide clinicians in the diagnosis and treatment of cervical diseases.Objective to investigate the clinical significance of HPV L1 shell protein detection and cervical liquid-based thin layer cytology in screening cervical lesions in order to obtain a better screening method to guide clinical shunt management and treatment.Methods from July 2014 to June 2015, 1052 women in gynecological outpatient department of the first affiliated Hospital of Xinxiang Medical College were examined by TCT and HPV typing, and the results of TCT were positive.Patients with high risk HPV-HR-HPV-positive or both were examined by colposcopy and cervical biopsy under colposcopy. The expression of HPV L1 shell protein was detected by immunocytochemistry in patients with positive TCT results.Results the positive rates of HR-HPV in atypical squamous epithelial cells with no clear significance, low grade squamous intraepithelial lesions, high squamous intraepithelial lesions and squamous cell carcinoma were found in 156 cases with abnormal TCT results.The positive rate of HR-HPV in high grade cervical intraepithelial neoplasia was higher. LR-HPV positive rate was mainly found in low grade cervical intraepithelial neoplasia. TCT abnormality. The positive rate of ASCUSLSILHSILILSCC in histopathological CIN and above were 54.44% 3768 / 60.8% 31 / 51T, respectively. The results showed that the positive rate of HR-HPV was 85.22% 23272727% and 1010.10% TCT, respectively.The coincidence rate between low grade cervical lesions and histopathological results was lower than that of high grade cervical lesions (蠂 2 / 49.762 P 0.001).The more serious the cytological diagnosis, the more consistent with the histopathological results.The detection rate of cervical lesions in 262 cases with histopathological findings was significantly higher than that in patients with single positive HR-HPV of TCTT (50.095U, P 0.001); 蠂 2 (72.034) (P 0.001). The difference was statistically significant. The positive rate of TCT combined with HPV was the highest in patients with CIN 鈪，

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