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目的探讨宫颈液基细胞(TCT)检测系统、高危人乳头瘤病毒(HPV)-DNA分型检测联合阴道镜在宫颈癌前病变筛查中的应用价值。方法选择1 300例宫颈癌前病变筛查妇女,同时行TCT检查及高危HPV-DNA分型检测,以组织病理学检查结果为诊断的金标准,对于其中1项或2项检查同时阳性的患者在阴道镜下行宫颈活检、组织病理学检查,并对检测结果进行分析。结果根据TBS分级标准,1 300例宫颈病变筛查妇女标本检测结果显示,未见上皮内病变(NILM)818例占62.92%、非典型鳞状细胞(ASC)185例占14.23%、LSIL154例占11.85%、HSIL135例占10.39%、SCC8例占0.62%,TCT检测总阳性率为52.46%。HPV阳性247例,HPV-DNA检测总阳性率为19.00%;HPV高危级别的感染率随着病理级别的升高呈明显上升趋势,HPV低危型感染率则随着病理级别的升高呈明显下降趋势,各组间相比差异有统计学意义(P<0.05);NILM患者的HPV-DNA和阴道镜检的阳性率显著低于ASC、LSIL、HSIL及SCC的患者,差异有统计学意义(P<0.05)。且HPV-DNA检测和阴道镜检查的阳性率随着TCT检查诊断级别的升高逐渐升高;TCT检测联合HPV-DNA检测的双阳性率随着病理级别升高检出率越高,在浸润癌中达到了100.00%,各组间相比差异有统计学意义(P<0.05);TCT、HPV-DNA分型检测联合阴道镜检测对CINⅠ、CINⅡ、CINⅢ的检出率均高于TCT、HPV-DNA分型检测,差异均有统计学意义(P<0.05),对浸润癌的检出率均为100.00%。结论 TCT、HPV-DNA分型联合阴道镜检测在宫颈病变筛查中具有较高的检出率,可有效降低漏诊率,值得在临床上推广应用。
Objective To investigate the value of cervical liquid-based cell (TCT) detection system and high-risk human papillomavirus (HPV) -DNA genotyping combined with colposcopy in the screening of cervical precancerous lesions. Methods A total of 1300 women with cervical precancerous lesions were screened for TCT and high-risk HPV-DNA typing at the same time. The histopathological examination was used as the gold standard for diagnosis. One of the two women with positive test Cervical biopsy under colposcopy, histopathological examination, and the test results were analyzed. Results According to the TBS grading standards, the test results of 1 300 cases of cervical lesions screening showed that 818 cases of non-epithelial lesions (NILM) accounted for 62.92%, 185 cases of atypical squamous cells (ASC) accounted for 14.23%, LSIL154 cases 11.85%, HSIL135 cases accounted for 10.39%, SCC8 cases accounted for 0.62%, TCT test positive rate was 52.46%. HPV positive 247 cases, the total positive rate of HPV-DNA test was 19.00%; HPV infection rate of high-risk level increased with the pathological level was significantly increased, low-risk HPV infection rate with the pathological grade was significantly increased (P <0.05). The positive rates of HPV-DNA and colposcopy in patients with NILM were significantly lower than those in ASC, LSIL, HSIL and SCC patients, the difference was statistically significant (P <0.05). The positive rate of HPV-DNA test and colposcopy increased gradually with the increase of diagnosis level of TCT. The positive rate of double positive rate of TCT combined with HPV-DNA test increased with the increase of pathological grade, (P <0.05). The detection rates of CINⅠ, CINⅡ and CINⅢ by TCT and HPV-DNA typing combined with colposcopy were all higher than that of TCT, HPV-DNA typing detection, the differences were statistically significant (P <0.05), the detection rate of invasive carcinoma were 100.00%. Conclusion TCT and HPV-DNA typing combined with colposcopy have a high detection rate in screening cervical lesions, which can effectively reduce the rate of misdiagnosis, which is worth popularizing in clinic.