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目的探讨液基薄层细胞检测(TCT)、高危型人乳头状瘤病毒检测(HR-HPV)、阴道镜及3种方法联合使用对高危人群宫颈上皮内瘤变(CIN)及宫颈癌的筛查价值。方法以2013年1月-2015年1月就诊的466例有同房出血史患者为研究对象,采用回顾性的方法对TCT、HR-HPV、阴道镜检查以及3种方法联合使用对CIN及宫颈癌的筛查价值进行评价。结果 466例患者中诊断为宫颈炎症165例,CIN 1级116例,CIN 2~3级182例,宫颈癌3例。阴道镜检查的灵敏度最高(84.1%),特异度最低(59.4%),假阳性率高(40.6%),假阴性率低(15.9%),阴性预测值最高(67.1%);TCT特异性最高(84.8%),假阳性率最低(15.2%);HR-HPV的上述指标值介于TCT和阴道镜之间。HR-HPV检查的阳性预测值最高(84.5%)、阴道镜的阴性预测值最高(67.1%),3种方法比较差异均有统计学意义(P<0.05)。单一TCT、HR-HPV检测与病理诊断一致性差(K=0.213、0.343),阴道镜一致性中等(K=0.446)。TCT与HR-HPV联合后灵敏度明显提高(93.0%),假阴性率下降(7.0%),约登指数0.736,与病理检查结果高度一致(K=0.748)。结论对于同房出血史或其他异常的宫颈病变高危人群,单一TCT、HR-HPV检查对筛查CIN及宫颈癌的灵敏度较低,假阴性率高,阴道镜检查灵敏度较高,特异度低。将TCT、HR-HPV联合,灵敏度高,漏诊率低,筛查真实性、可靠性、预测值均明显提高,与病理检查有较好的一致性。
Objective To investigate the diagnostic value of TCT, HR-HPV, colposcopy and three methods for the screening of high-risk cervical intraepithelial neoplasia (CIN) and cervical cancer Check the value. Methods From January 2013 to January 2015, 466 cases of patients with the same room bleeding were enrolled in this study. Retrospective methods were used to evaluate the effect of TCT, HR-HPV, colposcopy and three methods on CIN and cervical cancer The screening value of the evaluation. Results Among the 466 cases, 165 cases were diagnosed as cervical inflammation, 116 cases were CIN 1, 182 cases CIN 2 ~ 3 and 3 cases cervical cancer. Colposcopy had the highest sensitivity (84.1%), lowest specificity (59.4%), false positive rate (40.6%), false negative rate (15.9%) and negative predictive value (67.1% (84.8%), the lowest false positive rate (15.2%); HR-HPV above the target value between TCT and colposcopy. The positive predictive value of HR-HPV test was the highest (84.5%), and the negative predictive value of colposcopy was the highest (67.1%). The differences among the three methods were statistically significant (P <0.05). Single TCT, HR-HPV testing and pathological diagnosis of poor consistency (K = 0.213,0.343), colposcopy consistency (K = 0.446). Sensitivity was significantly increased after combined use of TCT and HR-HPV (93.0%), false negative rate (7.0%), and Youden index of 0.736, consistent with the pathological findings (K = 0.748). Conclusions The sensitivity of single TCT and HR-HPV test to screening CIN and cervical cancer is low, the false negative rate is high, colposcopy sensitivity is high and the specificity is low for the same room bleeding history or other abnormal high risk of cervical lesions. Combination of TCT and HR-HPV, high sensitivity, low rate of missed diagnosis, screening authenticity, reliability, predictive value were significantly improved, and the pathological examination has a good consistency.