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目的研究高危型人乳头瘤病毒(HR-HPV)检测与液基薄层细胞学技术(TCT)在宫颈癌前病变中的临床运用效果,对比分析其敏感性及特异性。方法 350例宫颈癌病理筛查阳性者分别采用TCT与HR-HPV检测进行筛查,对筛查阳性患者6个月1次采用TCT与HR-HPV联合检测进行跟踪测定,持续3年,分析研究HPV-脱氧核糖核酸(DNA)载量与疾病进程的关联性,并与病理诊断结果比较,讨论两者对疾病检测的敏感性及特异性。结果 350例筛查阳性患者中,其中HR-HPV筛查阳性328例,阳性率93.7%(328/350),TCT筛查阳性234例,阳性率66.9%(234/350),比较差异有统计学意义(P<0.05)。328例HR-HPV阳性患者中,与病理检查结果宫颈上皮内瘤变(CIN)Ⅱ级以上者相符合为126例,敏感性为89.6%、特异性为38.4%;234例TCT筛查阳性患者中,与病理结果符合者190例,敏感性为68.6%、特异性为81.2%,两项检测特异性、敏感性比较差异有统计学意义(P<0.05)。经过追踪检测发现,宫颈病变CINⅠ级或以上病例病灶复发/残留与病毒载量有一定关联性,宫颈病变CIN分级越高,与病毒载量相关性越高(P<0.05)。结论 TCT技术和HR-HPV检测方法各有优势,HR-HPV联合TCT技术可以有效提高宫颈癌检出效率,能够弥补单一检测方法的不足;HR-HPV检测可以作为病程监控的敏感指标;将TCT与HR-HPV联合检查,值得推荐。
Objective To study the clinical application of high-risk human papilloma virus (HR-HPV) detection and liquid-based thin-layer cytology (TCT) in cervical precancerous lesions and to compare the sensitivity and specificity. Methods A total of 350 cases of pathologically positive cervical cancer were screened by TCT and HR-HPV test. The patients with positive screening were followed up once every 6 months by TCT and HR-HPV for 3 years. HPV-DNA (DNA) load and disease progression, and compared with the pathological diagnosis of the two to discuss the sensitivity and specificity of disease detection. Results Of the 350 screening positive cases, 328 were positive for HR-HPV screening, the positive rate was 93.7% (328/350), the TCT screening positive rate was 234 cases, the positive rate was 66.9% (234/350), with statistical differences Significance (P <0.05). Of the 328 HR-HPV positive patients, 126 were consistent with pathological findings of cervical intraepithelial neoplasia (CIN), with a sensitivity of 89.6% and a specificity of 38.4%; 234 patients with positive TCT screening Among the 190 cases, the sensitivity was 68.6% and the specificity was 81.2%. The specificity and sensitivity of the two tests were statistically significant (P <0.05). After follow-up testing found that cervical lesions CIN Ⅰ or more cases of recurrence / residual disease and viral load have a certain relevance, cervical lesions higher CIN classification, and the higher the viral load (P <0.05). Conclusion TCT and HR-HPV detection methods have their own advantages. HR-HPV combined with TCT can effectively improve the detection rate of cervical cancer and make up for the lack of a single detection method; HR-HPV detection can be used as a sensitive indicator of disease monitoring; TCT With HR-HPV joint examination, it is recommended.