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目的:探讨HPH感染与宫颈癌前病变及宫颈癌的关系,并提出相应的干预措施。方法:2006年4月～2008年4月选取开展妇女健康体格检查较好的深圳市福田区教育系统及尚未很好开展子宫颈癌筛查的深圳市龙岗区居民社区健康妇女为研究对象,对30～60岁妇女进行人类乳头瘤病毒(HPV)检测及阴道镜检查筛查子宫颈癌前病变(子宫颈上皮内瘤变,CIN)和子宫颈癌。结果:筛查深圳市福田区教育系统女性教职工1761例,HPV阳性者208例(11.81%),≥CINⅠ病变34例(1.93%);深圳市龙岗区紫薇社区妇女764例,HPV阳性者122例(16.00%),≥CINⅠ病变34例(4.57%),两者差异有统计学意义(χ2=8.1049,P=0.0044,χ2=12.9075,P=0.0003);HPV阳性者≥CINⅠ病变检出率明显高于HPV阴性者(OR=25.47,95%CI:14.35～45.23);以病理组织学诊断为金标准,评价HPV检测对预测子宫颈上皮内瘤样病变(≥CINⅠ病变)的临床价值,其敏感度:76.47%,特异度:88.69%,阳性预测值:15.75%,阴性预测值:98.46%。结论:HPV感染与子宫颈癌前病变及子宫颈癌密切相关,应将HPV感染者作为高危人群进行监测;健康人群普查能有效预防子宫颈癌前病变及子宫颈癌;应加强健康教育,促进健康人群自觉参与子宫颈癌筛查。
Objective: To investigate the relationship between HPH infection and cervical precancerous lesions and cervical cancer and to propose corresponding interventions. Methods: From April 2006 to April 2008, we selected the education system of Futian District, Shenzhen, which had a good physical examination for women, and the healthy women in community of residents in Longgang District, Shenzhen, which did not yet have a good screening of cervical cancer. 30 ~ 60-year-old women for human papillomavirus (HPV) detection and colposcopy screening for cervical precancerous lesions (cervical intraepithelial neoplasia, CIN) and cervical cancer. Results: A total of 1761 female teaching staff, 208 (11.81%) were HPV-positive, 34 (≥ 1.93%) were diagnosed in the education system of Futian District, Shenzhen. 764 women with Ziwei community in Longgang district of Shenzhen City were found to have HPV positive (16.00%), ≥CINⅠ lesions in 34 cases (4.57%), the difference was statistically significant (χ2 = 8.1049, P = 0.0044, χ2 = 12.9075, P = 0.0003); HPV positive ≥CIN Ⅰ lesion detection rate (OR = 25.47,95% CI: 14.35 ~ 45.23). The diagnostic value of HPV testing for cervical intraepithelial neoplasia (≥CINⅠ lesion) was evaluated by histopathology as the gold standard, The sensitivity: 76.47%, specificity: 88.69%, positive predictive value: 15.75%, negative predictive value: 98.46%. Conclusion: HPV infection is closely related to cervical precancerous lesions and cervical cancer. HPV infected persons should be monitored as high-risk groups. Healthy population census can effectively prevent cervical precancerous lesions and cervical cancer. Health education should be strengthened to promote Healthy people consciously participate in cervical cancer screening.