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目的分析高危型人乳头状瘤病毒检查(HR-HPV DNA)联合三阶梯技术(即:TCT+HPV检查→阴道镜检查→宫颈组织病理学诊断)在宫颈病变筛查中的应用价值。方法 550例筛查对象均进行TCT及HR-HPV DNA检测,对发现TCT异常和(或)HPV DNA阳性者行阴道镜检查,并在镜下行病理组织学检查(或宫颈管骚刮术),以组织病理学诊断为金标准,将其病理结果与TCT、HPV结果对照分析。结果(1)550例经TCT检测,阳性者62例,其中ASCUS 47例、LSIL 9例、HSIL 6例;(2)550例经HR-HPV DNA检测,阳性者88例,阴性者462例;(3)对97例TCT异常和(或)HR-HPV DNA阳性的患者行阴道镜检查并行镜下多点活检,病理结果:慢性宫颈炎59例,CIN I 21例,CIN II 12例,CIN III 4例,SCC 1例;(4)单一TCT漏诊率为10.53%,单一HPV漏诊率为21.05%,两者比较差异具有统计学意义(P<0.01)。结论应用HR-HPV DNA检查联合三阶梯技术能提高宫颈病变的阳性检出率,降低漏检率,在宫颈癌前病变及宫颈癌的筛查中具有重要的临床应用价值。
Objective To analyze the value of HR-HPV DNA combined with triple-ladder technique (ie TCT + HPV examination → colposcopy → cervical histopathology) in the screening of cervical lesions. Methods All the 550 screening subjects were tested for TCT and HR-HPV DNA. Colposcopy was performed on patients with TCT abnormalities and / or HPV DNA positive and histopathology (or cervical canal curettage) under microscope. Histopathological diagnosis as the gold standard, the pathological results and TCT, HPV results of controlled analysis. (2) 550 cases were detected by HR-HPV DNA, 88 cases were positive, 462 cases were negative; (3) 97 cases of TCT abnormalities and / or HR-HPV DNA positive patients underwent colposcopy multi-point biopsy, pathological results: chronic cervicitis in 59 cases, CIN I in 21 cases, CIN II in 12 cases, CIN III in 4 cases and SCC in 1 case. (4) The rate of single TCT misdiagnosis was 10.53% and single HPV misdiagnosis rate was 21.05%. There was significant difference between the two (P <0.01). Conclusion The combination of HR-HPV DNA test and triple-ladder technique can improve the positive detection rate of cervical lesions and reduce the missed detection rate, which has important clinical value in the screening of cervical precancerous lesions and cervical cancer.