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目的探讨子宫颈TCT异常病例与HPV-DNA及病理组织学诊断结果的关系。方法收集TCT异常的2458例蒙古族妇女作为研究对象,TBS描述性诊断结果与病理组织学结果进行比较,同时进行子宫颈脱落细胞HPV-DNA基因分型检测。观察接受子宫颈Leep术与子宫颈冷刀锥切术HPV-DNA转阴情况。结果 TCT诊断与病理组织学诊断结果TCT诊断为癌29例,其中18例病理组织学诊断证实为浸润癌,符合率62%。HSIL组348例中有94例为湿疣/CIN1,符合率27%,84例为CIN2,符合率25%,69例为CIN3,符合率20%,CIN1～3总符合率72%。统计分析显示,TCT诊断与病理组织学诊断相比,差异有统计学意义(χ2=612.4P<0.01)。HPV-DNA检测与病理组织学结果比较,病理组织学诊断43例浸润性癌中有40例HPV-DNA检测为阳性(93.03%);CIN3130例中HPV-DNA阳性119例(91.54%);CIN2171例中HPV-DNA阳性155例(90.65%);湿疣/CIN1597例中HPV-DNA阳性537例(89.95%);HPV-DNA阴性组与阳性组相比较,差异有统计学意义(χ2=248.6,P<0.01)。TCT诊断与HPV-DNA检测结果比较,检测阳性314例,占90.23%;659例TCT诊断为LSIL,HPV-DNA检测阳性544例,占82.55%,HPV-DNA检测与TCT诊断结果相比较,差异有统计学意义(χ2=101.9,P<0.01)。CIN患者治疗前后HPV-DNA转阴率,总的HPV-DNA转阴率84.87%,治疗后总的HPV-DNA转阴率95.56%。CIN患者行子宫颈Leep术和子宫颈锥切术治疗后HPV-DNA均显著降低(P<0.01)。结论 TCT检查对子宫颈癌前病变,尤其是高度病变具有有效的预警作用。HPV-DNA的阳性检出率与TBS分级及病变程度密切相关,HPV-DNA阳性可对子宫颈癌起到有效预警作用,临床上对于已经接受手术治疗的CIN患者行HPV-DNA检测评估治疗、判断预后及进一步跟踪随访治疗都有非常重要的指导意义。
Objective To investigate the relationship between cervical TCT abnormalities and HPV-DNA and histopathological diagnosis. Methods A total of 2458 Mongolian women with TCT abnormalities were collected as subjects. The diagnostic results of TBS were compared with the histopathological results. HPV-DNA genotyping was also performed in exfoliated cells of the cervix. To observe the cervical Leep surgery and cervical cold knife conization of HPV-DNA negative situation. Results TCT diagnosis and histopathological diagnosis of TCT diagnosis of 29 cases of cancer, of which 18 cases of pathological diagnosis confirmed invasive carcinoma, consistent rate of 62%. In 348 cases of HSIL group, 94 cases were condyloma / CIN1, the coincidence rate was 27%, 84 cases were CIN2, the coincidence rate was 25%, 69 cases were CIN3, the coincidence rate was 20%, and the total coincidence rate of CIN1 ~ 3 was 72%. Statistical analysis showed that the difference between TCT and histopathological diagnosis was statistically significant (χ2 = 612.4P <0.01). The results of HPV-DNA test and histopathology showed that HPV-DNA was detected in 40 cases (93.03%) in 43 cases of histological diagnosis, 119 cases (91.54%) of HPV-DNA positive in CIN3130 cases, CIN2171 The HPV-DNA was positive in 155 cases (90.65%) in the cases and 537 cases (89.95%) in genital warts / CIN1597 cases. The HPV-DNA negative group was significantly different from the positive group (χ2 = 248.6, P <0.01). There were 314 positive cases (90.23%) in TCT diagnosis and HPV-DNA test results, 654 cases of TCT were diagnosed as LSIL, 544 cases were positive HPV-DNA test, accounting for 82.55%. The difference between HPV-DNA test and TCT diagnosis was There was statistical significance (χ2 = 101.9, P <0.01). Before and after treatment of HPV, the negative rate of HPV-DNA, the total negative rate of HPV-DNA was 84.87%, and the total negative rate of HPV-DNA after treatment was 95.56%. HPV-DNA in CIN patients was significantly lower after cervical Leep surgery and cervical conization (P <0.01). Conclusion TCT has an effective early warning effect on cervical precancerous lesions, especially on highly pathological changes. The positive detection rate of HPV-DNA is closely related to the grade of TBS and the degree of lesion. HPV-DNA positive can play an effective early warning role for cervical cancer. Clinically, HPV-DNA detection and evaluation are performed in CIN patients who have undergone surgical treatment, To judge the prognosis and follow-up treatment have a very important guiding significance.