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 evaluate the clinical value of HR-HPV DNA subtypes combined with "three-step"technology( TCT +HPV→colposcopy→cervical pathology) in the screening of cervical cancer. Methods 550 cases have been carried out TCT and HRHPV DNA checking,the positive patient with one or more indexes were examined with colposcopy and cervical biopsy and / or ECC performance. Pathological diagnosis of cervical biopsy was considered as the gold standard. The pathological result was compared with TCT,HR-HPV DNA results respectively. Results( 1) Among the 550 cases who were detected with TCT checking,62 cases were found positive which including 47 ASCUS,9 LSIL and 6 HSIL;( 2) Among the 550 cases who were detected by HR-HPV DNA checking,88 cases were found high-risk HPV-DNA- positive;( 3) The 97 cases who were found unusual TCT and / or high risk HPV DNA positive had done colposcopy checking and cervical biopsy,pathological result found 59 chronic inflammation,21 CINI,12 CIN II,4 CIN III and 1 SCC;( 4) The rate of missed diagnosis in single TCT check is 10. 53%,the rate of missed diagnosis in single HPV check is 21. 05%,the difference was statistically significant( P < 0. 01). Conclusion HR-HPV DNA combined with "three-step"technology could significantly increase the positive detection rate,and reduce the rate of missed diagnosis. It is conducive to detect cervical intraepithelial neoplasia and cervical cancer early.