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目的探讨高危型人乳头瘤病毒(HPV)的病毒负荷量与宫颈癌及其癌前病变(CIN)的关系。方法选择2003年1月至2004年7月间在广东省人民医院宫颈疾病专科门诊就诊的妇女5584例,采用第2代杂交捕获试验(HC-Ⅱ)进行高危型HPVDNA的半定量检测,阴道镜下定位活检,病理学结果为确诊标准。结果高危型HPV检测阳性1590例,阳性率28.47%,各种病理类型的宫颈病变中高危型HPV感染率分别为:宫颈鳞癌88.89%,宫颈腺癌66.67%,CINⅢ92.77%,CINⅡ86.30%,CINⅠ44.58%,宫颈扁平型湿疣86.69%,慢性宫颈炎9.59%。随着宫颈病变严重程度的增加,高危型HPV的病毒负荷量也增高,它们之间的相关性有显著意义(H=1984.714,P<0.01),其中慢性宫颈炎与宫颈癌及CIN的差异有显著性意义(P<0.01);CINⅠ与宫颈腺癌之间的差异无显著性意义(P>0.05),但与宫颈扁平型湿疣、CINⅡ、CINⅢ及宫颈鳞癌的差异有显著性意义(P<0.01);而宫颈扁平型湿疣、CINⅡ、CINⅢ与宫颈鳞癌之间的差异无显著性意义(P>0.05)。用ROC曲线分析HC-Ⅱ检测宫颈高度病变,最能平衡敏感度和特异度的阳性分界点是3.7pg/mL,Youden指数为0.72,敏感度为92%,特异度为80%。结论高危型HPV的病毒负荷量增高与宫颈病变严重程度的增加密切相关;合理设置阳性分界点,可提高HC-Ⅱ检测宫颈高度病变的特异度。
Objective To investigate the relationship between the viral load of high-risk human papillomavirus (HPV) and cervical cancer and precancerous lesions (CIN). Methods From January 2003 to July 2004, 5584 women were treated in the Department of Cervical Diseases Outpatient, Guangdong Provincial People’s Hospital. The second generation hybridization capture test (HC-Ⅱ) was used to detect the high-risk HPVDNA. The colposcopy Under the biopsy, pathological results for the diagnosis of standard. Results High-risk HPV test positive 1590 cases, the positive rate of 28.47%, various pathological types of cervical lesions in high-risk HPV infection rates were: cervical squamous cell carcinoma 88.89%, cervical adenocarcinoma 66.67%, CIN Ⅲ 92.77%, CIN Ⅱ 86.30 %, CINⅠ44.58%, cervical flat condyloma 86.69%, chronic cervicitis 9.59%. As the severity of cervical lesions increased, the viral load of high-risk HPVs also increased. The correlation between them was significant (H = 1984.714, P <0.01). The difference between chronic cervicitis and cervical cancer and CIN was (P <0.01). There was no significant difference between CINⅠ and cervical adenocarcinoma (P> 0.05), but there was significant difference between CINⅠand cervical squamous cell carcinoma, CINⅡ, CINⅢ and cervical squamous cell carcinoma (P <0.01). There was no significant difference between cervical flat condyloma acuminatum, CINⅡ, CINⅢ and cervical squamous cell carcinoma (P> 0.05). Using ROC curve analysis of HC-Ⅱ for detecting cervical height lesions, the positive cut-off point for the best balance of sensitivity and specificity was 3.7 pg / mL, the Youden index was 0.72, the sensitivity was 92% and the specificity was 80%. Conclusion High-risk HPV infection is closely related to the increase of the severity of cervical lesions. Setting a reasonable cut-off point can improve the specificity of HC-Ⅱ in detection of cervical lesions.