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目的探讨联合应用人类染色体端粒酶(h TERC)基因检测、高危人乳头瘤病毒(HPV)检测及液基薄层细胞学检查(TCT)在宫颈癌筛查中的意义。方法选取2015年2月-2016年6月来院诊治的520例怀疑宫颈癌的女性为研究对象,所有患者均进行TCT、高危HPV检测、h TERC基因检测及病理检查,以病理检查结果为金标准。将3种检测方法的结果与病理检查结果进行比较,计算不同检查方法的敏感性及特异性。结果以病理检查结果为金标准,TCT检测的阳性率为68.65%(357/520)。TCT对未见上皮内病变(非SIL)的诊断符合率明显高于低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)及鳞状细胞癌(SCC)(P<0.05);TCT对LSIL的诊断符合率明显高于SCC(P<0.05)。高危HPV检测对非SIL的诊断阳性率明显低于LSIL、HSIL及SCC(P<0.05)。h TERC基因检测对非SIL的诊断阳性率明显低于LSIL、HSIL及SCC(P<0.05);h TERC基因检测对LSIL的诊断阳性率明显低于HSIL及SCC(P<0.05)。TCT、高危HPV检测、h TERC基因检测诊断宫颈病变的灵敏性分别为52.98%、97.11%、72.01%;特异性分别为93.06%、45.01%、98.59%。结论 3种检测方法联合应用可大大提高宫颈癌前病变的检出率。
Objective To investigate the significance of hTERC gene detection, high-risk human papillomavirus (HPV) detection and liquid-based thin-layer cytology (TCT) screening in cervical cancer screening. Methods A total of 520 women suspected of having cervical cancer from February 2015 to June 2016 were enrolled in this study. All patients underwent TCT, high-risk HPV test, hTERC gene test and pathological examination. The pathological examination results were the gold standard . The results of the three test methods were compared with the pathological test results to calculate the sensitivity and specificity of the different test methods. The results of pathological examination as the gold standard, TCT test positive rate was 68.65% (357/520). The coincidence rate of TCT in the diagnosis of no intraepithelial lesion (non-SIL) was significantly higher than that in LSIL, SCIL and SCC (P <0.05) ). The coincidence rate of TCT to LSIL was significantly higher than that of SCC (P <0.05). The positive rate of high-risk HPV testing for non-SIL was significantly lower than that of LSIL, HSIL and SCC (P <0.05). h The positive rate of TERC gene detection for non-SIL was significantly lower than that of LSIL, HSIL and SCC (P <0.05). The positive rate of hTERC gene detection for LSIL was significantly lower than that of HSIL and SCC (P <0.05). The sensitivity of TCT, high-risk HPV test and hTERC gene diagnosis of cervical lesions were 52.98%, 97.11%, 72.01% respectively; the specificity was 93.06%, 45.01%, 98.59% respectively. Conclusion The combined application of three detection methods can greatly improve the detection rate of cervical precancerous lesions.