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目的分析阴道镜联合人乳头瘤病毒(human papilloma virus,HPV)检查在非典型鳞状上皮细胞(atypical squamous cells of undetermined significance,ASCUS)中的应用价值。方法选择连续纳入2013年1—12月经液基薄层细胞检测(thinprep celltest,TCT)并诊断为ASCUS的患者102例,均做阴道镜检查及HPV-DNA检测,并在阴道镜下活检,以病理诊断结果为金标准。计数资料采用百分率表示,采用卡方检验,P<0.05为差异有统计学意义;一致性采用Kappa检验,Kappa>0.75为一致性较好。结果 102例患者中HPV-DNA检测阳性占49.02%,其中低危型占42.00%,高危型占58.00%。阴道镜检查结果阴性占56.86%,宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅰ占25.49%,CINⅡ占9.80%,CINⅢ占7.84%。宫颈活检病理结果发现1例原位癌。HPV-DNA检测结果与宫颈活检病理结果的比较,灵敏度为82.00%,特异度为85.25%。以HPV-DNA检测结果是否为阳性及病理结果是否为炎症,根据Kappa一致性检验,可得Kappa=0.765,一致性较好。阴道镜Reid评分结果与宫颈活检病理结果比较,灵敏度为97.62%,特异度为95.08%。根据Kappa一致性检验,可得Kappa=0.813,一致性较好。结论阴道镜联合HPV检查能够快速高效地对宫颈ASCUS患者进行管理并进一步诊断,与病理结果一致性好,对社区宫颈病变早期筛查、诊断及宫颈癌的防治工作具有重要意义。
Objective To analyze the value of colposcopy combined with human papilloma virus (HPV) in atypical squamous cells of undetermined significance (ASCUS). Methods A total of 102 consecutive patients with ASCUS diagnosed as thinprep cell test (TCT) from January to December in 2013 were selected for colposcopy and HPV-DNA testing. Colposcopy was performed under colposcopy. Pathological diagnosis for the gold standard. Count data using the percentage, using chi-square test, P <0.05 for the difference was statistically significant; consistency using Kappa test, Kappa> 0.75 for consistency. Results The positive rate of HPV-DNA in 102 cases was 49.02%, of which 42.00% in low-risk type and 58.00% in high-risk type. Colposcopy negative results accounted for 56.86%, cervical intraepithelial neoplasia (CIN) Ⅰ accounted for 25.49%, CIN Ⅱ accounted for 9.80%, CIN Ⅲ accounted for 7.84%. Cervical biopsy showed 1 case of carcinoma in situ. The results of HPV-DNA test and cervical biopsy showed that the sensitivity was 82.00% and the specificity was 85.25%. HPV-DNA test results are positive and the pathological results are inflammation, according to Kappa consistency test, Kappa = 0.765 available, consistency is better. Colposcopy Reid score results compared with cervical biopsy results, the sensitivity was 97.62%, the specificity was 95.08%. According to Kappa consistency test, we can get Kappa = 0.813, the consistency is better. Conclusion Colposcopy combined with HPV test can quickly and efficiently manage and further diagnose cervical ASCUS patients. It has good consistency with pathological findings and is of great significance for early screening and diagnosis of cervical lesions and prevention and treatment of cervical cancer.