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目的评价人端粒酶基因(human telomerase RNA component,h TERC)及液基细胞学(liquid-based cytology test,LCT)、HPV检测在宫颈高级别病变(≥CINⅡ)筛查中的价值。方法收集在厦门市妇幼保健院就诊并接受LCT和HPV检测宫颈病变患者115例,运用FISH技术检测宫颈病变组织h TERC基因扩增情况。以病理结果为标准,评价3种方法不同组合方案在筛查≥CINⅡ病变中的价值。结果单一方法筛查时,HPV敏感度最高(91.2%),h TERC基因的特异性(86.5%)和阳性预测值(88.1%)最高;两种方法联合筛查时,LCT+HPV的敏感度最高(98.4%),但特异性最低(37.5%);任意两种方法联合筛查均能明显提高敏感度和阴性预测值,但不能提高特异性。诊断≥CINⅡ的受试者工作特征(receiver operating characteristic,ROC)曲线下面积以h TERC基因最高(0.85),筛查效率最高(P<0.05);联合筛查则LCT+h TERC基因筛查效率最高,但联合筛查方案的筛查效率与单一筛查方案相比差异无统计学意义(P>0.05)。结论 LCT、HPV与h TERC基因均是筛查≥CINⅡ病变的有效方法,h TERC基因的效率最高,但成本最高,可作为常规筛查的补充;联合筛查能提高敏感度和阴性预测值,提高对≥CINⅡ的检出率,但不能提高筛查效率。LCT+HPV联合筛查是一种相对经济和高效的方案,可作为基础筛查进行。
Objective To evaluate the value of human telomerase RNA (hTERC), liquid-based cytology (LCT) and HPV testing in the screening of high-grade cervical lesions (≥CINⅡ). Methods A total of 115 cases of cervical lesions were detected by LCT and HPV in Xiamen MCH hospital. FISH was used to detect the amplification of hTERC gene in cervical lesions. The pathological results as the standard, evaluation of three different combinations of methods in the screening of ≥ CIN Ⅱ disease value. Results The results of single-method screening showed the highest HPV sensitivity (91.2%), the highest specificity of TERC gene (86.5%) and the highest positive predictive value (88.1%). LCT + HPV sensitivity The highest (98.4%), but the lowest specificity (37.5%); any combination of two screening methods can significantly improve the sensitivity and negative predictive value, but can not improve the specificity. The area under the receiver operating characteristic (ROC) curve for diagnosis ≥ CIN II had the highest (0.85) h TERC gene and the highest screening efficiency (P <0.05), while the LCT + h TERC gene screening efficiency But the screening efficiency of the combined screening program was not significantly different from the single screening program (P> 0.05). Conclusions LCT, HPV and h TERC genes are both effective methods for screening ≥CINII pathology. H TERC gene is the most efficient but highest cost, which can be used as a supplement to routine screening. Combined screening can improve the sensitivity and negative predictive value, Improve the detection rate of ≥ CIN Ⅱ, but can not improve the screening efficiency. LCT + HPV screening is a relatively economical and efficient program that can be used as a basis for screening.