宫颈细胞学阴性HPV阳性妇女的HPV分型检测

张珊，洪颖，马莉，兰明

(南京大学医学院附属鼓楼医院，南京210008)

摘要：目的探讨宫颈细胞学阴性人乳头瘤病毒(HPV)阳性妇女接受HPV分型检测的临床意义。方法宫颈细胞学阴性HPV阳性的妇女200例，对其进行HPV分型检测并转诊阴道镜及组织病理学检查，分析感染HPV型别与宫颈上皮内瘤变(CIN) Ⅱ+的关系，并在受检1 a后对病理检查结果为CINⅠ及宫颈炎症的患者进行随访，随访方法为宫颈新柏氏液基细胞学检查及HPV分型检测。结果200例受检者中检出CIN Ⅱ+患者37例(18.6%)，HPV16型感染者发生CINⅡ+的风险是不伴HPV16型感染者的2.608倍(OR值为2.608，P<0.05)。151例完成随访的CIN Ⅰ及宫颈炎症患者中，同型HPV感染者的宫颈上皮内瘤变患病率显著高于非同型感染者(P<0.01)，且同型感染者发生病理高级别进展的风险是非同型感染患者的14.89倍。结论 HPV分型检测对宫颈细胞学阴性HPV阳性妇女有重要的临床意义。宫颈细胞学阴性HPV16型感染者应立即转诊阴道镜检查。HPV分型检测用于细胞学阴性HPV阳性妇女的随访，随访中发现同型HPV阳性的患者应转诊阴道镜检查，尤其HPV16型感染患者。

关键词：人乳头瘤病毒；宫颈细胞学检查；第二代杂交捕获技术人乳头瘤病毒脱氧核糖核酸检查；宫颈上皮内瘤变；宫颈癌

doi：10.3969/j.issn.1002-266X.2015.43.002

中图分类号：R737.33 文献标志码：A

基金项目：江苏省科技厅科技支撑计划-社会发展项目(BE2012606)。

作者简介：第一张珊(1988-)，女，学士，在读研究生，主要研究方向为宫颈癌前病变的诊治。E-mail: 83237854@qq.com

作者简介：通信洪颖(1960-)，女，学士，主任医师，主要研究方向为宫颈癌前病变的诊治。E-mail: hongyingwjm@sina.com

收稿日期：(2015-06-30)

HPV genotyping detection of HPV positive women with negative cervical cytology

ZHANGShan,HONGYing,MALi,LANMing

(NanjingDrumTowerHospital,theAffiliatedHospitalofNanjingUniversity

MedicalSchool,Nanjing21008,China)

Abstract:ObjectiveTo investigate the clinical significance of HPV genotyping detection in patients with negative cervical cytology and positive human papilloma virus (HPV). MethodsA total of 200 women with negative cervical cytology and positive HPV received the HPV genotyping detection and were referred to colposcopy and histopathological examination. The correlation between different HPV subtype infection and cervical intraepithelial neoplasia(CIN Ⅱ)+ was analyzed. The women whose pathological diagnosis were CIN Ⅰ and cervicitis were followed up for one year by the method of TCT and HPV genotyping detection. ResultsOf 200 women, 37 patients were CIN Ⅱ+ (18.6%). The risk of patients with HPV16 infection to develop CIN Ⅱ+ was 2.608 times higher than that of patients without HPV16 infection (OR=2.608， P<0.05). Of 151 patients with CIN Ⅰ and cervicitis who finished the follow-up, the prevalence of cervical intraepithelial neoplasia in patient with homotype HPV infection was higher than that in patients with heterotype HPV infection (P<0.01). And the risk of higher pathological progression in patients with homotype infection was 14.89 times higher than that in patients with heterotype HPV infection. ConclusionsHPV genotyping detection has important clinical significance for cervical cytology negative and HPV positive women. It is recommend that cervical cytology negative and HPV16 positive women should be referred to colposcopy immediately. HPV genotyping detection can be used for the follow-up of cervical cytology negative and HPV positive women, and patients with positive homotype HPV infection should be referred to colposcopy, especially those with HPV16 infection.

Key words: human papilloma virus; cervical cytology testing; second-generation hybrid capture human papilloma virus deoxyribonucleic acid examination; cervical intraepithelial neoplasia; cervical carcinoma

近几十年来，关于宫颈癌的筛查指南在不断完善和更新。2005年WHO推荐对30岁以上妇女行宫颈细胞学和人乳头瘤病毒(HPV)联合检测的筛查方法，提高了宫颈癌前病变的诊断率，同时也发现了大量的宫颈细胞学检查阴性而第二代杂交捕获技术人乳头瘤病毒脱氧核糖核酸(HC2-HPV-DNA)阳性的妇女。宫颈新柏氏液基细胞学检查(TCT)取代传统的宫颈巴氏涂片检查，提高了宫颈上皮内瘤变的诊断率，但仍然有一定的假阴性率，而且HPV检测的敏感度高而特异度相对比较低，这都成为了近些年关注的焦点。……