魏宝丽 王海平

[摘要] 目的 探讨宫颈液基薄层细胞学（Cytology of cervical fluid base，TCT）检测与人乳头瘤病毒（Human papilloma virus，HPV）联合检测对诊断宫颈病變的临床分析，为更好地进行宫颈癌筛查提供依据。 方法 选取2014年1月1日～2016年6月30日在本院就诊的7000例患者，其中4500例单纯进行TCT检测，检测出459例阳性患者为TCT组；2500例进行TCT+HPV联合检测，检测出阳性（TCT、HPV只要有一项异常）患者363例为联合组。所有阳性患者均行阴道镜下活检，以病理组织学结果为金标准，比较两组检测方法的效果。结果 TCT组检出细胞学异常459例，检出率为10.2%（459/4500）；联合组检出阳性患者363例（其中TCT和HPV均阳性的共有234例；TCT阳性，HPV阴性的76例；TCT阴性，HPV阳性的53例），检出率为14.5%（363/2500）。两组比较，差异有统计学意义（P<0.05）。联合组宫颈高级别（CIN2及以上）病变检出率3.5%（87/2500）与TCT组1.5%（69/4500）比较，差异有统计学意义（P<0.05）。 结论 TCT+HPV联合组可明显提高宫颈病变的筛查率以及宫颈高级别病变诊断的准确率，是医患接受的理想方法。

[关键词] TCT；HPV；宫颈病变；宫颈癌

[中图分类号] R711 [文献标识码] B [文章编号] 1673-9701（2018）02-0054-03

[Abstract] Objective To investigate the combined detection of cytology of cervical fluid base（TCT） and human papilloma virus（HPV） in the clinical diagnosis of cervical lesions， to provide a basis for better cervical cancer screening. Methods A total of 7000 patients admitted in our hospital from January 1， 2014 to June 30， 2016 were selected. Among them， 4500 cases were tested by TCT alone， and 459 positive patients detected were as TCT group. 2500 cases underwent the combined detection of TCT+HPV， and 363 cases with positive （TCT， HPV as long as there was abnormal in one term） were as the combined group. All the positive patients underwent colposcopic biopsy. Choosing histopathological results as the gold standard， the effectiveness between two test methods was compared. Results 459 cases of cytological abnormalities were detected in TCT group， with a detection rate of 10.2%（459/4500）. In the combined group， 363 cases were positive （of which 234 were positive for both TCT and HPV； 76 cases were TCT positive and HPV negative； 53 cases were TCT negative and HPV-positive）， with the detection rate of 14.5%（363/2500）. The difference between the two groups was statistically significant（P<0.05）. There was a statistically significant difference in the detection rate of cervical high-grade between the combined group（3.5%， 87/2500） and the TCT group （1.5%， 69/4500）. Conclusion The combination of TCT+HPV can significantly improve the screening rate of cervical lesions and diagnosis accuracy of high-grade cervical lesions， which is the ideal method for doctors and patients to accept.

[Key words] TCT； HPV； Cervical lesions； Cervical cancer

宫颈癌是妇科常见的恶性肿瘤之一，其发病率仅次于乳腺癌[1]。其发生、发展是一漫长的过程，依次经过宫颈不典型增生、宫颈原位癌、早期浸润癌及浸润癌[2]。因此，合理有效的筛查方法可以使宫颈癌的发生率明显降低[3]。临床上宫颈癌筛查的主要方法为TCT检测[4]，近些年，HPV的检测得到广泛关注和认可。本次研究通过将TCT检测及TCT+HPV联合检测两种方法进行对比，分析TCT+HPV联合检测对诊断宫颈病变的效果，得出宫颈癌筛查的有效方法，现报道如下。

1 资料与方法

1.1 一般资料

选取2014年1月1日～2016年6月30日在本院就诊的7000例患者为研究对象，所有患者均为已婚或有2年以上性生活史，避开月经期，排除既往HPV感染史及宫颈手术史。年龄25～69岁。将患者随机进行检测，其中4500例单纯进行TCT检测，2500例进行TCT+HPV联合检测。……