华诏召　曾莉　曹俊岩

[摘要] 目的 探討子宫腔脱落细胞的DNA倍体分析技术应用于子宫内膜病变筛查的可行性及应用价值。 方法 选取2014年1月～2016年5月就诊于贵阳中医学院第二附属医院疑似子宫内膜病变患者500例为研究对象，采集子宫腔脱落细胞标本，采用Feulgen染色和全自动DNA倍体分析系统分析患者DNA倍体情况，同时行分段诊断性刮宫术检测，以分段诊断性刮宫术检测结果为金标准，观察DNA倍体分析对诊断子宫内膜病变的敏感性和特异性。 结果 分段诊断性刮宫术检测发现，子宫内膜癌39例（78.0%），癌前病变98例（19.6%），子宫内膜量增生258例（51.6%），正常子宫内膜105例（21.0%）。子宫腔脱落细胞DNA倍体分析子宫内膜癌检出率相似于病理检查，差异无统计学意义（P > 0.05）；子宫腔脱落细胞DNA倍体分析癌前病变检出率相似于病理检查，差异无统计学意义（P > 0.05）。以病理活检结果为金标准，DNA倍体分析筛查子宫内膜病变的敏感性、特异性、准确度分别为92.7%、83.8%、86.2%，DNA倍体分析筛查子宫内膜癌的敏感性、特异性、准确度分别为94.9%、67.7%、69.8%。 结论 DNA倍体分析对子宫内膜癌的筛选敏感性高，可用于子宫内膜病变的早期筛查，具有一定临床推广价值。

[关键词] 子宫腔脱落细胞；DNA倍体分析；子宫内膜病变；筛查

[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0087-05

[Abstract] Objective To investigate the feasibility and application value of DNA quantitative analysis of uterine cavity exfoliated cells in screening endometrial lesions. Methods Five hundred patients with suspected endometrial lesions from January 2014 to May 2016 in the Second Affiliated Hospital of Guiyang Traditional Chinese Medicine College were selected as the research objects， specimens of uterine cavity exfoliated cells were collected， DNA ploidy was analyzed by Feulgen staining and automatic DNA quantitative analysis system， segmented diagnostic curettage was performed at the same time， the segmented diagnostic curettage results were the gold standard， the sensitivity and specificity of DNA quantitative analysis in diagnosis of endometrial lesions was observed. Results Segmental diagnostic curettage detection showed， 39 cases of endometrial carcinoma （78.0%）， 98 cases of precancerous lesion （19.6%）， 258 cases of endometrial hyperplasia （51.6%）， 105 cases of normal endometrium （21.0%）. The detection rate of endometrial carcinoma of DNA ploidy analysis of uterine cavity exfoliated cells was similar to pathological examination， the difference was not statistically significant （P > 0.05）. DNA ploidy analysis of exfoliated uterine cavity precancerous lesions were similar to the pathological examination， the difference was not statistically significant （P > 0.05）. With the pathological biopsy results as the gold standard， the sensitivity， specificity and accuracy of endometrial lesions DNA quantitative analysis were 92.7%， 83.8% and 86.2% respectively. The sensitivity， specificity and accuracy of DNA quantitative analysis in screening endometrial cancer were 94.9%， 67.7% and 69.8% respectively. Conclusion DNA quantitative analysis of endometrial cancer has high screening sensitivity， can be used for early screening of endometrial lesions， has a certain clinical value.

[Key words] Uterine cavity exfoliated cells； Image cytometry DNA ploidy； DNA quantitative analysis； Endometrial lesions； Screening

子宫内膜癌（endometrial cancer，EC）是发生于子宫内膜的一组上皮性恶性肿瘤，其死亡率居女性恶性肿瘤第二位，严重威胁女性生命健康[1]。目前子宫内膜癌的诊断主要借助诊刮术进行组织学检查，但其操作复杂，费用高，且存在病情长期监控难、患者依从性差等问题[2]，因此亟需寻找一种质优价廉、安全无痛、简便易行、准确性高的子宫内膜病变筛查方法。脱氧……