汤敏 聂爱连

[摘要] 目的 探讨人乳头瘤病毒（HPV）联合液基薄层细胞学（TCT）在宫颈癌筛查中的价值。 方法 选取2018年5月至2020年5月宜春市妇幼保健院550名健康体检宫颈癌筛查妇女作为研究对象，入院后分别行HPV检查与TCT检查，将阴道镜下宫颈病理组织活检作为金标准，比较HPV、TCT单一检测与两者联合检测的应用价值。 结果 550名受检者中62例疑似宫颈癌，阴道镜病理活检结果显示42例阳性，20例阴性;联合诊断敏感度、特异度、符合率分别为95.24%、90.00%、93.55%，显著高于HPV单一检测的76.19%、35.00%、62.90%与TCT单一检测的80.95%、40.00%、67.74%，差异有统计学意义（P<0.05）。 结论 HPV联合TCT检测应用于宫颈癌筛查，操作简单，具有无创性，能够弥补单一检测的不足，敏感度、特异度高，可予以推广。

[关键词] HPV;TCT;阴道镜病理活检;宫颈癌筛查;敏感度;特异度

[中图分类号] R737.33          [文献标识码] B          [文章编号] 1673-9701（2021）32-0140-03

[Abstract] Objective To explore the value of human papillomavirus（HPV） combined with the thin prep liquid-based cytology test （TCT） in cervical cancer screening. Methods A total of 550 healthy women screened for cervical cancer in Yichun Maternal and Child Healthcare Hospital from May 2018 to May 2020 were selected as the study subjects. They underwent HPV and TCT examination after admission. Colposcopic cervical biopsy was used as the gold standard. The application value of single detection of HPV and TCT and their combination detection was compared. Results Out of the 550 subjects， 62 were suspected of cervical cancer. The results of the colposcopic biopsy showed that 42 cases were positive and 20 cases were negative. The sensitivity， specificity， and coincidence rate of combined diagnosis were 95.24%， 90.00%， and 93.55%， respectively， which were significantly higher than 76.19%， 35.00%， and 62.90% of HPV single detection and 80.95%， 40.00%， and 67.74% of TCT single detection. The difference was statistically significant （P<0.05）. Conclusion The application of HPV combined with TCT in cervical cancer screening is simple and noninvasive， making up for the lack of single detection. It has high sensitivity and specificity and can be promoted.

[Key words] HPV; TCT; Colposcopic biopsy; Cervical cancer screening; Sensitivity; Specificity

作為常见的妇科恶性肿瘤疾病，宫颈癌多发于35～55岁年龄段，其发病率随着生活方式的变化逐年攀升，且越来越趋于年轻化[1]。流行病学调查研究发现，宫颈癌与人乳头瘤病毒（Human papillomavirus，HPV）感染、性生活开始早及免疫功能缺陷等有着密不可分的联系[2]，早期无明显表现，容易被忽视，随着疾病进展会出现阴道出血，多数患者确诊后达到晚期，无法应用手术治疗，降低了预后及生存率，因此对宫颈癌的早期预防及筛查尤为重要[3]。临床筛查宫颈癌常见方法包括液基薄层细胞学（Thinprep cytologic test，TCT）、HPV及阴道镜检查等，不同筛查方式各有优缺点。目前，临床诊断宫颈癌及癌前病变金标准为阴道镜活检，其将患者宫颈放大10～40倍[4]。……