刘婷婷 郑明康

[摘要] 目的 探討阴道镜联合HPV检测在诊断子宫颈肿瘤中的临床价值。 方法 回顾性分析2018年7月至2019年6月在我院就诊行阴道镜检查患者资料，将符合要求患者分为两组。对照组在行阴道镜宫颈活检前未行HPV检测，如活检结果正常不再行HPV检测，活检结果有子宫颈肿瘤的患者再行HPV检测;观察组为在HPV检测阳性后阴道镜下行宫颈活检术者。对两组患者宫颈活检情况数据进行统计分析。 结果 对照组活检阳性率为28.05%，观察组活检阳性率为35.29%，观察组活检阳性率高于对照组，差异有统计学意义（P<0.05）;阴道镜联合HPV诊断效果AUC为0.5362。各组各年龄段阴道镜活检阳性率和阴性率比较，差异有统计学意义（P<0.05）。30～50岁年龄组活检阳性率高，但癌症比例不高，>50岁组癌症比例明显高于其他年龄组（P<0.05）。在对照组中对阴道镜活检阳性的患者行HPV检测阳性率为74.68%，其中对照组中宫颈癌症患者的HPV阳性率为100.00%;阴道镜联合HPV分年龄诊断效果，<30岁AUC为0.5311，30～50岁AUC为0.5340，>50岁AUC为0.5522。 结论 阴道镜联合HPV检测能提高阴道镜的准确性，降低漏诊率。对于HPV感染患者，能较好地指导患者日后的随诊，可对高危患者实现及时有效的早期筛查及诊断，较好地预防和治疗宫颈肿瘤。

[关键词] 宫颈肿瘤;人乳头瘤病毒检测;阴道镜;宫颈活检

[中图分类号] R737.33          [文献标识码] A          [文章编号] 1673-9701（2021）09-0030-04

The clinical value of colposcopy combined with human papillomavirus detection in the diagnosis of cervical neoplasms

LIU Tingting   ZHENG Mingkang

Department of Gynecology， Zhuhai Maternal and Child Health Hospital in Guangdong Province， Zhuhai  519000， China

[Abstract] Objective To explore the clinical value of colposcopy combined with HPV detection in the diagnosis of cervical tumors. Methods The data of patients who underwent colposcopy in our hospital from July 2018 to June 2019 were retrospectively analyzed. The eligible patients were divided into two groups. The control group did not undergo HPV testing before colposcopy cervical biopsy. If the biopsy results were normal， HPV testing would not be performed. Patients with cervical tumors in the biopsy results would be tested for HPV. The observation group underwent cervical colposcopy biopsy after the HPV test was positive. The two groups of cervical biopsy data were statistically analyzed. Results The biopsy′s positive rate was 28.05% in the control group and 35.29% in the observation group. The positive rate of biopsy in the observation group was higher than that in the control group（P<0.05）. The AUC for the diagnosis of colposcopy combined with HPV detection was 0.5362. The positive rate and negative rate of colposcopy biopsy in each age group were significantly different（P<0.05）. The positive rate of biopsy in the 30-50 age group was high， but the proportion of cancer was not high. The proportion of cancer in the group >50 years old was significantly higher than in other age groups（P<0.05）. In the control group， the positive rate of HPV test for patients with positive colposcopy biopsy was 74.68%， and the positive rate of HPV detection in patients with cervical cancer in the control group was 100.00%. The AUC for the <30 age was 0.5311. The AUC for the 30-50 age was 0.5340. And the AUC for the >50 age group was 0.5522. Conclusion Colposcopy combined with HPV detection can greatly improve the accuracy of colposcopy and reduce the missed diagnosis rate. For patients with HPV infection， it can better guide the follow-up of patients in the future， realize timely and effective early screening and diagnosis for high-risk patients， and can better prevent and treat cervical tumors.

[Key words] Cervical neoplasms; Human papillomavirus detection; Colposcopy; Cervical biopsy

子宫颈肿瘤分为良性肿瘤和恶性肿瘤。良性肿瘤主要指子宫颈鳞状上皮内病变（Cervical squamous intraepithelial lesion，SIL）。宫颈恶性肿瘤是女性生殖系统三大恶性肿瘤之一，近年来以全世界每年47万人的发病人数增长，每年死亡人数高达21万，并呈年轻化趋势[1]。有研究证明[2-3]，子宫颈肿瘤与人乳头瘤病毒（Human papilloma virus，HPV）感染密切相关，HPV分为高危型人乳头瘤病毒（High-risk human papilloma virus，HR-HPV）和低危型人乳头瘤病毒（Low-risk human papilloma virus，LR-HPV）。从HPV感染进展至SIL（子宫颈癌前病变），再进而发展至子宫颈癌需要经过一个较长的过程。90%以上的子宫颈恶性肿瘤患者有HPV感染[4]，对适龄妇女进行筛查及时发现SIL能有效降低宫颈恶性肿瘤发病率[5]。……