邓俊 陈燕 唐雍华

【摘要】目的：探讨HR-HPV、TCT检测联合电子阴道镜下宫颈活檢在宫颈癌前病变及宫颈癌患者中的诊断效果。方法：选择2016年12月至2020年6月期间宫颈癌前病变及宫颈癌筛查女性72例为对象，所有患者均经临床检查确诊（金标准），入院后均完成HRHPV、TCT、电子阴道镜下宫颈活检，并将不同检查结果与金标准进行比较，绘制ROC曲线，分析HR-HPV、TCT检测联合电子阴道镜下宫颈活检在宫颈癌前病变及宫颈癌患者中的诊断效能（灵敏度、特异度）。结果：所有患者均经临床检查确诊，患者中CINI 34例、CINII 20例、CINIII 13例、宫颈癌5例；HR-HPV确诊65例，诊断符合率为90.28%；TCT检查确诊83.33%；电子阴道镜下宫颈活检确诊68例，诊断率为94.44%；ROC曲线结果表明：HR-HPV、TCT检测联合电子阴道镜下宫颈活检联合检测在宫颈癌前病变及宫颈癌患者中的诊断灵敏度高于单一检测（P<0.05）；特异度低于单一检测（P<0.05）。结论：HR-HPV、TCT检测联合电子阴道镜下宫颈活检用于宫颈癌前病变及宫颈癌患者中能获得较高的检出率，患者诊断灵敏度较高，可指导临床诊疗，值得推广应用。

【关键词】HR-HPV、TCT检测；电子阴道镜下宫颈活检；宫颈癌

[中图分类号]R737.33 [文献标识码]A [文章编号]2096-5249（2021）11-0147-03

HR-HPV、 TCT detection combined with cervical biopsy under electronic colposcopy for clinical screening of cervical precancerous lesions and cervical cancer

DENG Jun， CHEN Yan， TANG Yong-hua （Department of Obstetrics and Gynecology， Nancheng Hospital， Dongguan Guangdong 523000， China）

[Abstract] Objective： To investigate the diagnostic effect of HR-HPV and TCT combined with cervical biopsy under electronic colposcopy in patients with cervical precancerous lesions and cervical cancer. Methods： Selected 72 women who were screened for cervical precancerous lesions and cervical cancer from December 2016 to June 2020 as subjects. All patients were diagnosed by clinical examination （gold standard）， and completed HR-HPV， TCT， electronic Cervical biopsy under colposcopy， compare different examination results with the gold standard， draw ROC curve， analyze the diagnostic efficacy of HR-HPV and TCT combined with electronic colposcopy in cervical precancerous lesions and cervical cancer patients （sensitivity） ， Specificity）. Results： All patients were diagnosed by clinical examination. Among the patients， 34 were CINI， 20 were CINII， 13 were CINIII， and 5 were cervical cancer； 65 were diagnosed with HR-HPV， with a diagnosis coincidence rate of 90.28%； TCT diagnosis was 83.33%； electronic Cervical biopsy under colposcopy confirmed 68 cases with a diagnosis rate of 94.44%； ROC curve results showed that the combined detection of HR-HPV and TCT combined with cervical biopsy under electronic colposcopy has higher diagnostic sensitivity in cervical precancerous lesions and cervical cancer patients Single test （P<0.05）； specificity is lower than single test （P<0.05）. Conclusion： HR-HPV， TCT detection combined with cervical biopsy under electronic colposcopy can obtain a higher detection rate in patients with cervical precancerous lesions and cervical cancer， and the diagnosis sensitivity of patients is high， which can guide clinical diagnosis and treatment and is worthy of promotion and application.

[Key words] HR-HPV， TCT detection； cervical biopsy under electronic colposcopy； cervical cancer； diagnostic accuracy；Malignant tumor； Cervical precancerous lesions； High risk human papillomavirus； The ROC curve

宮颈癌是常见的女性生殖器官恶性肿瘤之一，发病率位于乳腺癌和直肠癌之下第三位的女性恶性肿瘤。原位癌的高发年龄为30～35岁，浸润性癌的高发年龄为45～55岁，多个性伴侣、初次性生活<16岁、早年分娩、多产与宫颈癌密切相关[1]。大多数患者有阴道排液，液体为白色或血性，稀薄如水样或米泔状、有腥臭味，晚期时继发症状因癌症受累程度而异，当输尿管受压或癌变时，可能引起输尿管阻塞，由于癌组织坏死和感染，可能会有大量米泔样或化脓性恶臭白带，尿频、尿急、便秘、下肢肿痛等症状也多出现于晚期[2]。……