DNA非整倍体定量检测在中老年妇女宫颈病变诊治中的临床价值

Lifeng Wang, Yunheng Zhu, Xiuxiang Zhu
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摘要

目的探讨DNA非整倍体定量检测在中老年妇女宫颈病变诊断和治疗中的临床价值。方法对1404例接受宫颈早期病变筛查的中老年妇女进行回顾性分析。患者分为40 ~ 49岁组(n=897)和50 ~ 78岁组(n=507)。采用DNA倍体分析筛查宫颈病变,并与液基细胞学、阴道镜检查和高危人乳头瘤病毒(HPV)筛查结果进行比较。结果HPV DNA倍体分析阳性检出率为54.4%(764/1 404)。1 404例患者中,HPV16/18型感染占21.3%(299/1 404)。异倍体细胞检出率为50.92%(715/1 404)。HPV感染类型与宫颈上皮细胞倍体变化呈正相关(r=870, P=0.001)。HPV液基细胞学检出率为45.08%,低于DNA非整倍体检出率(χ2=9.594, P=0.002)。DNA非整倍体患者低级别鳞状上皮内病变(LSIL)、高级别鳞状上皮内病变(HSIL)及以上类别病变的发生率差异均有统计学意义(χ2=289.598, P=0.000)。40-49岁组与50-78岁组在DNA倍体细胞异常发生率、HPV感染率、LSIL、HSIL及以上类别病变比例等方面差异均有统计学意义(P<0.05)。结论与常规细胞学检测相比,DNA非整倍体定量检测具有更高的灵敏度和更好的特异性,与高危HPV检测无显著差异。可作为中老年妇女,特别是HPV高危感染人群宫颈病变筛查的方法之一。关键词:DNA非整倍体;子宫颈肿瘤;乳头瘤病毒感染
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Clinical value of quantitative detection of DNA aneuploidy in the diagnosis and treatment of cervical lesions in middle-aged and senile women
Objective To investigate the clinical value of quantitative detection of DNA aneuploidy in the diagnosis and treatment of cervical lesions in middle-aged and senile women. Methods A total of 1 404 middle-aged and elderly women who underwent screening for early cervical lesions were retrospectively studied.Patients were divided into the two groups: the 40-49 years old group(n=897)and the 50-78 years old group(n=507). Cervical lesions were screened by DNA ploidy analysis and the results were compared with those screened by liquid-based cytology, colposcopy and high-risk human papillomavirus(HPV). Results The positive detection rate of HPV by DNA ploidy analysis was 54.4%(764/1 404). Of 1 404 patients, HPV16/18 infection accounted for 21.3%(299/1 404). The detection rate of heteroploid cells was 50.92%(715/1 404). There was a significant positive correlation between HPV infection type and cervical epithelial cell ploidy changes(r=870, P=0.001). The detection rate of HPV by liquid-based cytology was 45.08%, which was lower than that by DNA aneuploidy(χ2=9.594, P=0.002). The differences in the incidences of low-grade squamous intraepithelial lesion(LSIL)and high-grade squamous intraepithelial lesion(HSIL)and above categories of lesions were statistically significant(χ2=289.598, P=0.000)between patients with and without DNA aneuploidy.The statistically significant differences were found between the 40-49 years old group and 50-78 years old group(P<0.05)in the occurrence of abnormal DNA ploidy cells, HPV infection rate, the proportion of LSIL, HSIL and above categories of lesions. Conclusions Compared with the conventional cytology, DNA aneuploidy quantitative detection has higher sensitivity and better specificity, and has no significant difference from the high-risk HPV detection.It can be used as one of methods for screening cervical lesions in middle-aged and elderly women, especially those with high-risk HPV infection. Key words: DNA aneuploid; Uterine cervical neoplasms; Papillomavirus infections
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