标题：HPV基因分型联合TCT检测在适龄女性宫颈病变筛查中的应用

      作者：张颖，张静，刘丽益，龙敏，邓茜    张颖，张静，刘丽益，龙敏，邓茜深圳市南山区妇幼保健院病理科，广东 深圳 518067

      卷次： 2023年34卷9期

      【摘要】 目的 观察人乳头瘤病毒(HPV)基因分型检测联合宫颈液基细胞学(TCT)检查在深圳市南山区适龄女性宫颈病变筛查中的应用效果。方法 收集 2018年 3月至 2020年 2月深圳市南山区妇幼保健院 72 143例行HPV检测的适龄女性相关资料，记录HPV感染阳性率及HPV分型分布情况、不同年龄层HPV感染阳性率情况；其中 1 169例适龄女性经阴道镜组织学活检确诊，记录不同宫颈病变者HPV基因分型分布及TCT检测情况，分析HPV分型、TCT及其联合检测对宫颈病变的诊断价值。结果 72 143例适龄女性中7 443例HPV阳性(10.32%)，其中5 524例为单一感染(74.22%)，以 52型(20.13%)、53型(7.75%)、16型(7.31%)、58型(7.08%)、51型(5.72%)、68型(5.20%)等高危型HPV分型居多，低危型HPV仅1例(0.01%) 43型；1 919例(25.78%)为多重感染，其中高危型HPV感染最多的分型为52型、53型、58型、16型、51型、68型，低危型HPV感染最多的分型为81型、42型、43型。7 443例HPV阳性者以20~60岁居多，>60岁者较少，<20岁者最少。不同宫颈病变者均检出高危型HPV感染，不同宫颈病变者TCT阳性率比较差异有统计学意义(P<0.05)，其中CINⅠ~Ⅲ病变TCT阳性率明显高于宫颈组织正常者，差异有统计学意义(P<0.05)。Kappa一致性检验显示，高危型HPV阳性、TCT阳性及其联合检测对宫颈癌的诊断价值不高(P>0.05)。结论 深圳市南山区HPV感染的适龄女性以52型、53型等高危型HPV感染为主，可为宫颈病变防控提供一定指导意见，但本研究尚未发现HPV分型检测联合TCT的诊断价值，仍需在后续研究中深入探讨。
      【关键词】 人乳头瘤病毒；分型；宫颈液基细胞学；适龄女性；宫颈；病变
      【中图分类号】 R711.74 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1272—04

Application of human papillomavirus genotyping detection combined with Thinprep cytology test in the screeningof cervical lesions in women of child-bearing age.
ZHANG Ying, ZHANG Jing, LIU Li-yi, LONG Min, DENG Xi.Department of Pathology, Shenzhen Nanshan Maternal and Child Health Hospital, Shenzhen 518067, Guangdong, CHINA
【Abstract】 Objective To observe the application effects of human papillomavirus (HPV) genotyping detectioncombined with Thinprep cytology test (TCT) in the screening of cervical lesions in women of child-bearing age in Nan-shan District of Shenzhen. Methods The relevant data of 72 143 women of child-bearing age who underwent HPV de-tection in Shenzhen Nanshan Maternal and Child Health Hospital were collected between March 2018 and February2020, and the positive rate of HPV infection, the distribution of HPV typing, and positive rate of HPV infection in dif-ferent age groups were recorded. Among the 72 143 women, 1 169 were diagnosed with HPV by colposcopy-directedbiopsy. The HPV genotype distribution and TCT detection status were recorded among patients with different cervicallesions, and the diagnostic value of HPV typing, TCT, and their combined detection on cervical lesions was analyzed.Results There were 7 443 HPV-positive cases (10.32%) among 72 143 women of child-bearing age. Among them,5 524 cases were with single infection (74.22%), most of which were high-risk HPV types [type 52 (20.13%), type53 (7.75%), type 16 (7.31%), type 58 (7.08%), type 51 (5.72%), and type 68 (5.20%)], and only 1 was low-risk HPV type(0.01%, type 43). A total of 1 919 cases (25.78%) were with multiple infections, and main high-risk types of HPV infec-tion were type 52, type 53, type 58, type 16, type 51, and type 68, and main low-risk types of HPV infection were type 81,type 42, and type 43. Among 7 443 HPV-positive patients, most of them were 20-60 years old, few were>60 years old,and the least were<20 years old. High-risk HPV infection was detected among patients with different cervical lesions,and there was a statistically significant difference in the positive rate of TCT among patients with different cervical le-sions (P<0.05), and the positive rate of TCT in CINⅠ-Ⅲ lesions was higher than that in normal cervical tissues (P<0.05). Kappa consistency test showed that the diagnostic value of high-risk positive HPV, positive TCT or their com-bined detection on cervical cancer was not ideal (P>0.05). Conclusion HPV infection types in women of child-bearingage in Nanshan District of Shenzhen are mainly type 52 and type 53 high-risk HPV infections, and the study can providecertain guidance for the prevention and control of cervical lesions. However, this study has not yet found the diagnosticvalue of HPV typing detection combined with TCT. It is necessary to discuss in depth in follow-up research.
      【Key words】 Human papillomavirus; Typing; Thinprep cytology test; Women of child-bearing age; Cervix; Lesions