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目的分析人乳头瘤病毒(HPV)检测在宫颈病变诊断和治疗中的临床价值。方法选择2015年1月-2016年1月在台州医院妇产科就诊的486例30岁以上宫颈病变患者作为研究对象,所有患者均因出现宫颈不适及症状就诊,按照2013年美国妇产科医师学会(ACOG)关于《异常宫颈癌筛查结果和宫颈癌前病变的处理》建议的程序对486例患者进行诊断及治疗。所有患者均根据细胞学、组织学、多点活检等检测结果诊断,按照确诊结果将患者分为宫颈炎组(215例)、宫颈癌前病变组(158例)、宫颈癌组(113例),所有患者均行HPV检测并按照ACOG规则进行治疗和随访。比较3组患者就诊时HPV检出阳性情况、高危型HPV检出情况,完成治疗疗程后HPV检出阳性情况、高危HPV检出情况并比较。结果 3组患者入组前年龄、产次、性生活频率比较差异均无统计学意义(均P>0.05),宫颈癌组患者阴道不规则流血、白带带血率明显高于宫颈炎和宫颈癌前病变组患者,宫颈炎组患者小腹胀痛率明显高于宫颈癌前病变组和宫颈癌组患者,经比较差异有统计学意义(P<0.05),其他临床症状比较差异无统计学意义(P>0.05)。入组时3组患者HPV阳性率比较差异无统计学意义(P>0.05),但高危型HPV阳性率比较,宫颈癌组检出率最高,其次为宫颈癌前病变组,宫颈炎组最低,组间比较差异均有统计学意义(均P<0.05),高危型HPV的构成比较,3组差异无统计学意义(P>0.05)。3组患者完成治疗周期后,HPV阳性率和高危的HPV阳性率均较治疗前明显下降(P<0.05),但宫颈炎组和宫颈癌前病变组HPV阳性率明显低于宫颈癌组,差异有统计学意义(P<0.05);宫颈炎组的HPV检出率和高危HPV检出率均明显低于宫颈癌前病变组和宫颈癌组,差异有统计学意义(P<0.05),高危型HPV构成比比较差异无统计学意义(P>0.05)。结论高危型HPV检测在30岁以上女性宫颈病变的诊断和治疗预后中具有较高的指导意义。
Objective To analyze the clinical value of human papillomavirus (HPV) detection in the diagnosis and treatment of cervical lesions. Methods From January 2015 to January 2016, 486 cervical lesions over the age of 30 were treated in Department of Obstetrics and Gynecology of Taizhou Hospital. All patients were treated with cervical discomfort and symptoms. According to the American obstetrician The ACOG’s recommended procedure for “Treatment of abnormal cervical cancer screening and precancerous lesions of the cervix” was to diagnose and treat 486 patients. All patients were diagnosed according to the results of cytology, histology and multi-point biopsy. The patients were divided into cervicitis group (215 cases), cervical precancerous lesions group (158 cases), cervical cancer group (113 cases) , All patients underwent HPV testing and follow the ACOG rules for treatment and follow-up. Comparison of 3 groups of patients at the time of diagnosis of HPV positive, high-risk HPV detection, after completion of treatment of HPV positive detection, high-risk HPV detection and comparison. Results There was no significant difference in age, parity and sex life before enrollment among the three groups (all P> 0.05). In the cervical cancer group, vaginal irregular blood flow and leucorrhea rate were significantly higher than those of cervicitis and cervical cancer The incidences of abdominal distension and pain in patients with cervicitis and cervicitis were significantly higher than those in patients with cervical precancerous lesions and cervical cancer (P <0.05). There was no significant difference in other clinical symptoms (P < P> 0.05). There was no significant difference in the positive rate of HPV between the three groups (P> 0.05). However, the positive rate of high-risk HPV was the highest in cervical cancer group, followed by cervical precancerous lesion group and cervicitis group, There was significant difference between the two groups (all P <0.05). There was no significant difference in the constitution of high risk HPV between the three groups (P> 0.05). The HPV positive rate and high-risk HPV positive rate of three groups of patients after treatment cycle were significantly lower than those before treatment (P <0.05), but the positive rate of HPV in cervicitis group and cervical precancerous lesions group was significantly lower than that in cervical cancer group (P <0.05). The detection rate of HPV and high-risk HPV in cervicitis group were significantly lower than those in cervical precancerous lesions group and cervical cancer group (P <0.05), and high risk HPV type constitutional difference was not statistically significant (P> 0.05). Conclusion The high-risk HPV test has high guiding significance in the diagnosis and prognosis of cervical lesions in women aged over 30 years.