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目的探讨单次人乳头状瘤病毒(human papillomavirus,HPV)DNA分型检测对意义未明的不典型鳞状细胞(atypical squamous cells of undetermined significance,ASCUS)分层处理的价值。方法对同时行HPV-DNA分型检测及宫颈细胞学检查确诊的ASCUS患者804例行阴道镜检查及镜下多点活检,分析HPV感染与宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)2及以上级别病变(CIN2+)的关系。结果 804例ASCUS患者高危型HPV感染460例(57.2%),高危型HPV阳性检出CIN2+的敏感性为90.9%(190/209),特异性为54.6%(325/595);高危HPV阳性者CIN2+检出率(41.3%)明显高于高危HPV阴性者(5.5%)(P<0.05);高危型HPV感染患者中16/18型阳性者CIN2+检出率(63.2%)明显高于其他高危型阳性组(29.3%)(P<0.01);HPV多重感染者CIN2+检出率(54.2%)明显高于HPV单一感染者(41.5%)(P<0.05)。结论单次HPV-DNA分型检测在ASCUS分层处理中有重要意义,HPV-DNA分型检测高危型HPV阳性尤其是16/18型阳性及多重感染的ASCUS患者需行阴道镜检查。
Objective To investigate the value of single genotyping of human papillomavirus (HPV) DNA in the stratification of atypical squamous cells of undetermined significance (ASCUS). Methods Eighty-four patients with ASCUS diagnosed simultaneously by HPV-DNA typing and cervical cytology were examined by colposcopy and microscopic multipoint biopsy. The correlation between HPV infection and cervical intraepithelial neoplasia (CIN) 2 and The above level of lesions (CIN2 +) relationship. Results High-risk HPV infection was found in 460 cases (57.2%) of 804 ASCUS patients. The positive rate of HPV infection in high-risk HPV was 90.9% (190/209) and the specificity was 54.6% (325/595) The detection rate of CIN2 + was significantly higher in CIN2 + patients (41.3%) than in those with high risk of HPV (5.5%) (P <0.05). The positive rate of CIN2 + in patients with high-risk HPV infection was 63.2% (29.3%) (P <0.01). The detection rate of CIN2 + was significantly higher in patients with multiple HPV infection (54.2%) than in patients with HPV infection alone (41.5%, P <0.05). Conclusion Single HPV-DNA typing is of great importance in the stratification of ASCUS. HPV-DNA typing of high-risk HPV-positive patients, especially those with positive and multiple infections of type 16/18, should be colposcopy.