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目的:探讨阴道镜联合HPV-DNA检测在宫颈上皮内瘤变(CIN)及人乳头瘤病毒(HPV)亚临床感染(SPI)诊断中的应用价值及临床意义。方法:将572例宫颈细胞学阳性患者随机分为两组,观察组351例均进行高危型HPV-DNA检测及阴道镜图像定位取活检,对照组221例仅做传统肉眼宫颈四点活检,对高级别的CIN及宫颈癌患者以手术后标本病检结果为最后诊断标准,对两种诊断结果进行比较分析。结果:观察组宫颈活检病理诊断阳性率52.14%,HPV阳性率41.31%,手术标本病检结果诊断符合率为100.00%,宫颈活检漏诊率为0%。对照组宫颈活检诊断阳性率为34.39%,HPV阳性率12.67%,手术标本病检结果诊断符合率为71.43%,宫颈活检漏诊率9.95%。二者在宫颈活检阳性率、HPV阳性率、诊断符合率、宫颈活检漏诊率比较差异均有统计学意义(P<0.05),在SPI中二者阳性率差异有统计学意义(P<0.05)。结论:阴道镜联合HPV-DNA检测在宫颈癌前病变,特别是在高级别宫颈上皮内瘤变及人乳头瘤病毒亚临床感染诊断中阳性预测值较理想、敏感性较好、漏诊率低,具有较高的推广价值。
Objective: To investigate the value and clinical significance of colposcopy combined with HPV-DNA in the diagnosis of cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) subclinical infection (SPI). Methods: 572 cases of cervical cytology positive patients were randomly divided into two groups, the observation group were 351 cases of high-risk HPV-DNA detection and colposcopy image biopsy, 221 cases of control group only conventional cervical macular biopsy, High-level CIN and cervical cancer patients with postoperative pathological examination results as the final diagnostic criteria, the two diagnostic results were analyzed. Results: The positive rate of cervical biopsy in the observation group was 52.14%, the positive rate of HPV was 41.31%. The coincidence rate of the pathological examination of the surgical specimens was 100.00% and the rate of cervical biopsy was 0%. The positive rate of cervical biopsy in the control group was 34.39%, the positive rate of HPV was 12.67%, the coincidence rate of pathological examination of the surgical specimens was 71.43%, and the rate of misdiagnosis of cervical biopsy was 9.95%. The positive rate of cervical biopsy, the positive rate of HPV, the coincidence rate of diagnosis and the rate of misdiagnosis of cervical biopsy showed statistical significance (P <0.05). There was a significant difference in the positive rates of cervical biopsy (P <0.05) . Conclusion: The positive predictive value of colposcopy combined with HPV-DNA in cervical precancerous lesions, especially in the high-grade cervical intraepithelial neoplasia and human papillomavirus sub-clinical infection diagnosis is better, the sensitivity is better, the rate of missed diagnosis is lower, Has a high promotional value.