切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (01) : 33 -39. doi: 10.3877/cma.j.issn.1673-5250.2013.01.008

所属专题： 专题评论； 文献；

论著

广东省潮州地区农村妇女宫颈癌不同筛查方法的效果评价
李兵1, 张小庄1,*,*(), 罗喜平1, 毛玲芝1, 张佳立1, 李艺1, 谢龙旭2, 李玉辉3   
  1. 1. 511442　广州，广州医学院附属广东省妇幼保健院
    2. 广东凯普生物科技有限公司
    3. 潮州市妇幼保健院
  • 收稿日期:2012-07-11 修回日期:2012-11-18 出版日期:2013-02-01
  • 通信作者: 张小庄

Evaluation of Effectiveness of Variable Cervical Cancer Screening Methods in Rural Areas of Chaozhou City, Guangdong Province

Bing LI1, Xiao-zhuang ZHANG1(), Xi-ping LUO1, Ling-zhi MAO1, Jia-li ZHANG1, Yi LI1, Long-xu XIE2, Yu-hui LI3   

  1. 1. Department of Gynecology and Obstetrics, Guangdong Women and Children Hospital, Guangzhou 511442, Guangdong Province, China
  • Received:2012-07-11 Revised:2012-11-18 Published:2013-02-01
  • Corresponding author: Xiao-zhuang ZHANG
  • About author:
    Corresponding author: ZHANG Xiao-zhuang, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李兵, 张小庄, 罗喜平, 毛玲芝, 张佳立, 李艺, 谢龙旭, 李玉辉. 广东省潮州地区农村妇女宫颈癌不同筛查方法的效果评价[J]. 中华妇幼临床医学杂志(电子版), 2013, 09(01): 33-39.

Bing LI, Xiao-zhuang ZHANG, Xi-ping LUO, Ling-zhi MAO, Jia-li ZHANG, Yi LI, Long-xu XIE, Yu-hui LI. Evaluation of Effectiveness of Variable Cervical Cancer Screening Methods in Rural Areas of Chaozhou City, Guangdong Province[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2013, 09(01): 33-39.

目的

探讨对广东省潮州地区农村妇女采用高危型人乳头状瘤病毒(HPV)感染、液基细胞学(LBC)和传统巴氏涂片(CPS)筛查法进行宫颈癌筛查的效果，为建立适宜农村地区妇女的宫颈癌筛查策略提供依据。

方法

选择2011年3月至6月，采用分阶段整群抽样法在潮州地区5个乡镇招募的3723例35～59岁符合筛查条件的农村常住妇女为研究对象(子宫颈完整存在)。对其同时采用高危型HPV，LBC和CPS筛查法进行宫颈癌筛查，并对其中HPV呈阳性者进行HPV分型。对宫颈细胞学改变为低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、HPV呈阳性的未明确诊断意义的不典型鳞状上皮细胞(ASC-US)、非典型鳞状细胞、不能排除高级别鳞状上皮内病变(ASC-H)的受试者，进行阴道镜下宫颈组织活检及随访，评价不同筛查法的筛查效果(本研究遵循的程序符合广东省妇幼保健院人体试验委员会所制定的伦理学标准，得到该委员会批准，并与受试者签署临床研究知情同意书)。

结果

3723例接受宫颈癌筛查的受试者中，高危型HPV感染率为8.2%，常见HPV亚型为HPV-52，-16，-58，-33及-68；宫颈上皮内瘤变(CIN)Ⅰ～Ⅲ检出率分别为1.05%(39/3723)，0.40%(15/3723)和0.54%(20/3723)。若以宫颈组织病理学活检结果≥CINⅡ为标准，则高危型HPV，LBC和CPS筛查法的灵敏度与特异度分别为94.4%(34/36)与46.6%(27/58)，97.2%(35/36)与25.9%(15/58)及52.9%(9/17)与38.0%(19/50)。3种宫颈癌筛查方法的灵敏度与特异度比较，差异均有统计学意义(P<0.05)。LBC与CPS对宫颈癌筛查的阳性预测值(PPV)分别为44.9%(35/78)与22.5%(9/40)，且差异具有统计学意义(χ2＝5.7，P＝0.02)。

结论

在广东省潮州地区农村妇女中开展宫颈癌筛查发现，高危型HPV检测法相对于LBC，具有更高灵敏度和特异度，在成本许可条件下具有一定推广价值；而LBC相对于CPS，具有更高灵敏度、PPV和更好的制片效果。

关键词: 宫颈癌筛查, 人乳头瘤病毒, 液基细胞学, 传统巴氏涂片
Objective

To evaluate the effectiveness of high-risk human papilloma virus( HPV) strains testing, liquid based cytology (LBC), and conventional Pap smear (CPS) in rural areas of Chaozhou city, Guangdong Province, China.

Methods

A stratified, multistage cluster sampling method was used to collect samples from 5 selected villages in rural areas of Chaozhou city from March to June, 2011. Recruitment of 3723 women aged 35-59 (cervical integrated exist) were done vialocal television advertisements and flyers, as well as notifications by the healthcare professionals. All participants accepted variable cervical cancer screening methods at the same time such as high-risk HPV strains testing using PCR kit, LBC, and CPS, and who were found positive for the high-risk HPV types further underwent HPV genotyping, while samples with abnormal cervical cytology such as low-grade intraepithelial lesion(LSIL), high-grade intraepithelial lesion (HSIL), atypical squamous cells of undetermined signification (ASC-US) with high-risk HPV positive were further followed up with histological examination and analysis, and finally evaluated the effectiveness of variable cervical cancer screening methods which was the best. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Guangdong Women and Children Hospital. Informed consent was obtained from all participants.

Results

Among 3723 women participated in the study, 8.2% of the women were infected by the high-risk HPV. The popular high-risk HPV types in this study were HPV-52, -16, -58, -33, and -68. CIN Ⅰ-Ⅲ were 1.05%(39/3723), 0.40%(15/3723) and 0.54%(20/3723), respectively. Based on the abnormal standard of cervical pathology with CINⅡ lesions or above, the sensitivity of high-risk HPV types testing, LBC and CPS were 94.4% (34/36), 97.2% (35/36) and 52.9% (9/17), while the specificity were 46.6% (27/58), 25.9% (15/58) and 38.0% (19/50), respectively, and there had significance difference(P<0.05) in sensitivity and specificity among three methods.There had significance difference (χ2=5.7, P=0.02) in positive predictive value(PPV) between LBC and CPS [44.9% (35/78) vs.22.5% (9/40)], too.

Conclusions

Cervical cancer screening in rural areas of Chaozhou city, Guangdong Province, high-risk HPV types testing had shown a higher sensitivity and specificity than those of cervical cytology methods, it was worth to practice under a acceptable cost. Compared to CPS and LBC, high-risk HPV types testing had shown a greater sensitivity and PPV, and had a better and clearer slide background.

Key words: cervical cancer screening, human papilloma virus, liquid based cytology, conventional Pap smear
表1 3723例受试者中不同亚型人乳头状瘤病毒感染的感染频次分布情况 [n(%)]
Table 1 Distribution of different detected HPV types among 3723 cases subjects [n(%)]
HPV type Rate of infection HPV type Rate of infection
-52 92(2.47) -59 10(0.27)
-16 60(1.61) -66 9(0.24)
-58 40(1.07) -56 7(0.19)
-33 34(0.91) -51 6(0.16)
-68 30(0.81) -39 5(0.13)
-18 22(0.59) -11 4(0.11)
-CP8304 18(0.48) -35 2(0.05)
-31 13(0.35) -44 2(0.05)
-53 12(0.32) -42 1(0.03)
表2 3723例受试者的宫颈细胞学改变与高危型人乳头状瘤病毒感染的关系[n(%)]
Table 2 Relation between cervical cytology changes and high risk HPV types infected among 3723 cases subjects [n(%)]
Cervical cytology n High risk HPV type
Positive Negative
HSIL 20 20(100.0) 0 (0.0)
LSIL 53 24 (45.3) 29(54.7)
ASC-US or ASC-H 229 21 (9.2) 208(90.8)
Non-neoplastic cervicalabnormality 3389 239 (7.1) 3150(92.9)
Normal 32 2 (6.3) 30(93.8)
Total 3723 306 (8.2) 3417(91.8)
表3 本组94例接受组织病理学活检受试者的高危型人乳头状瘤病毒感染与宫颈细胞学改变及病理改变的关系[n(%)]
Table 3 Relationship among high risk HPV infection, cervical cytology and pathology changes in 94 cases subjects [n(%)]
High risk HPV type Cervical cytology results n Grade in cyto-pathology
CINⅠ CINⅡ CINⅢ SCC Cervical inflammation
Positive HSIL 20 2(10.0) 7(35.0) 10(50.0) 1(5.0) 0 (0.0)
? LSIL 24 11(45.8) 4(16.7) 7(29.2) 0(0.0) 2 (8.3)
? ASC 21 11(52.4) 3(14.3) 2 (9.5) 0(0.0) 5(23.8)
? Total 65 24(36.9) 14(21.5) 19(29.2) 1(1.5) 7(10.8)
Negative LSIL 29 15(51.7) 1 (3.4) 1 (3.4) 0(0.0) 12(41.4)
? Total 29 15(51.7) 1 (3.4) 1 (3.4) 0(0.0) 12(41.4)
Total ? 94 39(41.5) 15(16.0) 20(21.3) 1(1.1) 19(20.2)
表4 94例接受组织病理学活检受试者的宫颈液基细胞学与巴氏涂片检测的细胞学改变与病理学改变的关系[n(%)]
Table 4 Relationship between cervical pathology with liquid-based cytology and conventional Pap test among 94 cases subjects [n(%)]
Cervical cytology test n Grade in cyto-pathology
CINⅠ CINⅡ CINⅢ SCC Cervical inflammation
Liquid-based cytology ? ? ? ? ? ?
? HSIL 19 2(10.5) 6(31.6) 10(52.6) 1(5.3) 0 (0.0)
? LSIL 44 20(45.5) 5(11.4) 8(18.2) 0(0.0) 11(25.0)
? ASC-US or ASC-H 15 7(46.7) 3(20.0) 2(13.3) 0(0.0) 3(20.0)
Non-neoplastic cervical abnormalityor normal 16 10(62.5) 1 (6.3) 0 (0.0) 0(0.0) 5(31.3)
Conventional Pap test ? ? ? ? ? ?
? HSIL 5 1(20.0) 4(80.0) 0 (0.0) 0(0.0) 0 (0.0)
? LSIL 25 15(60.0) 1 (4.0) 3(12.0) 0(0.0) 6(24.0)
? ASC-US or ASC-H 10 6(60.0) 0 (0.0) 1(10.0) 0(0.0) 3(30.0)
Non-neoplastic cervical abnormalityor normal 27 12(44.4) 4(14.8) 4(14.8) 0(0.0) 7(25.9)
Unsatisfied smear slide 27 5(18.5) 6(22.2) 12(44.4) 1(3.7) 3(11.1)
Total 94 39(41.5) 15(16.0) 20(21.3) 1(1.1) 19(20.2)
表5 3723例受试者巴氏涂片检测和液基细胞学检测相关性分析 [n(%)]
Table 5 Comparison between liquid-based cytology and conventional Pap test among 3723 cases subjects [n(%)]
Liquid-based cytology n Conventional Pap Smear
ASC-US ASC-H LSIL HSIL Non-neoplastic cervical abnormality Normal Unsatisfied smear slide
ASC-US 144 17(11.8) 0(0.0) 1 (0.7) 0 (0.0) 111(77.1) 1 (0.7) 14 (9.7)
ASC-H 2 0 (0.0) 0(0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 2(100.0)
LSIL 44 3 (6.8) 0(0.0) 16(36.4) 0 (0.0) 19(43.2) 0 (0.0) 6 (13.6)
HSIL 19 1 (5.3) 0(0.0) 0 (0.0) 4(21.1) 2(10.5) 0 (0.0) 12 (63.2)
Non-neoplastic cervical abnormality 3248 79 (2.4) 1(0.0) 8 (0.2) 1 (0.0) 2962(91.2) 75 (2.3) 122 (3.8)
Normal 219 3 (1.4) 0(0.0) 1 (0.5) 0 (0.0) 184(84.0) 26(11.9) 5 (2.3)
Unsatisfied smear slide 47 0 (0.0) 0(0.0) 0 (0.0) 0 (0.0) 46(97.9) 1 (2.1) 0 (0.0)
Total 3723 103 (2.8) 1(0.0) 26 (0.7) 5 (0.1) 3324(89.3) 103 (2.8) 161 (4.3)
[1]
Wang LH, Qiu X, Zheng RM, et al. Review and prospection of epidemiology and preventive and treatment strategy of cervix cancer in china[J]. Chin J Women Child Health，2010，1(3):145-149.
[2]
Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: A review of current American Cancer Society guidelines and issues in cancer screening[J]. CA Cancer J Clin, 2009，59:27-41.
[3]
Grce M．Primary and secondary prevention of cervical cancer[J]. Exp Rev Mol Diagn, 2009，9:851-857.
[4]
Meng RL, Ma WJ, Xu YJ, et al.The analysis of relative factors of the rate of women breast and cervix cancer screening in Guangdong province，south China[J]. J Prevent Med, 2010, 36(2):8-10, 14.
[5]
Sherris J, Wittet S, Kleine A, et al. Evidence-based, alternative cervical cancer screening approaches in low-resource settings[J]. Int Perspect Sexual Reprod Health，2009, 35(3):Special report.
[6]
Ye J, Cheng XD, Chen XJ, et al. Prevalence and risk profile of cervical human papillomavirus infection in Zhejiang province, southeast China: A population-based study[J]. Virol J, 2010，7:66.
[7]
Lippman SA, Sucupira MC, Jones HE, et al. Prevalence, distribution and correlates of endocervical human papillomavirus types in Brazilian women[J]. Int J STD AIDS，2010，21(2):105-109.
[8]
Rossi PG, Bisanzi S, Paganini I, et al. Prevalence of HPV high and low risk types in cervical samples from the Italian general population: A population based study[J]. BMC Infect Dis，2010, 10:214.
[9]
Confortini M, Carozzi F, Zappa M, et al. Rhesueamrch aartnicl epapilloma virus infection and risk factors in a cohort of Tuscan women aged 18-24: Results at recruitment[J]. BMC Infect Dis，2010, 10:157.
[10]
Lin M, Yang LY, Li LJ, et al. Genital human papillomavirus screening by gene chip in Chinese women of Guangdong province[J]. Aust N Z J Obstet Gynaecol, 2008, 48(2):189-194.
[11]
Insinga RP, Liaw KL, Johnson LG, et al. A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal and vulvar precancers and cancers in the United States[J]. Cancer Epidemiol Biomarkers Prev, 2008，17(7):1611-1622.
[12]
Mariani L, Monfulleda N, Alemany L, et al. Human papilloma virus prevalence and type-specific relative contribution in invasive cervical cancer specimens from Italy[J]. BMC Infect Dis，2010, 10:214.
[13]
Uusküla A, Kals M, Kosenkranius L, et al. Population-based type-specific prevalence of high-risk human papillomavirus infection in Estonia[J]. BMC Infect Dis，2010, 10:63.
[14]
Smith RA, Cokkinides V, Brooks D, et al. Cancer screening in the United States, 2010: A review of current American Cancer Society guidelines and issues in cancer screening[J]. CA Cancer J Clin，2010，60:99-119.
[15]
Haverkos HW. Multifactorial etiology of cervical cancer: A hypothesis[J]. Med Gen Med. 2005, 7(4):57.
[16]
Ronco G, Cuzick J, Pierotti P, et al. Accuracy of liquid based versus conventional cytology: Overall results of new technologies for cervical cancer screening randomised controlled trial[J]. BMJ, 2007，10:1136.
[17]
Ogilvie GS, van Niekerk DJ, Krajden M, et al. A randomized controlled trial of human papillomavirus (HPV) testing for cervical cancer screening: Trial design and preliminary results (HPV focal trial)[J]. BMC Cancer，2010, 10:111.
[18]
Gravitt PE, Paul P, Katki HA, et al. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India[J]. PLoS ONE，2010，5(10):e13711.
[19]
Dahlstrom LA, Ylitalo N, Sundstrom K, et al. Prospective study of human papillomavirus and risk of cervical adenocarcinoma[J]. Int J Cancer，2010，127(8):1923-1930.
[20]
Siebers AG, Klinkhamer PM, Grefte JM, et al. Comparison of liquid-based cytology with conventional cytology for detection of cervical cancer precursors[J]. JAMA，2009，302(16):1757-1764.
[21]
Suh DH, Kim JW, Aziz MF, et al. Asian Society of Gynecologic Oncology Workshop 2010[J]. J Gynecol Oncol, 2010，21(3):137-150.
[22]
Gok M, Heideman DA, van Kemenade FJ, et al. HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: Cohort study[J]. BMJ，2010，340:c1040.
[23]
McAdam M, Sakita J, Tarivonda L, et al. Evaluation of a cervical cancer screening program based on HPV testing and LLETZ excision in a low resource setting[J]. PLoS ONE，2010，5(10):e13266.
[1] 卫怡妙, 李亚芹, 赵卫红. 环状RNA与宫颈癌发病机制的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 512-516.
[2] 杨春, 陈悦悦, 周琳, 张丹. 阴道微环境失衡与高危型人乳头瘤病毒持续感染[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(06): 740-744.
[3] 薛钰, 吴丹, 李柱南, 张峥嵘, 林婧, 许颖, 熊振虹, 曹丹. CO2激光治疗宫颈上皮内瘤变和阴道上皮内瘤变临床疗效[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(04): 483-491.
[4] 陈锐, 冯凌, 付艳, 王黎明, 谭洁, 廖秦平. 派特灵治疗宫颈病变术后高危型人乳头瘤病毒持续呈阳性的临床研究[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(04): 438-443.
[5] 王文豪, 王卉, 郝敏. 宫颈癌与叶酸相关信号通路的研究进展[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(02): 245-248.
[6] 孙笑非, 顾依群, 王爱春, 王荔, 孟凡凡, 王军, 卢利娟. 细胞块p16/Ki-67双染对子宫颈炎患者宫颈上皮内瘤变的诊断价值[J]. 中华实验和临床感染病杂志(电子版), 2022, 16(06): 418-425.
[7] 余娟平, 魏琦, 王倩倩, 常中宝, 叶红, 徐庆华, 李晓华. 安徽地区17 160例健康体检女性人乳头瘤病毒感染状况及基因分型[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(05): 389-395.
[8] 李沐宸, 温星桥. 前列腺癌与微生物的联系[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(02): 188-192.
[9] 李秘, 邱华娟, 纪燕琴, 周明辉. P16、Ki67表达及病毒载量对宫颈上皮内瘤变Ⅱ合并高危型人乳头瘤病毒感染患者病变转归的影响[J]. 中华临床医师杂志(电子版), 2023, 17(03): 272-278.
[10] 朱琳琳, 赵帆, 闫琳琳, 郑凤芝, 王静, 胡守奎. 北京京西地区女性高危型HPV感染状况及基因型分析[J]. 中华临床医师杂志(电子版), 2022, 16(09): 897-901.
[11] 陈学敬, 周立娟, 杜伟丽, 李琨, 车南颖. 细胞DNA定量分析技术在肺癌诊断中的应用价值[J]. 中华临床医师杂志(电子版), 2021, 15(05): 331-334.
[12] 杨旭梅, 金蓉蓉, 周慧玲, 蒋小芹, 于鸿. HPV疫苗研究进展及推广接种过程中的影响因素[J]. 中华临床医师杂志(电子版), 2021, 15(03): 218-223.
[13] 孔蕊, 姚群, 吴晓博, 张小红, 范颖. 高危型人乳头状瘤病毒感染类型及载量与子宫颈癌前病变严重程度及病变范围的相关性[J]. 中华临床医师杂志(电子版), 2020, 14(05): 376-379.
[14] 秦毓, 杨苗, 畅锴, 王舒宁. 山西省女性人乳头瘤病毒感染现状分析[J]. 中华临床实验室管理电子杂志, 2023, 11(02): 105-108.
[15] 尹嫚, 杨林青, 王云飞. 女性生殖道同期发生的黏液上皮化生和肿瘤的诊断学特征并文献复习[J]. 中华诊断学电子杂志, 2022, 10(03): 193-196.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号