目的 了解农村地区妇女和医务人员对宫颈癌及宫颈癌筛查的认知和评价,分析宫颈癌筛查在实施中的现实问题,为进一步提高宫颈癌筛查项目提供科学依据.方法 采用横断面调查方法,对筛查妇女和医务人员进行关于宫颈癌以及筛查的认知和评价的问卷调查.结果 共调查2292名妇女和14名医务人员,其中1988名妇女(87.3％)听说过宫颈癌,但仅有228名(10.0％)知道HPV是宫颈癌的主要病因,认知度与年龄、文化程度、职业、经济条件有关(P＜0.05).大部分妇女(87.7％)不了解宫颈癌筛查技术,但2036名(89.1％)妇女希望接受筛查技术相关的培训.参与筛查最主要的原因是为了解自身健康状况(83.2％),不愿意参与筛查的主要原因是觉得自己没有症状,不需要筛查(63.7％).超过60％的妇女对筛查秩序、对妇科医生较为满意.作为医务人员,仍有21.4％不了解HPV可以导致哪些疾病.结论 大部分妇女对宫颈癌筛查项目比较满意,但妇女和医务人员对宫颈癌筛查的认知均需进一步提高,加强健康教育是提高宫颈癌筛查质量的关键.

高危型人乳头瘤病毒(HR-HPV) E6癌蛋白在宫颈癌发生发展中起重要作用.本研究旨在评估一种新型、快速、低成本的HPV E6癌蛋白检测技术(OncoE6TM,AVC,Sunnyvale,CA,USA)在棉签和液基细胞学(Liquid-based cytology,ThinPrep(R))两种不同采样和储存介质宫颈标本中对HPV E6癌蛋白检测结果的一致性和对宫颈上皮内瘤变2/3(CIN2/3)及以上病变检出准确性.依托于1999年在山西省建立的宫颈癌筛查队列,对2014年随访中HPV DNA检测(第二代杂交捕获技术,HC2)阳性妇女的棉签和ThinPrep(R)标本均进行E6癌蛋白检测,并用线性反向探针杂交技术(LiPA,Innogenetics)进行HPV基因分型.在294例HPV阳性妇女的棉签和ThinPrep标本中,E6癌蛋白阳性率相当(11.2％ vs 7.8％,P=0.16);两者一致率为96.6％、Kappa值0.8.E6癌蛋白检测和LiPA基因分型对HPV16和HPV18型别的检测结果在两种标本中的一致性均较高(＞90％).E6癌蛋白检测对CIN2+的检出效果如下:在棉签标本中,其灵敏度50.0％、特异度93.9％、阳性预测值51.6％;而ThinPrep标本中,灵敏度46.9％、特异度97.1％、阳性预测值68.2％;两者ROC曲线下面积同样为0.72;各项指标间无统计学差异(P＞0.05).同样,对CIN3+的检出效果也相当,各指标间无统计学差异(P＞0.05).E6蛋白检测在不同检测条件下可重复性较好,且两种标本有其不同的优势,应当根据不同地区卫生资源,适当选择标本类型,进行宫颈癌筛查.

[Objective] To evaluate the role of HPV16/18 DNA genotyping in predicting the risk of cervical precancerous or cancerous lesions in women with atypical squamous cells of undetermined significance(ASC -US),compared with hrHPV DNA testing.[Methods] The current study was conducted based on the cohort of Shanxi Province Cervical Cancer Screening Study Ⅰ (SPOCCS I).During the follow-up,women received hrHPV DNA testing (hybird capture 2,HC2),liquid-based cytology and visual inspection with acetic acid concurrently.Those with any positive screening result would be transferred to colposcopy and take biopsies if necessary.Meanwhile,HPV genotyping was performed on residual cervical exfoliated cell samples in HC2-positive women using reverse linear probe hybridization assay (LiPA).416 ASC-US women from the cohort were included to estimate the immediate risk of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) by hrHPV DNA,HPV16/18 genotyping status,as well as their clinical performances.The 5-year cumulative risk of CIN2+ and relative risk were assessed in the 253 ASC-US women detected in 2005.[Results] Among women with positive hrHPV,those infected with HPV16/18 had higher immediate risk of CIN2+ (9.7％) than those with other hrHPV infections (3.8％),but there was no significantly statistical difference (0R=2.7,95％CI:0.4～17.3).No case was found in hrHPV-negative women.Compared with hrHPV-negative women (1.9％),the 5-year cumulative risks of CIN2+ increased in groups of other hrHPV type positive [5.3％,RR=2.7(95％CI:0.3～23.0)],hrHPV positive [8.5％,RR=4.5(95％CI:1.1 ～17.8)] and HPV16/18positive (11.8％,RR=6.2 (95％CI:1.1～33.9)].Compared with hrHPV DNA testing,the sensitivity of HPV 16/18 genotyping for detecting CIN2+ declined [relative sensitivity:0.6 (95％CI:0.3～1.2)],and the specificity to exclude CIN2+ increased [relative specificity:1.3(1.2～1.4)].[Conclusion] Triaging ASC-US women with HPV16/18 genotyping can obtain higher specificity while losing some sensitivity.HPV16/18 genotyping can discriminate the instant and long-term CIN2+ risk in hrHPV-positive population,so it can be used to manage or triage ASC-US women.

HPV DNA 检测目前已成为宫颈癌筛查的主要方法 .探索特异性的分子标志物识别HPV初筛阳性人群中真正高风险人群将有利于提高HPV筛查方法 的特异度,合理分配卫生资源.E6 蛋白是 HPV 致癌过程中的最主要的癌蛋白之一,只有当病毒 DNA 整合入宿主细胞后,才得以表达.