目的：探讨DNA倍体定量分析联合高危型人乳头瘤病毒(high risk human papillomavirus，HR-HPV)检测技术在宫颈病变诊断中的应用价值。方法：对94例具有明确病理诊断结果的宫颈病变患者行DNA倍体定量和HR-HPV检测数据分析，分别计算单独和联合检测DNA异倍体、HR-HPV感染预测高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion，HSIL)及以上病变的灵敏度、特异度、阳性预测值、阴性预测值和诊断符合率，绘制相应的ROC曲线；分析DNA倍体定量的结果与HR-HPV检测的结果有无相关关系；比较DNA异倍体阳性的不同宫颈病变组织中>5c和>9c细胞的个数。结果：单独和联合检测DNA异倍体、HR-HPV感染预测HSIL及以上病变的灵敏度、特异度、阳性预测值、阴性预测值、诊断符合率分别为98.03%，94.11%，92.15%、41.86%，53.48%，72.09%、66.66%，70.58%，79.66%、94.73%，88.46%，88.57%、72.34%，75.53%，82.97%。从ROC曲线下面积可以直观地看出联合检测DNA异倍体和HR-HPV感染预测HSIL及以上病变的诊断价值最高。DNA异倍体阳性和阴性、HR-HPV阳性和阴性的不同宫颈病变发生率比较，差异均有统计学意义(P<0.01)。DNA倍体分析结果与HR-HPV检测结果呈正相关趋势(rn=0.281，P<0.01)。DNA异倍体阳性的不同宫颈病变组织每1 000个被测细胞中出现>5c的细胞个数，在慢性宫颈炎、低度鳞状上皮内病变(low-grade squamous intraepithelial lesion，LSIL)、HSIL和宫颈癌中分别为0.31±0.14、0.40±0.16、2.08±0.68、2.37±0.81；慢性宫颈炎、LSIL患者分别与HSIL、宫颈癌患者比较，差异均有统计学意义(P<0.01)。慢性宫颈炎、LSIL患者中未见>9c细胞，HSIL、宫颈癌患者中>9c细胞个数分别为1.31±0.65、1.64±0.75，差异无统计学意义(P>0.05)。结论：DNA倍体定量分析联合HR-HPV检测在宫颈病变，特别是宫颈HSIL及以上病变的筛查中具有较高的诊断价值。>9c异倍体细胞的检出很大可能提示宫颈HSIL及以上病变的存在。
Application value of DNA ploidy quantitative analysis combined with high risk type of human papillomavirus detection in cervical lesions
Objective: To investigate application value of DNA ploidy quantitative analysis combined with high risk type of human papillomavirus (HR-HPV) detection in cervical lesions. Methods: The data of DNA ploidy and HR-HPV were analyzed in 94 cases of cervical lesions with definite pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic coincidence rate of HSIL and the above lesions were calculated by HR-HPV infection and the detection of DNA ploidy alone or combined respectively. Drew the corresponding ROC curve. Explored the correlation between DNA ploidy and HR-HPV detection, and compared the numbers of 5c-exceeding and 9c-exceeding cells in different cervical lesions. Results: DNA ploidy or HR-HPV detection could predict high-grade squamous intraepithelial lesion (HSIL) and the above lesions, and their sensitivity, specificity, positive predictive value, negative predictive value and diagnosis accordance rate were 98.03%, 94.11%, 92.15%; 41.86%, 53.48%, 72.09%; 66.66%, 70.58%, 79.66%; 94.73%, 88.46%, 88.57%; 72.34%, 75.53, 82.97%; respectively. From the area under the ROC curve could be seen that the detection of DNA aneuploidy and HR-HPV infection in the diagnosis of HSIL and above lesions had the highest diagnostic value. The incidence rate of cervical lesions had significant difference between positive and negative case of DNA heteroploid or HR-HPV (P<0.01). The results of DNA ploidy were positively correlated with HR-HPV detection (rn=0.281, P<0.01). The amount of 5c-exceeding heteroploid cells among every 1 000 detected cells in chronic cervicitis, LSIL, HSIL and cervix cancer were respectively 0.31±0.14, 0.40±0.16, 2.08±0.68, 2.37±0.81. And there were significant differences in cervicitis or low-grade squamous intraepithelial lesion (LSIL) compared with HSIL or cervix (P<0.01). There was no 9c-exceeding heteroploid cells detected in chronic cervicitis and LSIL, the amount in HSIL and cervix cancer were 1.31±0.65, 1.64±0.75, with no significant difference (P>0.05). Conclusion: DNA ploidy quantitative analysis combined with HR-HPV detection in cervical lesions, especially HSIL and above lesions had a higher diagnostic value. 9c-exceeding heteroploid cells were likely to prompt the emergence of cervical HSIL and above the presence of lesions.