目的 探讨鳞状上皮细胞抗原（SCCA）、人乳头瘤病毒（HPV）-DNA联合阴道镜检查在宫颈鳞状细胞癌（SCC）筛查中的应用价值。方法 选择2019年1月1日—2021年12月31日在中山市博爱医院就诊并确诊为SCC的妇女作为研究对象,共纳入100例SCC患者（SCC组）,同时选择200例经活检确诊为宫颈慢性炎症的患者（宫颈慢性炎症组）作为阴性对照。采用阴道镜观察研究对象的宫颈情况,并采集研究对象的宫颈组织标本进行HPV-DNA检测。采集研究对象的静脉血,采用化学发光免疫法测定研究对象SCCA的水平。以病理检查结果为金标准,分别对HPV-DNA检测、外周血SCCA两者联用以及阴道镜、HPV-DNA检测、外周血SCCA三者联用进行筛查效果的评价。结果 SCC组研究对象的年龄≥40岁者、出血者、性生活开始年龄≤20岁者比例均高于宫颈慢性炎症患者组;而宫颈慢性炎症患者组疼痛的比例高于SCC患者组,差异均有统计学意义（P<0.01）。χ²检验结果显示,SCC组研究对象的SCCA阳性率高于宫颈慢性炎症组（P<0.001）。阴道镜结合SCCA、HPV-DNA检测筛查SCC的灵敏度和特异度均高于单独使用SCCA和HPV-DNA,并取得较好的约登系数（75%）和Kappa值（0.730）。结论 采用阴道镜结合HPV-DNA、SCCA可有效提高SCC疾病的约登系数与Kappa值,其联合诊断的效能高于单独使用阴道镜、HPV-DNA或SCCA诊断SCC。

Objective To study the application value of squamus cell carcinoma antigen（SCCA）and human papillomavirus（HPV）-DNA combined with colposcope in cervical squamous cell carcinoma（SCC）screening．Methods Women diagnosed with SCC who visited Boai Hospital of Zhongshan city from January 1,2019 to December 31,2021 were selected as research subjects,including 100 patients with SCC（SCC group）and 200 patients with chronic cervical inflammation confirmed by biopsy（chronic cervical inflammation group）．The cervix of the subjects was observed by colposcope,and cervical tissue samples were collected for HPV-DNA testing．Venous blood of subjects was collected and SCCA levels were determined by chemiluminescence immunoassay．Using pathological examination results as the gold standard,the screening effect of combination HPV-DNA test and peripheral blood SCCA test,combination colposcope,HPV-DNA test and peripheral blood SCCA were evaluated respectively．Results In SCC group,the proportion of age≥40 years old,bleeding,sexual life age ≤20 years old were higher than those in chronic cervical inflammation group,but chronic cervical inflammation group had higher rate of pain than those in SCC group（P<0.01）by Chi-square test．SCCA positive rate in SCC group was higher than that in chronic cervical inflammation group（P<0.001）by Chi-square test．The sensitivity and specificity of colposcope combined with SCCA and HPV-DNA were higher than those of SCCA and HPV-DNA alone,and better Youden’s coefficient（75%）and Kappa value（0.730）were obtained．Conclusions Colposcope combined with HPV-DNA and SCCA can effectively improve the Youden’s coefficient and Kappa value of SCC disease,and its combined diagnosis efficiency was higher than that of colposcope,HPV-DNA and SCCA alone in the diagnosis of SCC,which has high clinical promotion significance．

目的 探究液基细胞学检查联合鳞状上皮细胞癌抗原(SCCA)、癌抗原153(CA153)检测对宫颈癌诊断价值。方法 对子宫颈上皮内瘤变患者54例(内瘤变组)、子宫颈癌患者54例(宫颈癌组)及健康体检者54例(对照组)进行液基细胞学、血清SCCA、血清CA153进行检测,以病理活检诊断为金标准。分析液基细胞学检查、血清中SCCA、血清中CA153对宫颈癌诊断价值,并分析联合液基细胞学检查与血清中SCCA、血清中CA153检测的临床价值。结果 内瘤变组和宫颈癌组血清SCCA、CA153水平均高于对照组,宫颈癌组血清SCCA、CA153水平高于内瘤变组(P均<0.05)。单项检测中,液基细胞学检查阳性率高于SCCA、CA153,联合检测阳性率与其他各单项检测相比明显提高(P<0.05)。结论 宫颈癌患者体内SCCA、CA153水平高,液基细胞学检查联合SCCA、CA153检测对宫颈癌早期阳性检出率高。

Objective To explore the diagnostic value of liquid-based cytology combined with squamous cell carcinoma antigen (SCCA) and cancer antigen 153 (CA153) detection in patients with cervical cancer. Methods Liquid-based cytology, serum SCCA, and serum CA153 were detected on 54 patients with cervical intraepithelial neoplasia (neoplasia group), 54 patients with cervical cancer (cancer group), and 54 healthy subjects (control group). Pathological biopsy diagnosis was used as the gold standard. The diagnostic value of liquid-based cytology, serum SCCA, and serum CA153 in cervical cancer was analyzed, and the clinical value of combining liquid-based cytology with serum SCCA and serum CA153 detection was also analyzed. Results The levels of serum SCCA and CA153 in neoplasia group and cancer group were higher than those in control group, and the serum SCCA and CA153 levels in the cancer group were higher than those in the neoplasia group (P<0.05). In the single detection, the positive rate of liquid-based cytology was higher than that of serum SCCA and CA153, and the positive rate of combined detection was significantly higher than those of the single detection (P<0.05). Conclusions Cervical cancer patients have high levels of serum SCCA and CA153. Liquid-based cytology combined with SCCA and CA153 detection has high positive rate for early cervical cancer.

目的 探讨p16/Ki-67染色、HPV E6/E7mRNA和联合检测对HSIL+病变诊断的临床价值。方法 募集2017年3月—2020年8月期间,于中山市博爱医院妇产科就诊,组织学证实为宫颈炎患者209例、LSIL患者169例、HSIL患者131例和宫颈癌患者86例作为研究对象,回顾分析研究对象术前细胞学样本p16/Ki-67染色、HPV E6/E7mRNA检测结果,纵向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在不同级别宫颈病变的阳性率的差异,横向比较p16/Ki-67染色、HPV E6/E7mRNA和联合检测在相同宫颈病变的阳性率的差异,综合评估p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+病变效能的差异。结果 ①纵向比较:p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率随宫颈病变程度的加重呈趋势性升高(p16/Ki-67染色:χ²=374.34,P<0.001;HPV E6/E7mRNA检测:χ²=289.21,P<0.001;联合检测:χ²=343.90,P<0.001)。②横向比较:在宫颈炎、LSIL、宫颈癌组,p16/Ki-67染色、HPV E6/E7mRNA和联合检测阳性率之间差异均不具有统计学意义(均P>0.05)。在HSIL组,p16/Ki-67染色和联合检测之间阳性率差异有统计学意义(χ²=8.09,P=0.004); HPV E6/E7mRNA和联合检测之间阳性率差异有统计学意义(χ²=11.30,P=0.001)。③p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的灵敏度,总体差异有统计学意义(χ²=7.69,P=0.021)。p16/Ki-67染色与联合检测法之间的灵敏度差异有统计学意义(χ²=7.29,P=0.007);HPV E6/E7mRNA检测与联合检测法之间的灵敏度差异有统计学意义(χ²=4.84,P=0.028)。p16/Ki-67染色、HPV E6/E7mRNA和联合检测诊断HSIL+的特异度及符合率的总体差异不具有统计学意义(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628)。结论 p16/Ki-67染色、HPV E6/E7mRNA 和联合检测均可有效筛出HSIL+病变,但是联合检测能显著提高HSIL+病变诊断的灵敏度,降低漏诊率,同时保持了较好的特异度和符合率,建议将p16/Ki-67染色和HPV E6/E7mRNA联合检测作为早期诊断HSIL+病变的策略。

Objective To investigate the clinical value of p16/Ki-67 staining E6/E7 mRNA and combined detection in the diagnosis of HSIL+ lesions. Methods From March 2017 to August 2020,209 cases of cervicitis,169 cases of LSIL,131 cases of HSIL and 86 cases of cervical cancer confirmed by histology were selected as the research objects. The results of p16/Ki-67 staining and HPV E6/E7 RNA detection of the preoperative cytological samples were retrospectively analyzed and the p16/Ki-67 staining and HPV E6/E7 mRNA detection results were compared longitudinally. The positive rates of E6/E7mRNA and combined detection in different grades of cervical lesions were compared.The positive rates of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the same cervical lesions were compared horizontally.The differences in the diagnostic efficacy of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+lesions were comprehensively evaluated. Results ①Longitudinal comparison:the positive rates of p16/ Ki-67 staining, HPV E6/E7mRNA and combined detection increased with the severity of cervical lesions(p16/Ki-67 staining:χ²=374.34,P<0.001;HPV E6/E7 mRNA detection:χ²=289.21,P<0.001;joint detection:χ²=343.90,P<0.001). ②Transverse comparison: in cervicitis, LSIL and cervical cancer groups,there were no significant differences in the positive rates of p16/Ki-67 staining, HPV E6/E7 mRNA and combined detection (all P>0.05). In the HSIL group,there was significant difference in the positive rate between p16/Ki-67 staining and combined detection (χ²=8.09,P=0.004)and the difference between HPV E6/ E7 mRNA and combined detection was statistically significant(χ²=11.30,P=0.001). ③The sensitivity of p16/Ki-67staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+ was statistically significant(χ²=7.69,P=0.021). The sensitivity difference between p16/Ki-67 staining and combined detection was statistically significant(χ²=7.29,P=0.007);the sensitivity difference between HPV E6/E7 mRNA detection and combined detection method was statistically significant (χ²=4.84,P=0.028). There was no significant difference in the specificity and coincidence rate of p16/Ki-67 staining,HPV E6/E7 mRNA and combined detection in the diagnosis of HSIL+(χ²₁=5.38,P₁=0.068;χ²₂=0.93,P₂=0.628). Conclusion P16/Ki-67 staining,HPV E6/E7 mRNA and combined detection may effectively screen out HSIL+ lesions,reduce the missed diagnosis rate, but the combined detection may significantly improve the sensitivity of diagnosis of HSIL+ lesions, while maintaining good specificity and coincidence rate.It is suggested that p16/Ki-67 staining and HPV E6/E7 mRNA detection should be used as a strategy for early diagnosis of HSIL+ lesions.