高危型HPV检测在中国宫颈癌筛查中的应用

2021-01-03 MedSci原创 MedSci原创

hrHPV检测是基层医疗卫生中心宫颈癌筛查的有效初筛方法。将hrHPV检测纳入中国的国家筛查计划是合理有效的措施。

在中低收入国家,宫颈癌的发病率和死亡率都很高。2009年,中国启动了一项有关宫颈癌筛查的重大举措,到了2012年,国家计划扩大到每年为1000万妇女进行筛查。巴氏涂片和用醋酸和卢戈碘(VIA/VILI)染色肉眼观察法是宫颈癌主要的筛查方法。然而,该方案仅能满足不到30%的实际公共卫生需求。

高危人乳头瘤病毒(hrHPV)检测已被证实是宫颈癌筛查有效的方法。国外的大型前瞻性试验表明,与细胞学检查相比,基于HPV的筛查效果更好。我国的横断面研究发现,hrHPV检测对宫颈上皮内瘤变2级或更差的上皮内瘤变(CIN2+)检测灵敏度都很高,但特异性低于细胞学检测。

世界卫生组织(WHO)曾提出一个消除宫颈癌的中期目标,即到2030年,对70%的35~45岁女性进行高精度检测(性能与HPV检测相似)。但由于中国人口众多,这一目标给筛查系统带来了巨大压力。

那么,在国家计划中引入hrHPV检测是否能在常规条件下更好地检测出高级别CIN病例?为此,来自北京大学、科技大学、华西医学院等多所高校的研究专家团队开展了一项临床研究,旨在评估在基层医疗机构开展基于hrHPV的筛查时的筛查效果、成本效益和服务体系能力。结果发表在JAMA oncology杂志上。

这项基于人群的、多中心的、开放标签的随机临床试验在中国城市和农村地区的20个初级卫生保健中心进行。每个地点至少有3000名35-64岁的女性参加,共评估了60732名女性参与者。

在基线时,女性被随机分配到细胞学、hrHPV检测或用VIA/VILI检查。hrHPV检测阳性的妇女被随机分配到细胞学-分诊、VIA/VILI-分诊或直接阴道镜检查组。24个月后,进行细胞学、hrHPV检测和VIA/VILI的联合筛查,所有结果呈阳性的妇女都被转到阴道镜检查。主要研究结局是宫颈上皮内肿瘤2级或CIN2+和CIN3+情况。次要结果为阴道镜检查转诊率。

本研究共纳入60 732名女性,年龄中位数为47(41-52岁。城市女性中,8955人随机接受细胞学检查,18 176人接受hrHPV基因分型检查;农村女性中,11 136人随机接受VIA/VILI检查,7080人接受细胞学检查,15 385人接受hrHPV检测。其中,直接阴道镜检测hrHPV阳性的参与者在基线时有更高的疾病收益风险比(城市hrHPV vs 细胞学,CIN2+ RR=2.2;CIN3+ RR=2.0;农村hrHPV vs细胞学,RR=2.6和2.7;农村hrHPV vs VIA/VILI,RR=2.0和2.3) 。

24个月时,基线阴性的女性在农村地区的CIN2+(RR=0.3与0.3)和CIN3+(RR=0.3与0.4)的风险比显著低于细胞学检查或VIA/VILI的女性。hrHPV阳性农村妇女的阴道镜检查转诊率通过细胞学分流降低到2.8%,CIN2+的检出率明显高于细胞学(RR=2.1)或VIA/VILI(RR=1.6)。hrHPV基因分型与细胞学分流相比,显著降低了城市女性阴道镜检查转诊率(RR=0.8)。

上述结果提示,hrHPV检测是基层医疗卫生中心宫颈癌筛查的有效初筛方法。将hrHPV检测纳入中国的国家筛查计划是合理有效的措施。

 

参考文献:

Zhang J, et al. Effectiveness of High-risk Human Papillomavirus Testing for Cervical Cancer Screening in China: A Multicenter, Open-Label, Randomized Clinical Trial. JAMA Oncol. 2020 Dec 30. doi: 10.1001/jamaoncol.2020.6575.

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    2021-01-03 ms6000001352560379

    好厉害

    0

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    2021-01-03 孤舟蓑笠一老翁

    学习了,谢谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1408262, encodeId=5b76140826260, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Tue Jan 05 00:04:31 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448943, encodeId=ff4b144894312, content=<a href='/topic/show?id=2dcd4631494' target=_blank style='color:#2F92EE;'>#宫颈癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46314, encryptionId=2dcd4631494, topicName=宫颈癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0415457691, createdName=般若傻瓜, createdTime=Tue Jan 05 00:04:31 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913313, encodeId=0429913313c1, content=好厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210103/b6d69ee398174122b94be6c3414aabb2/36d00df5aa6e46fa926891e064061fbc.jpg, createdBy=27fa5446866, createdName=ms6000001352560379, createdTime=Sun Jan 03 15:05:56 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913257, encodeId=a63c91325e9b, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201221/137a6965d29349108c0e34d1034c142d/7d4214f027494937a9ccbccf0d523684.jpg, createdBy=84b02217108, createdName=孤舟蓑笠一老翁, createdTime=Sun Jan 03 11:12:01 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913252, encodeId=25e391325287, content=打卡打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/01/03/e657f7ea7fbbb3beff938a2e6cbfc891.jpg, createdBy=3f7e2516175, createdName=Lantain, createdTime=Sun Jan 03 11:05:37 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913230, encodeId=3cc691323080, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Sun Jan 03 09:34:10 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913228, encodeId=9c8e913228ff, content=学习打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Sun Jan 03 09:26:10 CST 2021, time=2021-01-03, status=1, ipAttribution=)]
    2021-01-03 Lantain

    打卡打卡

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1408262, encodeId=5b76140826260, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Tue Jan 05 00:04:31 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448943, encodeId=ff4b144894312, content=<a href='/topic/show?id=2dcd4631494' target=_blank style='color:#2F92EE;'>#宫颈癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46314, encryptionId=2dcd4631494, topicName=宫颈癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0415457691, createdName=般若傻瓜, createdTime=Tue Jan 05 00:04:31 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913313, encodeId=0429913313c1, content=好厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210103/b6d69ee398174122b94be6c3414aabb2/36d00df5aa6e46fa926891e064061fbc.jpg, createdBy=27fa5446866, createdName=ms6000001352560379, createdTime=Sun Jan 03 15:05:56 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913257, encodeId=a63c91325e9b, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201221/137a6965d29349108c0e34d1034c142d/7d4214f027494937a9ccbccf0d523684.jpg, createdBy=84b02217108, createdName=孤舟蓑笠一老翁, createdTime=Sun Jan 03 11:12:01 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913252, encodeId=25e391325287, content=打卡打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/01/03/e657f7ea7fbbb3beff938a2e6cbfc891.jpg, createdBy=3f7e2516175, createdName=Lantain, createdTime=Sun Jan 03 11:05:37 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913230, encodeId=3cc691323080, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Sun Jan 03 09:34:10 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913228, encodeId=9c8e913228ff, content=学习打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Sun Jan 03 09:26:10 CST 2021, time=2021-01-03, status=1, ipAttribution=)]
    2021-01-03 yangchou

    好文章,谢谢分享

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1408262, encodeId=5b76140826260, content=<a href='/topic/show?id=92194628826' target=_blank style='color:#2F92EE;'>#宫颈#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46288, encryptionId=92194628826, topicName=宫颈)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Tue Jan 05 00:04:31 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1448943, encodeId=ff4b144894312, content=<a href='/topic/show?id=2dcd4631494' target=_blank style='color:#2F92EE;'>#宫颈癌筛查#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46314, encryptionId=2dcd4631494, topicName=宫颈癌筛查)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0415457691, createdName=般若傻瓜, createdTime=Tue Jan 05 00:04:31 CST 2021, time=2021-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913313, encodeId=0429913313c1, content=好厉害, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210103/b6d69ee398174122b94be6c3414aabb2/36d00df5aa6e46fa926891e064061fbc.jpg, createdBy=27fa5446866, createdName=ms6000001352560379, createdTime=Sun Jan 03 15:05:56 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913257, encodeId=a63c91325e9b, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201221/137a6965d29349108c0e34d1034c142d/7d4214f027494937a9ccbccf0d523684.jpg, createdBy=84b02217108, createdName=孤舟蓑笠一老翁, createdTime=Sun Jan 03 11:12:01 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913252, encodeId=25e391325287, content=打卡打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/01/03/e657f7ea7fbbb3beff938a2e6cbfc891.jpg, createdBy=3f7e2516175, createdName=Lantain, createdTime=Sun Jan 03 11:05:37 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913230, encodeId=3cc691323080, content=好文章,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Sun Jan 03 09:34:10 CST 2021, time=2021-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=913228, encodeId=9c8e913228ff, content=学习打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Sun Jan 03 09:26:10 CST 2021, time=2021-01-03, status=1, ipAttribution=)]
    2021-01-03 liyu7822

    学习打卡

    0