摘要目的 探讨人乳头状瘤病毒(human papillomavirus,HPV)检测在中国宫颈细胞学诊断为不能明确意义的不典型鳞状细胞(atypical squamous cells of undetermined significance,ASC?US)患者中的阳性率和对宫颈上皮内瘤变(CIN)2+病例筛查效果的差异.方法 收集2005至2017年我国公开发表的104项报道中28923例ASC?US患者就诊医院的等级、分类、地区分布、检测方法、HPV阳性率和宫颈病理诊断结果,分析HPV筛查CIN2+的灵敏度及特异度.结果 28923例患者HPV总阳性率为52.09%,104项研究中阳性率最低为12.06%,最高为88.68%.在三级医院进行的79项研究21244例患者的HPV阳性率为52.46%,略高于在二级医院进行的22项研究6925例患者的阳性率50.87%,而综合医院和专科医院的阳性率差异无统计学意义.此外,66项采用第二代杂交捕获技术检测的19791例标本阳性率53.13%,略高于24项采用反向杂交技术检测的6338例标本的阳性率51.10%.在73项18163例有明确病理诊断结果的研究中,HPV检测筛查CIN2+的灵敏度为90.16%(95%CI:88.91%~91.28%),特异度为53.08%(95%CI:53.02%~54.57%),阳性预测值为23.24%,阴性预测值为97.24%.结论 HPV检测是ASC?US患者分流的有效方法,但不同医院患者HPV检测的阳性率变异范围较大,提示我国不同地区和医院间的诊断水平存在差异.

abstractsObjective To investigate the human papillomavirus(HPV)positive rate and its usefulness in predicting CIN2+ in women with atypical squamous cells of undetermined significance(ASC?US)cervical cytology. Methods A pooled analysis was conducted using published data of hospital classification,HPV positive rate and histopathologic diagnosis in ASC?US population during 2005 to 2017 from 104 studies which enrolled 28 923 ASC?US samples. Results The overall HPV positive rate was 52.09%(range from 12.06% to 88.68%). The HPV positive rate in 79 tertiary hospitals of 21 244 cases was 52.46%,slightly higher than the 50.87% in 22 second?class hospitals of 6 925 cases. There was no significant difference between specialized hospitals and general hospitals. In addition, the positive rate of HC2 conducted in 66 hospitals with 19 791 cases was 53.13%, which was slightly higher than 51.10% of reverse hybridization from 24 hospitals with 6 338 cases. In 73 studies of 18 163 cases with histological diagnosis, the sensitivity of HPV for detecting CIN2+ was 90.16%(95%CI:88.91% to 91.28%), specificity was 53.08%(95%CI:53.02% to 54.57%),positive predictive value was 23.24% and negative predictive value was 97.24%. Conclusion HPV detection is clinically validated for ASC?US triage, but there is a wide variation of HPV positive rate in population of cervical cytological diagnosis as ASC?US in China, suggesting different diagnostic level between regions and hospitals and further improvement is needed.