基于HPVDNA的查在中国卫生资源有限的地区的真实世界表现:一个多中心实施研究
Xinhua Jia1, Xi'ao Da2, Jingyi Shi3
1Chinese Academy of Medical Sciences & Peking Union Medical College beijin China.
概括
人类乳头瘤病毒 (HPV) DNA 检测是中国资源有限地区宫癌的可行和有效的初级查策略. 与单独的细胞学相比,HPV检测显著提高了检测率和转诊效率.
科学领域:
- 在瘤学瘤学.
- 公共卫生 公共卫生
- 传染性疾病 传染性疾病
背景情况:
- 宫癌在中国是一个重大的健康挑战.
- 国家宫癌查政策允许人类乳头瘤病毒 (HPV) DNA测试作为主要的查方法.
- 由于试剂和实验室平台的成本,许多中国县的有限资源阻碍了HPV DNA测试的采用.
研究的目的:
- 评估基于HPV DNA的宫癌查在中国卫生资源有限的环境中的可行性和有效性.
- 为了比较不同查策略的性能:单独细胞学,HPV DNA测试与细胞学分离,和HPV DNA测试与视觉检查与酸/卢戈尔的 (VIA/VILI) 分离.
主要方法:
- 这是一项多中心研究,涉及中国10个试点县的63,223名35-64岁女性.
- 查策略包括单独细胞学,HPV DNA测试与细胞学分拣,以及HPV DNA测试与VIA/VILI分拣.
- 分析的关键绩效指标是屏幕阳性率,肠镜率,CIN2+检测,阳性预测值 (PPV) 和需要引用的数量 (NNR),使用逆概率权重 (IPW) 调整后续损失.
主要成果:
- 基于HPV的查策略在所有测量指标上都显示出高于单独细胞学的优势.
- 基于HPV的方法的CIN2+检测率是基于HPV的方法的2-3倍.
- 用细胞学选组进行的HPV DNA测试显示出最高的阳性预测值 (21.9%) 和最低的推所需数量 (5.73),表明推效率提高.
- 使用VIA/VILI选策略进行的HPVDNA测试显著降低了随访率的损失,在45岁及以上的女性中观察到显著的好处.
结论:
- 基于HPV DNA的宫癌查是在实施的第一年内,在中国资源有限的地区是一种可行的和高度有效的方法.
- 灵活的分类模型,如使用VIA/VILI进行HPV DNA测试,可以成功地进行调整.
- 研究结果支持将HPV DNA测试纳入国家查计划,并强调需要强有力的后续系统,特别是在服务不足的人群中.
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