目的: 观察宫颈癌筛查“三阶梯”方案在我院妇科阴道镜门诊就诊病人中的应用价值。方法: 选取
2012 － 10 ～ 2014 － 08 就诊于解放军总医院妇科阴道镜门诊的连续病人704 例，以组织病理学为诊断金标准，计
算液基细胞学、高危型人乳头状病毒( Human popilloma virus，HPV) 检测及阴道镜结果的诊断指标。结果: 随年
龄增加，TCT、Hr － HPV、阴道镜及病理阳性率有升高趋势，TCT 和阴道镜统计学检验有显著性差异。TCT 灵敏度
90． 24%，特异度17． 55%，诊断符合率42． 18%，Kappa = 0． 049; HPV 灵敏度95． 11%，特异度21． 28%，诊断符合率
55． 62%，Kappa = 0． 155; 阴道镜灵敏度83． 84%，特异度75． 27%，诊断符合率79． 26%，Kappa = 0． 587。结论: 宫颈
癌筛查“三阶梯”方案可以有效地发现宫颈病变的高危人群，但由于细胞学检查和HPV 检测的特异度较低，使阴
道镜门诊存在过度转诊的现象，阴道镜的诊断价值较高，是三阶梯方案中不可缺少的重要部分。

Objective: To observe the effect of three － step protocol for cervical cancer screening in
the colposcopy clinics of the department of gynecology． Methods: 704 consecutive patients in the colposcopy
clinics of the department of gynecology，PLA General Hospital， from October 2012 to August
2014． Evaluate the diagnostic index calculation of liquid based cytology，colposcopy and high － risk
HPV detection results by histopathology as the gold standard for diagnosis． Results: TCT，Hr － HPV，
colposcopy and pathologic positive rate had a rising trend with the increase of age． The results of TCT
and colposcopy were statistically significant difference． TCT sensitivity of 90． 24%，specificity of
17． 55%，diagnosis rate 42． 18%，Kappa = 0． 049，HPV sensitivity of 95． 11%， specificity of 21． 28%，
diagnosis rate 55． 62%，Kappa = 0． 155，colposcopy sensitivity 83． 84%， specificity 75． 27%，diagnosis
rate 79． 26%，Kappa = 0． 587． Conclusion: The three － step protocol for cervical cancer screening can
effectively detect the high － risk population of cervical lesions，however， there is over referral to colposcopy
clinics because of low specificity of TCT and HPV testing． Colposcopy has higher diagnostic value
and plays the irreplaceable role in this protocol．

R737

 收稿日期: 2015 － 11 － 11; 修回日期: 2016 － 02 － 21
基金项目: 解放军总医院临床科研扶持基金( 2013FC － ZHCG － 1005)
作者简介: 杜欣欣( 1982 － ) ，女，解放军总医院妇产科主治医师，在读博士研究生。
通讯作者: 孟元光，教授，主任医师，博士研究生导师，E － mail: meng6512@ VIP． sina． com 解放军总医院妇产科，
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