Volume 4,Issue 9
HPV初筛联合LBC分流的宫颈癌筛查效能与卫生经济学评价
目的 评估高危型人乳头瘤病毒（HPV）初筛联合液基细胞学检查（LBC）分流策略在宫颈癌筛查中的分流效能及卫生经济学价值。方法 连续纳入2023年1月至2025年12月期间参与河源市免费“两癌”筛查的124,508名35～64岁户籍女性，采用HPV/LBC“一管法”进行检测。筛查路径为：HPV16/18阳性者直接转诊阴道镜；其他12种高危型
HPV阳性者依据LBC结果（以ASC-US为阈值）分流转诊。以阴道镜下活检组织病理学诊断为金标准，主要终点为宫颈上皮内瘤变2级及以上（CIN2+）及CIN3+。采用阳性预测值（PPV）、阴道镜转诊率及检出1例病变所需阴道镜数（NNC）等指标，量化评估LBC分流策略的效能。结果 高危型HPV总体阳性率为11.70%（14,564/124,508）。
联合筛查策略总体阴道镜转诊率为4.81%（5,984/124,508），共检出924例CIN2+及132例CIN3+病变。在非16/18型高危HPV阳性人群中，引入LBC分流后，阴道镜转诊率从理论上的10.01%降至3.12%，NNC从26.07降至3.85，阴道镜资源利用效率提升约6.8倍；分流后实际活检人群的CIN2+ PPV（25.94%）与HPV16/18阳性组（25.80%）持平。结论 基于大样本真实世界数据验证，“HPV初筛+LBC分流”策略在实现高级别病变高检出的同时，显著降低了阴道镜转诊负荷，是契合我国卫生经济学国情的宫颈癌筛查资源优化模型，适宜在消除宫颈癌行动中推广应用。
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