| 摘要: |
| 目的 探讨高危型人乳头瘤病毒（HR-HPV）E6/E7 mRNA 在宫颈不能明确意义的非典型鳞状上皮细胞（ASCUS）分 流诊断中的意义。 方法 选择 2014 年 1 月至 2015 年 7 月就诊且行液基薄层细胞学检测（TCT）结果为 ASCUS 的 205 例患者为研 究对象，并且行阴道镜下活检、HR-HPV E6/E7 mRNA 检测和 HR-HPV 分型 DNA 检测。 结果 根据阴道镜活检结果，将 205 例 ASCUS 患者分为慢性宫颈炎 105 例、低度宫颈鳞状上皮内病变（LSIL）48 例、高度宫颈鳞状上皮内病变（HSIL）48 例和宫颈鳞状细胞 癌（SCC）4 例。慢性宫颈炎、LSIL、HSIL 和 SCC 组 HR-HPV E6/E7 mRNA 阳性检出率分别为 56.2%、79.2%、85.4%和 100.0%，差异 有统计学意义（P＜0.01）；HSIL+SCC 组 HR-HPV E6/E7 mRNA 阳性检出率为 86.5%，高于慢性宫颈炎 +LSIL 组的 63.4%（P＜0.01）。HR-HPV E6/E7 mRNA 水平为 SCC＞HSIL＞LSIL＞慢性宫颈炎症，4 组差异有统计学意义（P＜0.01）。＜30 岁组与≥30 岁组 HR-HPV E6/E7 mRNA 水平分别为 292.23（109.77~903.34）copy/ml 和 175.26（0.00~1 032.90）copy/ml，两组差异无统计学意义（P ＞0.05）。 HR-HPV E6/E7 mRNA 水平与宫颈病变程度呈正相关（r=0.379，P＜0.01）。HR-HPV E6/E7 mRNA 检测方法的 AUC 为 0.702 （0.617~0.786），诊断阈值为 185.74copy/ml，检测 ASCUS 患者 HSIL+SCC 的灵敏度、特异度、阳性预测值、阴性预测值分别为76.9%、60.8%、40.0%和 88.6%，而 HR-HPV DNA 的检测灵敏度、特异度、阳性预测值、阴性预测值分别为 88.5%、31.3%、30.5%和88.9%；其中 HR-HPV E6/E7 mRNA 检测特异度明显高于 HR-HPV DNA（P＜0.05）。 结论 HR-HPV E6/E7 mRNA 检测在 ASCUS 筛查中特异度较高，有望成为宫颈细胞学 ASCUS 分流的新方法。 |
| 关键词: 高危人乳头瘤病毒 E6/E7 mRNA 宫颈不能明确意义的非典型鳞状上皮细胞 |
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| High-risk human papilloma virus E6 /E7 mRNA test in patients with atypical squamous cells of undetermined significance of cervical cytology |
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PAN Qionghui,HUANG Lingxiao,ZHU Xueyan,LIN Tao,ZHU Xueqiong
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the Third Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To evaluate the significance of high-risk human papilloma virus E6/E7 mRNA test in patients with atypical squamous cells of undetermined significance (ASCUS) of cervical cytology. Methods Two hundred and five gynecological outpatients underwent cervical thinpre cytological test(TCT) and diagnosed as ASCUS in Wenzhou People's Hospital from January 2014 to July 2015. High risk human papilloma virus (HR- HPV) E6/E7 mRNA test, HPV DNA test and histopathological examination were also performed in all patients. Results Among 205 patients, there were 105 cases of chronic cervicitis, 48 cases of low-grade squamous intraepithelial lesion (LSIL), 48 cased of high-grade squamous intraepithelis lesion (HSIL) and 4 cases of cervical carcinoma. The positive rate of HPV E6/E7 mRNA in chronic cervicitis, LSIL, HSIL and the cervical carcinoma groups were56.2％ , 79.2％ , 85.4％ and 100.0％ , respectively (P ＜0.01). HPV E6/E7 mRNA positive rate in HSIL+ carcinoma group was significantly higher than that in LSIL + cervicitis group (86.5％ vs 63.4％, P＜0.01). Rank analysis demonstrated that the severity of cervical lesions was correlated the expression of HPV E6/E7 mRNA (r=0.379, P＜0.01). When HPV E6/E7 mRNA≥185.74 copy/ml was used as criteria for screening HSIL and above lesions, the sensitivity, specificity, positive predictive value and negative predictive value of HPV E6/E7 mRNA were 76.9% , 60.8% , 40.0% and 88.6% , respectively in patients with ASCUS, while those parameters of HR-HPV DNA were 88.5% , 31.3% , 30.5% and 88.9% , respectively. The specificity of HPV E6/E7 mRNA was significantly higher than that of HPV E6/E7 DNA (P＜0.05). Conclusion The specificity of HPV E6/E7 mRNA test are higher than that of high-risk HPV DNA for diagnosis of HSIL+ in patients with ASCUS. |
| Key words: High -risk human papilloma virus E6/E7 mRNA Atypical squamous cells of undetermined significance |
