高危型人乳头瘤病毒E6/E7检测在宫颈细胞学ASC-US分流管理中的应用  

Application of high-risk human papillomavirus E6/E7 detection in triage management of ASC-US

作　　者：陈海迎 郑小冬[1] 郭敏[1] 郑智[1] 吕杰强[2] 

机构地区：[1]温州医科大学温州市第三临床学院温州市人民医院妇产科,浙江温州325000 [2]温州医科大学附属第二医院妇产科

出　　处：《中国妇幼保健》2015年第35期6186-6188,共3页Maternal and Child Health Care of China

基　　金：温州市科学技术局课题项目〔y20140546〕

摘　　要：目的探讨高危型人乳头瘤病毒(HR-HPV)E6/E7检测在宫颈细胞学非典型鳞状细胞(ASC-US)分流管理中的临床应用价值。方法因宫颈疾病行宫颈液基细胞学检查(TCT)结果为ASC-US的69例患者进行HR-HPV DNA分型检测及E6/E7 mRNA检测,同时行阴道镜检查及宫颈活组织检查。比较HR-HPVE6/E7mRNA检测与HPVDNA分型检测在TCT为ASC-US患者中敏感度、特异度差异。结果根据病理结果显示慢性宫颈炎及宫颈湿疣样改变患者26例,宫颈上皮内瘤变(CIN)I级16例,CINⅡ级16例,CINⅢ级10例及浸润癌1例。在CINII及以上病变(CIN2+)27例患者中,HR-HPVE6/E7阳性(≥500 copy/ml)为23例,阴性(<500 copy/ml)为4例,HPV阳性25例,阴性2例。HPV E6/E7在检测CIN2+敏感度为85.2%,低于HPV-DNA敏感度(92.6%),差异无统计学意义(P>0.05)。前者特异度为61.9%,高于HPV-DNA 19.0%,差异有统计学意义(P<0.05)。结论 HR-HPV E6/E7mRNA检测对诊断CIN2+的特异度高于HPV-DNA,对TCT为ASC-US患者的分流意义更为明确,对宫颈癌有一定的筛查价值。Objective To explore the clinical application value of high-risk human papillomavirus （HPV） E6/E7 detection in triage management of atypical squamous cells of undetermined significance （ASC-US） . Methods Sixty-nine patients were diagnosed as ASC-US by cervical ThinPrep cytology test （TCT） because of cervical diseases, then HR-HPV DNA genotyping and E6/E7 mRNA detection were conducted, meanwhile, colposcopy and cervical biopsy were carried ont. The differences of sensitivity and specificity of HR-HPV E6/E7 mRNA detection and HPV DNA genotyping among ASC-US patients were compared. Results After pathological examination, 26 patients were diagnosed as chronic cervicitis and cervical condyloma-like lesions, 16 patients were diagnosed as cervical intraepithelial neoplasia （CIN） I , 16 patients were diagnosed as CIN Ⅱ , 10 patients were diagnosed as CINⅢ, and one patient was diagnosed as cervical in-vasive carcinoma. Among 27 patients with CIN Ⅱ or lesions severer than CIN Ⅱ, 23 patients were found with positive HR-HPV E6/E7 （≥ 500 copy/ml）, 4 patients were found with negative HR-HPV E6/E7 （〈500 copy/ml）, 25 patients were found with positive HPV, 2 patients were found with negative HPV. The sensitivity of HPV E6/E7 mRNA detection for CIN Ⅱ or lesions severer than CIN Ⅱ was 85.2% , which was lower than that of HPV-DNA genotyping, but there was no statistically significant difference （P〉0. 05） . The specifieity of HPV E6/E7 mRNA detection for CIN Ⅱ or lesions severer than CIN Ⅱ was 61.9% , which was statistically significantly higher than that of HPV- DNA genotyping （P〈0.05） . Conclusion The specificity of HPV E6/E7 mRNA detection tor CIN Ⅱ or lesions severer than CIN Ⅱ was higher than that of HPV-DNA genotyping, which has significance in triage management of ASC-US patients and a certain screening value for cervical cancer.

关 键 词：人乳头瘤病毒 E6/E7mRNA 宫颈上皮内瘤变 非典型鳞状细胞 

分 类 号：R737.33[医药卫生—肿瘤]