HPV DNA和HPV E6/E7 mRNA检测在宫颈癌筛查中的应用价值探讨  

Application value of HPV DNA and HPV E6 / E7 mRNA assay in screening of cervical cancer

作　　者：蒙志平 黎勇明[2] 杨玲[1] 吴险[1] 梁金艳[2] 林丽文[1] 梁婷[2] 黄川英[1] 

机构地区：[1]广西壮族自治区贵港市人民医院检验科,广西贵港537100 [2]广西壮族自治区贵港市人民医院妇科,广西贵港537100

出　　处：《实用临床医药杂志》2016年第11期76-79,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨HPV DNA和HPV E6/E7 mRNA检测在宫颈癌筛查中的应用价值。方法选取宫颈病变筛查的受试者407例为研究对象,均行宫颈薄层液基细胞学(TCT)检查,并检测细胞学标本中HPV DNA和HPV E6/E7 mRNA的表达。215例行阴道镜宫颈活检,结合组织病理诊断结果进行统计分析。结果 407例细胞病理学诊断结果:正常范围(WNL)192例(47.17%)、意义不明的不典型鳞状上皮细胞(ASCUS)106例(26.04%)、低度鳞状上皮内病变(LSIL)70例(17.20%)和高度鳞状上皮内病变(HSIL)39例(9.58%)。诊断为LSIL和HSIL患者中,HPV DNA和HPV E6/E7 mRNA检出率差异无统计学意义(P>0.05);诊断为ASCUS患者中,HPV DNA检出率显著高于HPV E6/E7 mRNA(P<0.01)。215例组织病理学诊断结果:正常109例,阴性106例,包括CINⅠ级44例、CINⅡ级27例、CINⅢ级32例、宫颈鳞癌3例。对于诊断为CINⅡ级、CINⅢ级/宫颈癌患者,HPV DNA和HPV E6/E7 mRNA检测的灵敏度、特异度和阳性预测值差异无统计学意义(P>0.05),但HPV E6/E7 mRNA检测的阴性预测值和准确度显著高于HPV DNA检测(P<0.05或P<0.01)。结论 HPV E6/E7 mRNA检查较HPV DNA检查能更好地评估HPV感染患者宫颈病变恶化风险,联合TCT检测对提高宫颈癌早期筛查和诊断的准确度具有积极意义。Objective To investigate the application value of HPV DNA and HPV E6 / E7 mRNA assay in screening of cervical cancer. Methods A total of 407 cases received Thinprep Cytology Test（ TCT）,HPV DNA and HPV E6 / E7 mRNA assay. The cervical biopsy by colposcopy was performed in 215 cases and the data according to cytological and pathological results were statistically analyzed. Results There were 192,106,70 and 39 cases diagnosed as normal limits（ WNL）,atypical squamous cells of undetermined significance（ ASCUS）,lower-grade squamous intraepithelial lesions（ LSIL） and higher-grade squamous intraepithelial lesions（ HSIL） according to cytological results respectively. There was no significant difference in positive rate of HPV DNA and HPV E6 / E7 mRNA in those patients with cytological results of LSIL and HSIL（ P〉0. 05）. The positive rate was higher in HPV DNA than that of HPV E6 / E7 mRNA in ASCUS patients（ P〈0. 05）. Out of 215 cases,106 cases were confirmed with positive pathological results,including 44 cases of CIN Ⅰ,27 cases of CIN Ⅱ,32 cases of CIN Ⅲ and 3 cases of cervical cancer. There was no significant difference in sensitivity,specificity,positive predict value between HPV DNA and HPV E6 / E7 mRNA assay in diagnosis of CIN Ⅱ and CIN Ⅲ / cervical cancer（ P〉0. 05）,but HPV E6 / E7 mRNA assay had a higher negative predictive value and accuracy compared with the HPV DNA assay（ P〈0. 05 or P〈0. 01）. Conclusion HPV E6 / E7 mRNA assay shows advantage in predicting risk of deterioration of cervical lesions. The combination of TCT and HPV E 6 / E 7 mRNA assay is more valuable in screening of cervical cancer.

关 键 词：宫颈癌 宫颈上皮内瘤变 人乳头瘤状病毒 HPV DNA E6/E7基因 

分 类 号：R737.33[医药卫生—肿瘤]