高危型人乳头瘤病毒E6/E7 mRNA在宫颈细胞学ASCUS/LSIL/ASC-H分流中的意义  

Significance of high risk human papillomavirus E6/E7 mRNA in cervical cytology ASCUS/LSIL/ASC-H

作　　者：吕涛[1] 吴忧 廖秦平[1] 张蕾[1] Lü Tao Wu You Liao Qinping et al.(Beijing Tsinghua Changgung Hospital,School of Clinical Medicine, Tsinghua University, Beijing 102218 Department of Gynecology, Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100020)

机构地区：[1]清华大学附属北京清华长庚医院清华大学临床医学院,北京102218 [2]中国医学科学院肿瘤医院妇科,北京100020

出　　处：《现代妇产科进展》2017年第9期670-673,共4页Progress in Obstetrics and Gynecology

基　　金：北京市医院管理局临床医学发展专项经费资助(No:XMLX201605);国家自然科学基金(No:81671409)

摘　　要：目的:比较高危型人乳头瘤病毒(HR-HPV)E6/E7 mRNA与HR-HPV DNA检测在宫颈病变筛查中的诊断性能。探讨其在宫颈细胞学ASCUS/LSIL/ASC-H分流中的意义。方法:收集2016年5月至11月就诊于清华长庚医院妇科的液基细胞学结果为ASCUS、LSIL、ASC-H的患者251例,分别行宫颈脱落细胞HR-HPV DNA、HR-HPV E6/E7mRNA检测,并行阴道镜检查及宫颈活体组织检查,以组织学病理为金标准。结果:HRHPV E6/E7 mRNA阳性率在ASCUS、LSIL和ASC-H中分别为18.34%(20/108)、28.82%(30/102)和39.51%(17/41)。宫颈活检病理结果子宫颈低级别病变(湿疣/CIN1组)与高级别病变(CIN2/3)组的HR-HPV E6/E7 mRNA阳性率比较,差异有统计学意义(P=0.0125)。以子宫颈活检的组织学诊断结果为金标准,HR-HPV E6/E7 mRNA筛查子宫颈高级别病变的特异性及阳性预测值均明显高于HPV-DNA。ASCUS/LSIL/ASC-H中,HRHPV E6/E7 mRNA检测筛查宫颈高级别病变的ROC曲线面积均大于HPV-DNA,诊断效能优于HPV-DNA。结论:HPV E6/E7 mRNA检测诊断宫颈高级别病变的特异性及阳性预测值高于HPV-DNA,能辅助宫颈细胞学筛查及HPV-DNA,提高宫颈高级别病变诊断的特异性,在细胞学检查阶段对患者做出有效分流,预测宫颈高级别病变。Objective：To compare the difference of HR-HPV E6/E7 mRNA and HRHPV DNA in cervical cancer screening.To investigate the application value of human papillomavirus E6/E7 mRNA in the cytological screening ASCUS/LSIL/ASC-H.Methods：251 cases who suffering from ASCUS/LSIL/ASC-H in TCT were collected from Department of Gynecology outpatient in Beijing Tsinghua Changgung Hospital from May.2016 to Nov.2016.HR-HPV E6/E7 mRNA and HPV-DNA detection were performed on the cervical cells.The result was compared with the pathological result of colposcopebiopsy.Results：The positive rates of HR-HPV E6/E7 mRNA in ASCUS,LSIL and ASC-H were 18.34%（20/108）,28.82%（30/102） and 39.51%（17/41）,respectively.Cervical exfoliated cells HR-HPV E6/E7 mRNA expression rate difference was statistically significant（P=0.012 5） between cervical low-grade lesions（wet wart/CIN1 group） and high level lesions（Cin2/3 group）,The specificity and positive predictive value of HR-HPV E6/E7 mRNA detection and diagnosis were higher than that of HPV-DNA,and the ROC curve areas of HR-HPV E6/E7 mRNA were bigger than HPV-DNA in ASCUS/LSIL/ASC-H.Conclusion： The specificity and positive predictive value of HR-HPV E6/E7 mRNA in the diagnosis of cervical high grade lesion was higher than HR-HPV detection.HR-HPV E6/E7 mRNA could assist cervical cytology screening and HPV-DNA to improve the specificity of the diagnosis of high-grade cervical lesions,and make effective triage in the cytology stage to predict the possibility of high-grade cervical lesions.

关 键 词：ASCUS LSIL ASC-H HR-HPV E6/E7 MRNA HPV-DNA 

分 类 号：R711[医药卫生—妇产科学]