子宫颈液基细胞学异常患者中检测HPV E6/E7 mRNA的临床意义  

Clinical significance of human papillomavirus E6/E7 mRNA testing for women with abnormal cytology

作　　者：唐振利[1] 苏光[1] 衣淑娟[2] 刘晓刚[3] 薛慧忠[3] TANG Zhenli, SU Guang, YI Shujuan, LIU Xiaogang, XUE Huizhong.(Department of Obstetrics and Gynecology, Beijing Chuiyangliu Hospial, Beijing 100021, Chin)

机构地区：[1]北京市垂杨柳医院妇产科,100021 [2]北京市垂杨柳医院统计室,100021 [3]北京市垂杨柳医院病理科,100021

出　　处：《中国妇产科临床杂志》2018年第2期125-128,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：朝阳区科委课题项目(CYSF161201)

摘　　要：目的探讨子宫颈液基细胞学（TCT）异常患者中检测人乳头状瘤病毒（human papillomavims，HPV）E6／E7mRNA的临床意义。方法对267例TCT异常的患者和40例TCT未见恶性细胞及上皮内瘤变细胞者（对照组）进行HPVDNA检测和HPVE6／E7mRNA检测，以阴道镜检查病理结果为金标准。结果正常、ASCUS、低度鳞状上皮内病变（LSIL）和高度鳞状上皮内病变（HSIL）的HPVE6／E7mRNA阳性率分别为20．00％（8／40）、27．57％（51／185）、60．87％（42／69）和76．92％（10／13o病理诊断正常、LSIL（CIN1）、HSIL（CIN2／3和癌）的HPVE6／E7mRNA阳性率分别为11．72％（17／145）、34．07％（31／91）、87．88％（58／66）和5／5，差异均有统计学意义（P〈0．05）。HPVE6／E7mRNA对CIN2及以上（CIN2＋）诊断的灵敏度88．73％（95％C／：81．38％～96．09％）高于TCT对CIN2＋诊断的灵敏度22．68％（95％CI：20．19％～24．66％），HPVE6／E7mRNA对C1N2＋诊断的特异度79．66％（95％CI：74．53％～84．8．0％）低于TCT对CIN2＋的特异度86．10％（95％CI：84．44％～88．32％），差异均无统计学意义（P〉0．05）。TCT联合和HPVE6／E7mRNA试验筛查效果较好，灵敏度和特异度分别为85．92％（95％CI：77．8％～94．01％）和82．63％（95％CI：77．79％～87．6％）。结论HPVE6／E7mRNA阳性率随着病理学宫颈病变级别升高呈趋势性增加，TCT联合HPVE6／E7mRNA检测能够提高对宫颈病变筛查的敏感性和特异性，弥补TCT筛查的不足。Objective To investigate the significance of human papillomavirus（HPV） E6/E7 mRNA testing in patients abnormal of cytology. Methods HPV DAN testing and HPV E6/E7 mRNA testing were conducted on 267 women（the study group） who were abnormal of Thinprep cytological test（TCT） for primary screening and to 40 women（the control group） who were normal of TCT. Patient positive of any test were colposcopied and biopsied. Data was analyzed with pathology diagnosis as the golden standard. Results The positive rates of women with cytological normal, ASCUS, LSIL, and HSIL were 20.00%（8/40）, 27.57%（51/185）, 60.87%（42/69）, and 76.92%（10/13）, respectively. The positive rates of patients with pathological normal, CIN1, CIN2/3, and cancer were 11.72%（17/145）, 34.07%（31/91）, 87.88%（58/66）, and 100%（5/5）, respectively. There was significant difference in comparing the HPV positive rates of the women grouped according to the cytological and pathological results（P 〈 0.05）. The sensitivity of HPV E6/E7 mRNA tests in detecting CIN2＋ was 88.73%（95%CI：81.38%, 96.09%）, significantly higher than that of cytology（12.68%, 95%CI ： 10.19%-14.66%,（P 〈 0.05）. The specificity of HPV E6/E7 mRNA tests in detecting CIN2＋ was 79.66%（95%CI ： 74.53%-84.8.0%）, significantly lower than that of cytology [96.10%（95%CI ： 94.44% - 98.32%）]（P 〈 0.05）. The sensitivity and specificity in detecting CIN2＋ of the combined tests of HPV E6/E7 mRNA and cytology were 85.92%（95%CI ： 77.8%-94.01%） and 82.63%（95%CI ： 77.79%-87.6%）. Conclusion The positive rates of HPV E6/E7 mRNA testing tends to be higher in high grade of lesions than in low grade ones; HPV E6/E7 mRNA tests and cytology combined screening improves the sensitivity and specificity in detecting CIN2＋, thus makes up the lower specificity of cytology.

关 键 词：人乳头状瘤病毒 子宫颈上皮内病变 人乳头瘤病毒E6/E7 MRNA 

分 类 号：R737.33[医药卫生—肿瘤]