DNA倍体分析和HPV E6/E7检测诊断宫颈ASCUS的价值  

Value of DNA ploidy analysis and HPV E6/E7 mRNA in diagnosis of cervical ASCUS

作　　者：汤华晓 赵涛[2] 王海燕[1] 宋连连 孙迎晖[3] 李彦玮 逄蕾蕾 陆菊芳 TANG Hua-xiao1 , ZHAO Tao2, WANG Hai-yan1 , SONG Lian-lian1 , SUN Ying-hui3, LI Yan-wei1 , PANG Leiklei1 , LU Ju-fang1(1.Department of Pathology, 2.Department of Physiotherapy, 3.Department of Child Health Care, Weihai Second Municipal Hospital Affiliated to Qiingdao University, Shandong Weihai 264200, Chin)

机构地区：[1]青岛大学附属威海市立第二医院病理科,山东威海264200 [2]青岛大学附属威海市立第二医院理疗科,山东威海264200 [3]青岛大学附属威海市立第二医院儿童保健科,山东威海264200

出　　处：《中国妇幼健康研究》2018年第3期363-367,共5页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨细胞DNA倍体分析联合人乳头状病毒(HPV)E6/E7 mRNA监测对未明确诊断意义的不典型鳞状上皮细胞(ASCUS)的诊断结果影响。方法对2014年1月至2017年3月,在青岛大学附属威海市立第二医院经宫颈分泌物液基薄层细胞学检查(TCT)诊断为ASCUS的980例患者行DNA倍体分析及HPV E6/E7mRNA检测。所有受检者均于经期结束第3~10天在电子阴道镜下行宫颈活检作为对照诊断。依据病理结果将病例分为5组,分析DNA倍体异常情况及HPV E6/E7mRNA拷贝数与病变程度的相关性。结果 980例经阴道镜下宫颈活检的ASCUS患者,宫颈上皮内瘤变(CIN)Ⅰ及以上病变者458例。与DNA正常组相比,ASCUS伴DNA异倍体1~3个组发生CINⅠ及以上病变者显著降低,差异具有统计学意义(χ_1~2=15.399,P_1=0.000);而ASCUS伴DNA异倍体1~3个组发生CINⅠ及以上病变者低于ASCUS伴DNA异倍体>3个组比较,差异具有统计学意义(χ_3~2=17.288,P_3=0.000)。CINⅠ及以上的HPV E6/E7mRNA阳性率显著高于正常或良性组,差异具有统计学意义(χ~2值分别为13.221,35.302,23.894,18.439,均P=0.000),CINⅠ及以上病变者HPV E6/E7mRNA检出率提高。DNA倍体分析联合HPV E6/E7mRNA对CINⅡ及以上病变的灵敏度为92.4%,特异性为32.7%。结论DNA倍体分析联合HPVE6/E7mRNA可辅助用于ASCUS的分流诊断,从而避免过多的阴道镜活检,同时减少CIN及宫颈癌的漏诊。Objective To investigate the effect of DNA ploidy analysis combined with HPV E6/E7 mRNA monitoring on the diagnosis of atypical squamous epithelial cells （ASCUS） without definite diagnostic significance. Methods From January 9.014 to March 2017, 980 patients with ASCUS diagnosed by thinprep cytologic examination （TCT） of cervical secretion in Weihai Second Municipal Hospital Affiliated to Qiingdao University were analyzed by DNA ploidy and HPV E6/E7 mRNA detection. All the subjects accepted cervical biopsy under electronic colposcopy 3 to 10 days after menstrual cycle for contrast diagnosis. According to the pathological findings, the cases were divided into 5 groups. The DNA ploidy abnormalities and the correlation between the number of copies of HPV and E6/E7 mRNA and the severity of the lesions were analyzed. Results Among 980 patients with ASCUS who underwent colposcopy for cervical biopsy, 458 patients were diagnosed with CIN1 and above lesions. Compared with the group of normal DNA, incidence of CIN 1 and above lesions in group of ASCUS with 1- 3 DNA aneuploid was significantly reduced, and the difference was statistically significant （χ1^2= 15.399, P1 =0.000）. The cases of ASCUS with 1-3 DNA aneuploid developing CIN 1 and above lesions were fewer than those of ASCUS with 3 DNA aneuploid, and the difference was statistically significant （χ3^2=17.288, P3 =0.000）. Positive rate of HPV E6/E7 mRNA in group of CIN I or above was significantly higher than that in normal or benign group, and the difference was statistically significant （χ^2value was 13.221, 35.302, 23.894 and 18.439, respectively, all P=0.000）. The detection rate of HPV E6/E7 mRNA in CIN I and above was enhanced. The sensitivity and specificity of DNA ploidy analysis combined with HPV E6/E7 mRNA was 92.4% and 32.7%, respectively. Conclusion DNA ploidy analysis combined with HPV E6/E7 mRNA can assist in the diagnosis of ASCUS, so as to avoid excessive colposcopy and reduce the missed diagnosis of CIN and cervical cancer.

关 键 词：DNA倍体分析 E6/E7 mRNA 人乳头瘤病毒 

分 类 号：R711.7[医药卫生—妇产科学]