HPV E6/E7 mRNA检测对宫颈锥切术后ASC-US患者分流诊断的价值  

Diagnostic value of HPV E6/E7 mRNA in triage of patients with ASC-US after cervical conization

作　　者：张飞芳 叶丽燕 ZHANG Feifang;YE Liyan(Department of Obstetrics and Gynecology,Jinhua Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院妇产科,321000

出　　处：《浙江医学》2018年第7期680-683,共4页Zhejiang Medical Journal

摘　　要：目的探讨人乳头瘤病毒(HPV)E6/E7 m RNA检测在宫颈锥切术后宫颈残端不能明确意义的非典型鳞状上皮细胞(ASC-US)患者分流中的诊断价值。方法对160例宫颈锥切术后随访中液基细胞学检查(TCT)诊断为ASC-US患者行HPV E6/E7 m RNA和高危型HPV(HR-HPV)DNA检测,结合阴道镜检查、宫颈活检结果,以病理学结果为"金标准",与HR-HPV DNA检测相比较,评价HPV E6/E7 m RNA检测对宫颈锥切术后ASC-US患者分流诊断的价值。结果 HPV E6/E7 m RNA检测阳性率低于HR-HPV DNA检测阳性率(P<0.01)。宫颈上皮内瘤变(CIN)Ⅱ^+级和CIN Ⅲ^+级者HPV E6/E7 m RNA检测阳性率分别高于CIN Ⅱ^-级和CIN Ⅲ^-级者(均P<0.05)。HPV E6/E7 m RNA检测的灵敏度、特异度、阳性预测值、阴性预测值和诊断正确率分别为0.80、0.90、0.79、0.91和86.9%;HR-HPV DNA检测的灵敏度、特异度、阳性预测值、阴性预测值及诊断正确率分别为0.82、0.49、0.43、0.85和59.4%。HPV E6/E7 m RNA检测的特异度、阳性预测值和诊断正确率均高于HR-HPV DNA检测(均P<0.05)。宫颈病变级别高的患者HPV E6/E7 m RNA拷贝数明显增加,两者呈正相关(r=0.658,P<0.01)。结论 HPV E6/E7 m RNA检测对宫颈锥切术后ASC-US患者的残留/复发具有重要预测价值,可作为术后ASC-US患者分流的有效指标。Objective To assess the diagnostic value of human papilloma virus （HPV） E6/E7 mRNA test in triage of patients with atypical squamous cell of undetermined significance （ASC- US） after cervical conization. Methods A total of 160 patients after cervical conization with ASC-US cytology underwent colposcopic examination and cervical biopsy,and HPV E6/E7mRNA and high- risk HPV DNA （HR- HPV DNA） tests were performed.With pathological results as the gold standard, the diagnostic value of HPVE6/E7 mRNA in patients with ASC-US after cervix conization was analyzed and compared with HR- HPV DNA. Results The overall positive rate of HPVE6/E7 mRNA was lower than that of HR- HPV DNA （P〈0.01）. The positive rate of HPV E6/E7 mRNA for cervical intraepithelial neoplasia Ⅱ＋ （CIN Ⅱ-＋） and CIN Ⅲ-＋ were higher than that of CINⅡ-- and CINⅢ-- . The sensitivity, specificity,positive predictive value, negative predictive value and accuracy of HPV E6/E7 mRNA in diagnosis of high grades cervical intraepithelial neoplasia （CIN II-＋ and CIN Ⅲ-＋ ） were 0.80, 0.90, 0.79, 0.91 and 86.9%, respectively; while those indicators of HR- HPV DNA were 0.82, 0.49, 0.43, 0.85 and 59.4%, The specificity, positive predictive value and accuracy of HPV E6/E7 mRNA weve higher than those of HR- HPV DNA （a ll P〈0.05）. The results also demonstrated that the HPV E6/E7 mRNA copies were positively correlated with histological severity （r=0.658,P〈0.01）. Conclusion The detection of HPVE6/E7 mRNA is of value in predicting the residual/recurrence of ASC- US after cervix conization, indicating that it might be a promising technique in triage of patients with ASC- US after cervical conization.

关 键 词：人乳头状瘤病毒 HPV E6/E7 mRNA 不能明确意义的非典型鳞状上皮细胞 宫颈锥切术 

分 类 号：R737.33[医药卫生—肿瘤]