人乳头瘤病毒E6/E7 mRNA检测在宫颈上皮内瘤变1预后中的预测价值  

Predictive values of human papillomavirus E6/E7 mRNA test in the prognosis of cervical epithelial neoplasm 1

作　　者：张璐[1] 张永欣[1] 张友忠[2] Zhang Lu;Zhang Yongxin;Zhang Youzhong(Department of Gynecology,Yantaishan Hospital of Yantai,Yantai 264001,Shandong Province,China;Department of Gynecology,Qilu Hospital of Shandong University,Jinan 250000,Shandong Province,China)

机构地区：[1]烟台市烟台山医院妇科,山东264001 [2]山东大学齐鲁医院妇科,济南250000

出　　处：《中华妇幼临床医学杂志（电子版）》2018年第1期44-50,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：山东省科技厅2017年重点研发计划项目(2017CXGC1210);烟台市科技计划项目(2015YD008)~~

摘　　要：目的探讨人乳头瘤病毒(HPV)E6/E7mRNA检测在宫颈上皮内瘤变(CIN)1患者预后中的预测价值。方法选取2013年7月至2014年10月,于烟台市烟台山医院妇科经阴道镜下宫颈活组织病理学检查,首次确诊为CIN1的107例患者为研究对象。所有受试者均于首次确诊为CIN1前1个月内,同时接受宫颈液基薄层细胞学检查(TCT)、HPV DNA基因分型及HPV E6/E7mRNA检测;于阴道镜下宫颈活组织病理学检查确诊为CIN1后,对其进行为期2年的随访,每6个月随访1次。随访检查项目包括宫颈TCT、HPV DNA基因分型及HPV E6/E7mRNA检测,并对可疑病变者予以阴道镜下宫颈活组织病理学检查。根据随访结束时受试者的TCT、HPV DNA基因分型、HPV E6/E7mRNA检测结果及阴道镜下宫颈活组织病理学检查结果,将本研究受试者分为转阴组与持续或进展组。采用χ~2检验,对2组受试者的HPV E6/E7 mRNA阳性率进行比较;采用Mann-Whitney U秩和检验,对2组HPV E6/E7mRNA表达水平进行比较;计算3种宫颈病变筛查方法对于预测CIN1预后的敏感度和特异度;绘制HPV E6/E7mRNA表达水平预测CIN1预后的受试者工作特征(ROC)曲线,计算ROC曲线下面积(ROA-AUC),根据约登指数最大原则,确定HPV E6/E7mRNA表达水平预测CIN1预后的最佳临界值,同时计算其敏感度和特异度。本研究遵循的程序符合烟台市烟台山医院伦理委员会所制定的标准,获得该伦理委员会批准,并与受试者均签署临床研究知情同意书。结果 (1)根据随访结束时受试者的TCT、HPV DNA基因分型、HPV E6/E7mRNA检测结果及阴道镜下宫颈活组织病理学检查结果,将本研究受试者分为转阴组(n=63,随访结束时,TCT、HPV DNA基因分型及HPV E6/E7mRNA检测结果均为正常,或阴道镜下宫颈活组织病理学检查结果为阴性),持续或进展组(n=44,随访结束时,阴道镜下宫颈活组织病理学检查结果为CIN1及以上)。2组患者的年龄等一般临床资料比较,差�To evaluate the predictive values of human papilloma virus(HPV)E6/E7 mRNA test in the prognosis of patients with cervical intraepithelial neoplasia(CIN)1.Methods From July 2013 to October 2014,a total of 107 cases of patients who were initially diagnosed as CIN1 by pathologic results of colposcopic cervical biopsy in Department of Gynecology,Yantaishan Hospital of Yantai were selected as research subjects.All subjects received cervical ThinPrep liquid-based cytology test(TCT),HPV DNA genotyping test and HPV E6/E7 mRNA test within one month prior to initial diagnosis of CIN1.Two-year follow-ups and once every six months were conducted on all subjects,including the re-examination of TCT,HPV DNA genotyping test and HPV E6/E7 mRNA test.And cervical biopsies were conducted on suspicious lesions.According to the results of TCT,HPV DNA genotyping test,HPV E6/E7 mRNA test and colposcopic cervical biopsy at the end of follow-up,all subjects were enrolled into negative group and continuous or progressive group,respectively.Chi-square test was used to compare the positive rates of HPV E6/E7 mRNA between two groups.Mann-Whitney U rank sum test was used to compare expression levels of HPV E6/E7 mRNA between two groups.The sensitivities and specificities of these three cervical screening methods in predicting the prognosis of CIN1 were calculated respectively.Then receiver operator characteristic(ROC)curve of HPV E6/E7 mRNA expression level in predicting the prognosis of CIN1 was drawn,and the area under ROC curve(ROC-AUC)was calculated.The optimal critical value of HPV E6/E7 mRNA expression level in predicting the prognosis of CIN1 was obtained when the Youden index reaching the maximum value.And its sensitivity and specificity were calculated.This study was approved by the Ethics Committee of Human Beings in Yantaishan Hospital of Yantai and informed consent of clinical research has been signed with every subject.Results①According to the results of TCT,HPV DNA genotyping test,HPV E6/E7 mRNA test and colposcopic cervical bi

关 键 词：宫颈上皮内瘤样病变 人乳头瘤病毒 乳头瘤病毒E7蛋白质类 基因分型 预后 女(雌)性 

分 类 号：R737.33[医药卫生—肿瘤]