人乳头状瘤病毒E6/E7 mRNA检测在宫颈病变筛诊中的应用  

Application of human papillomavirus E6/E7 mRNA detection in screening of cervical lesions

作　　者：陈伟[1] 林美丽[1] 邵丽佳[1] 浮苗[1] 蒋惠霖 CHEN Wei;LIN Mei-li;SHAO Li-jia;FU Miao;JIANG Hui-lin(Clinical Laboratory,Jinhua Central Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院检验科,浙江金华321000

出　　处：《中国卫生检验杂志》2020年第16期1948-1951,1954,共5页Chinese Journal of Health Laboratory Technology

基　　金：金华市科学技术研究计划公益类项目(2017-4-038)。

摘　　要：目的探讨HPV E6/E7 mRNA在宫颈病变筛诊方面的应用价值。方法选取2017年11月-2018年11月在本院初诊的宫颈疾病疑似患者1 542例,进行TCT、HPV E6/E7 mRNA和宫颈活检检查。统计分析E6/E7 mRNA与宫颈病变的相关性;同时以宫颈活检为金标准,评价其在CINⅡ+中的筛诊效能。结果 HPV E6/E7 mRNA的阳性率随着细胞学和组织学分级的加重逐渐增高,呈线性关联(r值分别为0.334和0.232,P <0.001);拷贝数亦呈相关性(r值分别为0.393和0.281,P <0.001)。在ASC-US和LSIL中,E6/E7 mRNA阳性率随宫颈活检分级升高而升高(r=0.108,P=0.008),拷贝数亦呈正相关(r=0.151,P <0.001)。AC中E6/E7 mRNA阳性率低于SCC和其他宫颈活检分级(P <0.01)。HPV E6/E7 mRNA的灵敏度高于TCT,但其特异性低于TCT;当两者联合检测时可提高灵敏度;ROC曲线下面积HPV E6/E7 mRNA(0.648)小于TCT (0.705);E6/E7 mRNA对CINⅡ+筛诊的最佳临界值为703.52个/ml。结论 HPV E6/E7 mRNA有望成为筛诊和研究宫颈病变的新指标;同时在ASC-US和LSIL的分流中也有一定的应用价值;但单独使用容易造成腺癌的漏检;对CINⅡ+的筛诊效能相比传统的TCT并无优势。Objective To explore the application value of HPV E6/E7 mRNA in screening of cervical lesions.Methods A total of 1542 suspected patients with cervical diseases who were first went to see doctor in our hospital from November 2017 to November 2018 were selected.All of the patients have taken the examinations of TCT,HPV E6/E7 mRNA and cervical biopsy.The correlation between E6/E7 mRNA and cervical lesions was analyzed,and the screening efficacy of E6/E7 mRNA in CINⅡ+was evaluated by using cervical biopsy as the gold standard.Results The positive rate of HPV E6/E7 mRNA increased with the increase of cytology and histological grading,showing a linear correlation(r=0.334,r=0.232,P<0.001).The copy number was also correlated(r=0.393,0.281,P<0.001).The positive rate of E6/E7 mRNA increased with the increase of cervical biopsy grade(r=0.108,P=0.008),and the copy number was also positively correlated(r=0.151,P<0.001).The positive rate of E6/E7 mRNA in AC was lower than that of SCC and other cervical biopsy grades(P<0.01).The sensitivity of HPV E6/E7 mRNA is higher than THAT of TCT,but its specificity is lower than that of TCT.The sensitivity can be improved when the two are combined.The area of HPV E6/E7 mRNA under ROC curve(0.648)was smaller than that of TCT(0.705).The best threshold of E6/E7 mRNA in CINⅡ+screen diagnosis is 703.52 copy/ml.Conclusion HPV E6/E7 mRNA is expected to be a new indicator for screening and study of cervical lesions.At the same time it also has certain application value in ASC-US and LSIL shunt;but it is easy to cause adenocarcinoma missed detection when used alone.Compared with the traditional TCT,there is no advantage for the diagnosis efficiency of CINⅡ+screen.

关 键 词：宫颈上皮内瘤变 人乳头状瘤病毒E6/E7 mRNA 液基薄层细胞学检测 

分 类 号：R737.33[医药卫生—肿瘤]