HPV DNA检测、HPV E6/E7 mRNA检测和液基薄层细胞学检查对宫颈切除术后病灶残留或复发的预测价值  

Predictive value of HPV DNA detection,HPV E6/E7 mRNA detection and thinprep cytologic test for residual or recurrent lesions after cervical resection

作　　者：朱大华 陈家莲[1] 胡洋[1] 夏雪 赵雪 郭贝西 牟华平 Zhu Dahua;Chen Jialian;Hu Yang;Xia Xue;Zhao Xue;Guo Beixi;Mu Huaping(Department of Gynecology,the Second People's Hospital of Yibin,Sichuan,Yibin 644000,China)

机构地区：[1]宜宾市第二人民医院妇科,四川宜宾644000

出　　处：《发育医学电子杂志》2022年第3期203-208,共6页Journal of Developmental Medicine (Electronic Version)

基　　金：宜宾市科技计划(重点)项目(2017ZSF007-3)。

摘　　要：目的分析对比人乳头瘤病毒(human papilloma virus,HPV)DNA检测、HPV E6/E7 mRNA检测和液基薄层细胞学检查(thinprep cytologic test,TCT)在宫颈上皮内瘤样病变(cervical intraepithelial neoplasia,CIN)3+术后病变残留或复发的临床应用价值。方法选取2017年4月至2019年8月在宜宾市第二人民医院妇科手术治疗的530例宫颈CIN3+患者作为研究对象,术后对患者每3个月随访1次,共随访4次,建立随访档案。以HPV DNA、HPV E6/E7 mRNA检测和TCT作为随访监测指标,任一项指标异常即转诊阴道镜并行活检病理诊断,评估其对患者术后病灶残留或复发的随访价值。统计学方法采用t检验、χ^(2)检验。结果530例行宫颈切除术治疗的CIN3+患者随访1年,累计行阴道镜/活检的患者共114例,累计发现病灶残留/复发共计18例,残留/复发比例为5.7%(18/316)。手术后3、6、9、12个月,HPV E6/E7 mRNA检测阴性率分别为83.5%(264/316)、91.1%(288/316)、96.8%(306/316)、96.5%(305/316),TCT检测阴性率分别为97.2%(307/316)、97.2%(307/316)、98.7%(312/316)、99.1%(313/316),HPV DNA检测阴性率分别为53.2%(168/316)、72.8%(230/316)、81.0%(256/316)、85.4%(270/316),HPV E6/E7 mRNA与HPV DNA检测阴性率呈逐渐升高趋势。HPV E6/E7 mRNA检测联合TCT预测宫颈术后病变复发的敏感性低于HPV DNA检测联合TCT[44.4%(8/18)与55.6%(10/18)],但特异性[94.8%(91/96)]和阳性预测值[61.5%(8/13)]均高于HPV DNA检测联合TCT[89.6%(86/98)与50.0%(10/20)],差异均有统计学意义(P值均<0.05)。结论HPV E6/E7 mRNA检测联合TCT对于预测宫颈CIN3+手术治疗后复发或病灶残留的特异性和阳性预测值均较高,可用于评估宫颈高级别病变手术治疗的预后,早期发现病变风险,同时避免不必要的过度诊疗,减轻患者的焦虑和压力。Objective To analyze and compare the clinical application value of human papilloma virus(HPV)DNA detection,HPV E6/E7 mRNA detection and thinprep cytologic test(TCT)in residual or recurrence of postoperative cervical intraepithelial neoplasia(CIN3+).Method A total of 530 patients with CIN3+who underwent gynecological surgery in the Second People's Hospital of Yibin from April 2017 to August 2019 were selected as the research objects.The cases were followed up every 3 months after surgery for 4 times in total,and follow-up files were established.HPV DNA,HPV E6/E7 mRNA detection and TCT were used as follow-up monitoring indicators,and any abnormal indicators were referred to colposcopy for pathological diagnosis by biopsy and evaluated their follow-up value for postoperative residual or recurrence of lesions.Statistical methods were performed by t test orχ^(2) test.Result 530 CIN3+patients who underwent cervical resection were followed up for 1 year,a total of 114 cases underwent colposcopy or biopsy,and a total of 18 cases were found to have residual lesions or recurrence,the ratio of residual lesions or recurrence was 5.7%(18/316).The negative rates of HPV E6/E7 mRNA at 3,6,9 and 12 months after surgery were 83.5%(264/316),91.1%(288/316),96.8%(306/316),96.5%(305/316),respectively.The negative rates of TCT were 97.2%(307/316),97.2%(307/316),98.7%(312/316),99.1%(313/316),respectively.The negative rates of HPV DNA were 53.2%(168/316),72.8%(230/316),81.0%(256/316),85.4%(270/316),respectively.The negative rates of HPV E6/E7 mRNA and HPV DNA showed a gradually increasing trend.The sensitivity[44.4%(8/18)vs 55.6%(10/18)]of HPV E6/E7 mRNA combined with TCT was lower than that of HPV DNA combined with TCT,but the specificity[94.8%(91/96)]and positive predictive value[61.5%(8/13)]were higher than that of HPV DNA combined with TCT[89.6%(86/98)vs 50.0%(10/20)]showed statistical significance(all P<0.05).Conclusion HPV E6/E7 mRNA combined with TCT detection has high specificity and positive predictive value for predicting CIN3

关 键 词：人乳头瘤病毒 E6/E7 mRNA 液基薄层细胞学 HPV DNA 残留或复发 预测价值 

分 类 号：R737.33[医药卫生—肿瘤]