高危型HPV分型检测、HPV E6/E7mRNA检测及DNA倍体分析在宫颈HSIL+病变筛查中的应用价值  

Application value of high-risk HPV subtype,HPV E6/E7mRNA detection and DNA ploidy analysis in cervical HSIL+lesion screening

作　　者：张晓童 姚宗花[1] 刘钰[1] 孙苗苗[1] 郭山伟 贾相齐 南芳芳[1] ZHANG Xiaotong;YAO Zonghua;LIU Yu;SUN Miaomiao;GUO Shanwei;JIA Xiangqi;NAN Fangfang(Department of Gynecology,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China)

机构地区：[1]滨州医学院附属医院妇科,山东滨州256603

出　　处：《滨州医学院学报》2022年第3期182-185,共4页Journal of Binzhou Medical University

摘　　要：目的探讨高危型人乳头状瘤病毒(HR-HPV)分型检测、HPV E6/E7mRNA检测和DNA倍体分析在宫颈高级别鳞状上皮内病变(HSIL)+病变筛查中的临床价值,制定最合理的宫颈癌筛查方案。方法收集2017年6月1日至2018年12月30日于滨州医学院附属医院行三项宫颈癌筛查并有宫颈组织活检病理结果的516例患者的临床资料。根据病理结果分为宫颈HSIL+组(HSIL及宫颈癌)和宫颈低级别鳞状上皮内病变(LSIL)-组(炎症及LSIL),比较三种方法筛查宫颈HSIL+病变的灵敏度、特异度、阳性预测值、阴性预测值、约登指数、准确率及ROC曲线下面积,评价三种宫颈癌筛查方法在诊断宫颈HSIL+病变的临床价值。结果单独使用三种方法筛查宫颈HSIL+病变时,HR-HPV分型检测的灵敏度(94.2%)及阴性预测值(96.3%)最高,而DNA倍体分析的特异度(77.2%)、阳性预测值(48.6%)、约登指数(0.474)以及准确度(75.5%)最高,综合评价以HPV E6/E7mRNA的筛查效能最高(ROC-AUC=0.819)。联合筛查中以三种方法联合筛查的ROC曲线下面积最大(ROC-AUC=0.853)。结论三种筛查方法在筛查宫颈HSIL+病变时均有意义,三者联合筛查诊断价值最高,有效提高了宫颈高级别及以上病变的诊断率。Objective To investigate the clinical value of HR-HPV typing,HPV E6/E7mRNA detection and DNA ploidy analysis in screening for HSIL+lesions,and to develop the most reasonable cervical cancer screening program.Methods Clinical data were collected of 516 patients who underwent three cervical cancer screenings and had pathological results of cervical biopsy in Binzhou Medical University Hospital from June 1,2017 to December 30,2018.According to pathological results,the patients were divided into HSIL+group(HSIL and cervical cancer)and cervical LSIL-group(inflammation and LSIL).The sensitivity,specificity,positive predictive value,negative predictive value,Yoden index,accuracy and area under ROC curve of screening for HSIL+lesions were compared to evaluate the clinical value of three screening methods for cervical cancer in the diagnosis of HSIL+lesions.Results When the three methods were used alone to screen for HSIL+lesions,HR-HPV typing had the highest sensitivity(94.2%)and negative predictive value(96.3%),while DNA ploidy analysis had the highest specificity(77.2%),positive predictive value(48.6%),Yodon index(0.474)and accuracy(75.5%).HPV E6/E7mRNA screening efficiency was the highest(ROC-AUC=0.819)in overall evaluation.In the combined screening,the area under ROC curve of screening of the three methods combined was the largest(ROC-AUC=0.853).Conclusion The three screening methods have significance in screening for HSIL+lesions,and the combined screening of the three has the highest diagnostic value,which can effectively improve the diagnosis rate of high-grade and above cervical lesions.

关 键 词：宫颈癌 宫颈高级别鳞状上皮内病变 人乳头状瘤病毒 高危型HPV分型 HPV E6/E7mRNA DNA倍体分析 

分 类 号：R737.33[医药卫生—肿瘤]