高危型人乳头瘤病毒E6/E7 mRNA在妊娠期高级别宫颈病变中的应用研究  

Application of HR-HPV E6 and E7 mRNA detection in the management of high grade cervical lesions during pregnancy

作　　者：杨咏梅[1] 王凤英[1] 廖秦平[2] 肖群[1] 康宁[1] Yang Yongmei;Wang Fengying;Liao Qinping;Xiao Qun;Kang Ning(Department of Obstetrics and Gynecology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院妇产科,北京100045 [2]清华大学附属北京清华长庚医院清华大学临床医学院妇产科

出　　处：《北京医学》2022年第4期287-291,共5页Beijing Medical Journal

基　　金：北京市医院管理局临床医学发展专项——“扬帆”计划(XMLX201605)。

摘　　要：目的评估高危型人乳头瘤病毒(high risk-human papilloma virus,HR-HPV)E6/E7 mRNA载量和HR-HPV DNA检测对于妊娠期宫颈高级别病变筛查的有效性及敏感度。方法选取2016年1月至2019年1月在首都医科大学宣武医院妇产科建档定期产检的孕妇1058例,分别进行宫颈液基薄层细胞学检测(thinprep cytologic test,TCT)及HPV DNA检测,依据结果行阴道镜检查,同时检测HR-HPV E6/E7 mRNA片段,评估HR-HPV E6/E7 mRNA和HR-HPV DNA对于高级别宫颈病变筛查的有效性,并行产后随访。结果HPV E6/E7 mRNA检测、HPV DNA检测筛查效能ROC曲线的AUC分别为0.600(95%CI:0.473~0.727)、0.557(95%CI:0.431~0.684)。在HPVDNA检测阳性的基础上进行HR-HPVE6/E7mRNA检测,可以将宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅱ级以上的宫颈高级别病变检测特异度、阳性预测值、阴性预测值提高,其中特异度由21.8%提升至76.7%,差异有统计学意义(P<0.05)。在产后随访中,宫颈病变维持或进展的病例中,妊娠期HR-HPV E6/E7 mRNA检测阳性率为81.8%。结论将HR-HPV E6/E7 mRNA检测用于妊娠期HR-HPV DNA检测阳性的病例,可提高CINⅡ级及以上高级别宫颈病变的筛查特异度。Objective To evaluate the effectiveness and sensitivity of E6/E7 mRNA detection in the diagnosis of high-grade cervical lesions during pregnancy by comparing with high-risk papilloma virus(HR-HPV)DNA detection.Methods A total of 1058 pregnant women who were registered and got regular prenatal examination in the Department of Obstetrics and Gynecology of Xuanwu Hospital,Capital Medical University from January 2016 to January 2019 were selected.Cervical thinprep cytologic test(TCT)and HPV DNA test were performed,and colposcopy was performed according to the results.At the same time,the effectiveness of HR-HPV E6/E7 mRNA and HR-HPV DNA in screening for high-grade cervical lesions was evaluated.Postpartum follow-up was conducted among the patients.Results The areas under the ROC curve of detective efficacy were 0.600(95%CI:0.473-0.727)in HPV E6/E7 mRNA detection and 0.557(95%CI:0.431-0.684)in HPV DNA test,respectively.The detection of HR-HPV E6/E7 mRNA based on the positive detection of HPV DNA could improve the specificity,positive predictive value and negative predictive value of high-grade cervical lesions above cervical intraepithelial neoplasia(CIN)Ⅱ,and the specificity increased from 21.8%to 76.7%(P<0.05).In the cases of maintenance or progression,the positive rate of HR-HPV E6/E7 mRNA detection during pregnancy was 81.8%.Conclusions The additional detection of HR-HPV E6/E7 mRNA during pregnancy in the cases with positive HR-HPV DNA can improve the diagnostic specificity of high-grade cervical lesions.

关 键 词：人乳头瘤病毒 E6/E7 mRNA 妊娠期 

分 类 号：R737.33[医药卫生—肿瘤] R714.2[医药卫生—临床医学]