HPV E6/E7mRNA在不同级别上皮内瘤变中的表达及与临床病理因素、预后的关系研究  

Expression of HPV E6/E7 mRNA in different grades of intraepithelial neoplasia and its relationship with clinicopathological factors and prognosis

作　　者：周朋 沈需 吉晓霞 贺研 刘亚萍[3] ZHOU Peng;SHEN Xu;JI Xiao-xia(Department of Pathology,Yuncheng Central Hospital,Yuncheng Shanxi 044000,China;Department of Gynecology,Yuncheng Central Hospital,Yuncheng Shanxi 044000,China)

机构地区：[1]运城市中心医院病理科,山西运城044000 [2]运城市中心医院妇科,山西运城044000 [3]西安交通大学第一附属医院消化内科,陕西西安710061

出　　处：《临床和实验医学杂志》2022年第11期1188-1192,共5页Journal of Clinical and Experimental Medicine

基　　金：运城市中心医院院级项目(编号:YNLC2021034);陕西省重点研发计划项目(编号:2022SF-373)。

摘　　要：目的探讨在不同上皮瘤变(CIN)疾病患者宫颈组织中人乳头瘤变病毒(HPV)E6/E7 mRNA检出率差异及对CIN进展及诊断的影响作用。方法回顾性选取2018年1月至2020年10月运城市中心医院妇科门诊接受宫颈脱落细胞学检查发现HPV感染的妇女200例作为研究对象。根据阴道镜检及宫颈病理学检查将患者分为CINⅠ级98例、CINⅡ级63例、CINⅢ级30例、浸润性鳞癌及腺癌组9例。对比不同组别患者的HPV E6/E7 mRNA、HPV(PCR-反向点杂交)阳性表达率差异;观察不同HPV E6/E7 mRNA表达水平的CINⅠ级患者随访1年后疾病进展情况;采用单因素及多因素方法分析影响不典型鳞状上皮细胞诊断为高级别上皮瘤变的相关因素。结果CINⅠ级组患者的HPV(PCR-反向点杂交)、HPV E6/E7 mRNA的阳性表达率均低于CINⅡ级、CINⅢ级、浸润性鳞癌及腺癌组患者,差异均有统计学意义(P<0.05);CINⅡ级、CINⅢ级、浸润性鳞癌及腺癌组患者的HPV(PCR-反向点杂交)、HPV E6/E7 mRNA的阳性表达率差异无统计学意义(P>0.05)。HPV(PCR-反向点杂交)诊断CINⅡ级的灵敏度为74.78%,特异度为70.66%,曲线下面积(AUC)值为0.714;HPV E6/E7 mRNA的诊断CINⅡ级的灵敏度为83.69%,特异度为78.53%,AUC值为0.789;Logistic多因素模型,结果显示:HPV(PCR-反向点杂交)阳性率、HPV E6/E7 mRNA阳性率是诊断CINⅡ级的独立危险因素(P<0.05)。HPV E6/E7 mRNA阳性表达的CINⅠ级患者发展为CINⅡ级患者的发生率为52.00%,显著高于HPV E6/E7 mRNA阴性表达患者(23.29%),差异有统计学意义(P<0.05)。HPV E6/E7 mRNA阳性表达的CINⅠ级患者发展为CINⅡ级患者的中位时间为显著短于HPV E6/E7 mRNA阴性表达患者(P<0.05)。结论HPV E6/E7 mRNA、HPV(PCR-反向点杂交)阳性表达与CIN分级疾病进展具有密切的关系,是CIN高级别病变的独立危险因素。Objective To investigate the difference in the detection rate of human papillomavirus(HPV)E6/E7 mRNA in cervical tissue of patients with different cervical intraepithelial neoplasia(CIN)diseases and its influence on the progression and diagnosis of CIN.Methods A total of 200 women with HPV infection were retrospectively selected from Department of Gynecological Clinic of Yuncheng Central Hospital from January 2018 to October 2020 and were found to have HPV infection by cervical exfoliative cytology examination.According to colposcopy and cervical pathological examination,the patients were divided into 98 cases of CIN grade Ⅰ,63 cases of CIN grade Ⅱ,30 cases of CIN grade Ⅲ,and 9 cases of invasive squamous cell carcinoma and adenocarcinoma group.The differences in the positive expression rates of HPV E6/E7 mRNA and HPV(PCR-reverse dot blot)in different groups of patients were compared;the disease progression of CINⅠ patients with different HPV E6/E7 mRNA expression levels was observed after 1-year follow-up,and factors associated with the diagnosis of high-grade epithelial neoplasia in atypical squamous cells were analyzed using univariate and multivariate methods.Results The positive expression rates of HPV(PCR-reverse dot blot)and HPV E6/E7 mRNA in the CIN grade Ⅰ group were lower than those in the CIN grade Ⅱ,CIN grade Ⅲ,invasive squamous cell carcinoma and adenocarcinoma groups,and the differences were statistically significant(P<0.05);there was no significant difference in the positive expression rates of HPV(PCR-reverse dot blot)and HPV E6/E7 mRNA between CIN grade Ⅱ,CIN grade Ⅲ,invasive squamous cell carcinoma and adenocarcinoma groups(P>0.05).The sensitivity of HPV(PCR-reverse dot blot)in the diagnosis of CIN grade Ⅱ was 74.78%,the specificity was 70.66%,and the area under the curve(AUC)value was 0.714;the sensitivity of HPV E6/E7 mRNA in the diagnosis of CINⅡ was 83.69%,the specificity was 78.53%,and AUC value was 0.789.Logistic multivariate model,the results showed:HPV(PCR-reverse do

关 键 词：宫颈上皮瘤变 人乳头瘤变病毒 宫颈癌 宫颈脱落细胞学检查 

分 类 号：R737.33[医药卫生—肿瘤]