HPV DNA和HPV E6/E7 mRNA在宫颈细胞学诊断分流中的应用  

The application of HPV DNA and HPV E6/E7 mRNA in cervical cytology dignostic triage

作　　者：过华蕾 陈豪 王文慧 尹晓娜 龚仪棠 GUO Hualei;CHEN Hao;WANG Wenhui;YIN Xiaona;GONG Yitang(Hangzhou Women’s Hospital,Hangzhou 310007,China)

机构地区：[1]杭州市妇产科医院,浙江杭州310007

出　　处：《浙江实用医学》2023年第1期5-8,共4页Zhejiang Practical Medicine

摘　　要：目的比较人乳头瘤病毒(human papillomavirus;HPV)E6和E7 mRNA(E6/E7 mRNA)和HPV DNA检测在分流宫颈细胞学检查结果为意义不明确的非典型鳞状上皮细胞(ASCUS)患者中的应用价值。方法选取2021年3月~2022年1月浙江省杭州市妇产科医院共300例液基细胞学诊断为ASCUS的就诊患者作为研究对象。其中150例ASCUS患者行HPV DNA二代杂交捕获(HC2)检测,另外150例ASCUS患者行HPV E6/E7 mRNA检测。300例均接受阴道镜活检和病理学检查,并以阴道镜活检的病理结果作为金标准,分析HPV DNA HC2检测以及HPVE6/E7 m RNA检测结果与宫颈病变病理分级的相关性。结果150例ASCUS患者中HPV E6/E7 mRNA检测阳性122例,HPV DNA HC2检测阳性136例。HPV E6/E7 mRNA在ASCUS患者宫颈脱落细胞中的阳性率随宫颈病变程度增加而增加,且与宫颈病变病理结果密切相关(χ^(2)=12.5,P=0.002)。与HPV DNA HC2检测相比,HPV E6/E7 mRNA检测具有较高的敏感度(95.0%)、特异度(27.8%)、阳性预测值(46.7%)、阴性预测值(89.3%)和诊断符合率(53.3%)。结论HPV E6/E7 mRNA检测阳性率与宫颈病变程度密切相关。HPV E6/E7 mRNA检测对ASCUS人群的分流效果优于HPV DNA HC2检测,可作为细胞学ASCUS人群的有效分流手段,降低阴道镜转诊率的同时有效降低宫颈病变的漏诊率。Objective To compare the application value of HPV DNA and HPV E6/E7 mRNA detection in triaging women with atypical squamous cells of undetermined significance.Methods From March 2021 to January 2022,a total of300 patients diagnosed as ASCUS based on liquid-based cytologic test were selected as the research objects in Hangzhou Women's Hospital.Among them,150 patients received HPV DNA detection and the other 150 patients received HPV E6/E7m RNA detection.Cervical biopsy under colposcopy and histopathological examination were performed for all patients.The pathological results of colposcopy biopsy were used as the gold standard to analyze the correlation between the results of HPV DNA HC2 and HPVE6/E7 mRNA detection with pathological grading of cervical lesions.Results There are 122 cases positive in HPV E6/E7 m RNA detection,while 136 cases positive in HPV DNA HC2 detection among 150 patients diagnosed as ASCUS separately.The positive rates of HPV E6/E7 mRNA increased with aggravation of cervical lesion.HPVE6/E7 mRNA positive was positively correlated with pathological results of cervical lesions (χ^(2)=12.5,P=0.002).Compared with HPV DNA HC2 detection,HPV E6/E7 mRNA detection had higher sensitivity(95%),specificity(27.8%),positive predictive value(46.7%),negative predictive value(89.3%)and diagnostic accordance rate(53.3%).Conclusion The positive rates of HPV E6/E7 mRNA detection were closely correlated with the severity of cervical lesion.Compared with HPV DNA HC2 detection,HPV E6/E7 mRNA detection can be used as a better method of ASCUS stratification management,to avoid unnecessary colposcopy referral and reduce the missed diagnosis of cervical lesions.

关 键 词：宫颈细胞学 高危型人乳头瘤病毒 E6/E7 mRNA HPV DNA 

分 类 号：R737.33[医药卫生—肿瘤]