高危型人乳头状瘤病毒E6/E7 mRNA在宫颈CIN2+病变筛查中的应用价值

目的探讨高危型人乳头状瘤病毒(HR-HPV) E6/E7 mRNA在子宫颈上皮内瘤变中度及以上(CIN2+级)病变筛查中的临床应用价值。方法选取2016年6月至2017年6月在北京市垂杨柳医院因接触性阴道出血或疑似宫颈病变妇科门诊就诊的患者307例,均行液基薄层细胞检查(TCT)、HPV DNA、HPV E6/E7 mRNA的检测,并行阴道镜检查及活检。以病理结果为金标准,将病检结果为高级别鳞状上皮内病变(HSIL,包括CIN2和CIN3)或宫颈鳞癌或宫颈腺癌的71例患者作为观察组,记为CIN2+;将病检结果正常和低级别鳞状上皮内病变(LSIL,包括CIN1)的236例患者作为对照组,记为CIN2-。分析TCT、HPV DNA、HPV E6/E7 mRNA的灵敏度和特异度差异。结果 HPV E6/E7mRNA及HPV DNA对CIN2+诊断的特异度分别为79. 66%及19. 49%,差异有统计学意义(P <0. 05)。HPV E6/E7mRNA联合TCT及HPV DNA联合TCT检测对CIN2+诊断的特异度分别为82. 63%及35. 17%,差异有统计学意义(P <0. 05)。HPV E6/E7 mRNA、HPV DNA在筛查CIN2+的ROC曲线下面积分别为0. 8420和0. 5693,差异有统计学意义(P <0. 05)。结论 HPV E6/E7 mRNA较HPV DNA检测筛查宫颈CIN2+的病变效果更好,HPVE6/E-7mRNA联合TCT检测能够提高对CIN2+的病变筛查的特异性。

Clinical significance of HR-HPV E6/E7 gene in screening cervical CIN2+ lesions

Objective To explore the clinical value of high-risk human papillomavirus (HR-HPV) E6/E7 gene in screening cervical intraepithelial neoplasia (CIN2+grade) lesions. Methods From June 2016 to June 2017, 307 patients with contact vaginal bleeding or suspected cervical lesions in Gynecological Outpatient Clinic of Beijing Chuiyangliu Hospital were examined by liquid-based thin-layer cytology (TCT), HPV DNA, HPV E6/E7 mRNA, colposcopy and biopsy. The pathological results were regarded as the gold standard, and the pathological results were regarded as high-grade squamous intraepithelial lesions (HSIL), including CIN2 and CIN3, or 71 patients with cervical squamous cell carcinoma or cervical adenocarcinoma, were recorded as CIN2+. Then 236 patients with normal and low-grade squamous intraepithelial lesions (LSIL, including CIN1) as control group were recorded as CIN2-. The sensitivity and specificity of TCT, HPV DNA and HPV E6/E7 mRNA in two groups were analyzed. Results The specificity of HPV E6/E7 mRNA and HPV DNA in the diagnosis of CIN2+ was 79.66% and 19.49%, respectively, with significant difference (P<0.05). The specificity of HPV E6/E7 gene combined with TCT and HPV DNA combined with TCT in the diagnosis of CIN2+ was 82.63% and 35.17%, respectively, with significant difference (P<0.05). HPV E6/E7 and HPV DNA was 0.8420 and 0.5693 under the ROC curve of CIN2 + screening, respectively, with significant difference (P<0.05). Conclusion HPVE6/E7 mRNA is better than HPV DNA in screening CIN2+. HPVE6/E7 mRNA combined with TCT detection can improve the specificity of screening CIN2+.