人乳头瘤病毒 E6／E7 mRNA检测在宫颈癌筛查中的意义

目的：评估人乳头瘤病毒（HPV）E6／E7mRNA检测在宫颈癌筛查中的意义。方法对3381名行机会性宫颈癌筛查的女性分别行液基细胞学（TCT）、HPV DNA及HPV E6／E7mRNA检查，其中371例结果可疑者行阴道镜下活检。分别记录其TCT、HPV DNA及HPV E6／E7mRNA检测结果及活检病理结果等，采用SPSS 19．0软件进行数据分析。结果人群筛查中HPV E6／E7mRNA的总阳性率为16．47％（557／3381）；炎症患者与宫颈上皮内瘤变（CIN）Ⅰ级患者HPV E6／E7mRNA的阳性率分别为60．73％（116／191）和68．60％（83／121），差异无统计学意义（F＝1．98，P＞0．05）；炎症患者与CIN Ⅰ级患者mRNA表达量分别为7781．26±2686．13和7498．47±2860．08 copy／mL，亦无显著差异（ t＝0．07，P＞0．05），而CIN Ⅱ-Ⅲ级患者HPV E6／E7mRNA的阳性率为89．10％（49／55），mRNA表达量为30716．66±10281．89，均显著高于炎症患者（χ2＝15．55，t＝2．19）及CINⅠ患者（χ2＝8．47，t＝2．18），差异均有统计学意义（P＜0．05）；不同活检病理分级（≤CIN Ⅰ或≥CIN Ⅱ）中，只有HPV E6／E7mRNA的检测结果有显著性差异（χ2＝15．45，P＜0．05）；对于宫颈CIN Ⅱ以上病变的诊断，HPV E6／E7mRNA的敏感度最高（89．83％）；TCT特异度最高（62．18％）。 HPV E6／E7mRNA最佳工作点为1637．48copy／mL，其诊断宫颈高级别上皮内瘤变的敏感度为79．70％，特异度为63．50％。 ROC曲线下面积为0．75（P＜0．05）。结论 HPV E6／E7mRNA检测诊断宫颈高级别上皮内瘤变具有较高的敏感性和特异性，在宫颈癌筛查具有较为重要的意义。

Significance of human papillomavirus E6/E7mRNA detection in cervical cancer screening

Objective To evaluate the significance of human papillomavirus (HPV) E6/E7mRNA detection in cervical cancer screening . Methods A total of 3 381 women who had taken an opportunistic cervical cancer screening received thin -prep cytologic test (TCT), HPV DNA and HPV E6/E7mRNA examinations.Among them, 371 cases with suspicious results underwent colposcopy guided biopsy .The results of their TCT , HPV DNA and HPVE6/E7mRNA tests and the pathologic results were recorded and analyzed by SPSS 19.0 software. Results The total positive rate of the HPV E6/E7mRNA test was 16.47% (557/3 381).The positive rate of HPV E6/E7mRNA in patients with inflammation and cervical intraepithelial neoplasia Ⅰ(CIN Ⅰ) was 60.73% (116/191) and 68.60% (83/121), respectively.The difference was not significant (F=1.98, P>0.05).The mRNA expression levels of patients with inflammation and patients with CIN Ⅰwas 7 781.26 ±2 686.13 and 7 498.47 ±2 860.08 copy/mL, respectively.The difference was also not significant (t=0.07, P>0.05).However, the positive rate and mRNA expression levels of CIN Ⅱ-Ⅲpatients (89.10%[49/55];30 716.66 ± 10 281.89 copy/mL) were significantly higher than those of patients with inflammation (χ2 =15.55, t=2.19) and CINⅠpatients (χ2 =8.47, t=2.18).The differences were all statistically significant (all P<0.05).Only HPV E6/E7mRNA test results were significantly different (χ2 =15.45,P<0.05) in patients with different biopsy grade (≤CINⅠor≥CINⅡ).HPV E6/E7mRNA showed its highest sensitivity (89.83%) while TCT had the highest specificity (62.18%) in the diagnosis of CIN Ⅱand above.The optimal operating point of HPV E6/E7mRNA was 1 637.48copy/mL.The sensitivity in diagnosing high degree of CIN lesions was 79.70%and the specificity was 63.50%.The area under ROC curve was 0.75 (P<0.05).Conclusion HPV E6/E7mRNA test can detect and diagnose CIN lesions with relatively high sensitivity and specificity .Thus, it has important significance in cervical cancer screening .