高危型人乳头瘤病毒E6/E7 mRNA检测在意义不明的非典型鳞状上皮细胞中的分流价值

目的研究高危型人乳头瘤病毒(high-risk human papillomavirus,hrH PV)E 6/E 7 mRNA在结果意义不明的非典型鳞状上皮细胞(atypical squamous cells of undetermined significance,ASCUS)中的分流效率,探索其在ASCUS分流中的临床价值。方法选取2013年至2015年在青岛市立医院妇科门诊行细胞学筛查结果为ASCUS的女性405例,年龄21~65岁。根据HPV检测方法,分为3组:HC2组、HPV分型组、hrH PV E 6/E 7 mRNA(E6/E7)组。比较3种HPV检测方法分流ASCUS的灵敏度、特异度、阳性预测值、阴性预测值、阴道镜转诊率、CIN 2~+/CIN 3~+检出率。结果 (1)E 6/E 7分流ASCUS的CIN 2~+灵敏度为100.00%(90.51%~100.00%),CIN 2~+/CIN 3~+的特异度分别为64.84%(53.06%~75.99%)、56.46%(43.98%~69.72%),阴性预测值分别为100.00%(99.41%~100.00%)、100.00%(99.34%~100.00%),与HC2和HPV分型比较差异无统计学意义(P>0.05)。阳性预测值分别为40.79%(37.91%~44.29%)、15.79%(10.07%~20.94%),高于HC2(P<0.05)。阴道镜转诊率为47.80%,低于HC2和HPV分型(P<0.05)。CIN 2~+检出率为19.50%,高于HC2(P<0.05)。(2)E 6/E 7分流ASCUS检测CIN 2~+的曲线下面积为0.815,>HC2和HPV分型(P<0.05)。结论 hrH PV E 6/E 7mRNA分流ASCUS的灵敏度、特异度与HC2相似,PPV和CIN 2~+检出率更高,阴道镜转诊率更低,可用于ASCUS的分流。

Value of high - risk human papillomavirus E6/E7 mRNA in atypical squamous cells of undetermined significance triage

Objective To explore high-risk human papillomavirus( hrHPV) E6 / E7 mRNA performance in atypical squamous cells of undetermined significance( ASCUS) triage, and to research the clinical value and feasibility in cervical screening. Methods 405 women with ASCUS result in Qingdao Municipal Hospital Affiliated of Qingdao University from 2013 to 2015 were selected,who were between 21 and 65 years old. According to the HPV triage tests, patients were divided into three groups: HC2 group, HPV genotyping group and hrHPV E6 / E7 mRNA ( E6/E7 ) group. We compared the accuracy of three triage methods, including sensitivity, specificity, positive predictive value( PPV) , negative predictive value( NPV) , colposcopy referral rate, CIN 2 + / CIN 3 +detection rate. Results ① The sensitivities for CIN 2 + of ASCUS triage by E6/E7 were 100. 00% ( 90. 51% ~100. 00%) , specificities for CIN 2 + /CIN 3 + were 64. 84% ( 53. 06% ~75. 99%) , 56. 46% ( 43. 98% ~69. 72%) , NPVs were 100. 00%(99. 41% ~100. 00%), 100. 00% (99. 34% ~100. 00%) respectively, without significant difference compared with HC2 and genotyping(P>0. 05). PPVs were 40. 79% (37. 91% ~44. 29%), 15. 79% (10. 07% ~20. 94%), higher than HC2 (P<0. 05). The colposcopy referral rate was 47. 80%, lower than HC2 and genotyping ( P>0. 05 ) . CIN 2 + detection rate was 19. 50%, higher than HC2, the difference was statistically significant (P<0. 05). ②The AUC of E6/E7 for CIN 2 + were 0. 815,higher than HC2 and HPV genotyping statistically ( P <0. 05 ) . Conclusion The sensitivity and specificity of ASCUS triage by hrHPV E6/E7 mRNA is similar with HC2, with higher PPV and CIN 2 + detection rate and lower colposcopy referral rate. It is valuable in ASCUS triage.