HPV E6/E7 mRNA检测对宫颈锥切术后病灶残留和复发的诊断价值

目的：探讨HPV E6/E7 mRNA检测对宫颈上皮内瘤变 (cervical intraepithelial neoplasia，CIN)患者宫颈锥切术后病灶残留和复发的诊断价值。 方法：对已行宫颈锥切术并经组织病理学确诊为高级别宫颈上皮内瘤变(CIN II，III)、有完整随访资料的154例患者，在术后第3~6个月、第12个月行薄层液基细胞学检查 (thin-prep cytology test，TCT)、HPV-DNA检测、HPV E6/E7 mRNA检测，对细胞学异常[≥未明确意义的非典型鳞状上皮细胞(atypical squamous cell of undetermined significance，ASC-US) ]或高危型HPV-DNA(+)或HPV E6/E7 mRNA(+)者均再次行阴道镜检查及宫颈活检病理诊断。结果：病灶残留9例，复发22例。术后HPV-DNA(+)的57例中，残留/复发30例；HPV E6/E7 mRNA(+)的26例中，残留/复发24例。HPV-DNA检测敏感性、特异性、阳性预测值、阴性预测值及诊断正确率分别为96.8%，78.0%，52.6%，99.0%及81.8%；HPV E6/E7 mRNA检测敏感性、特异性、阳性预测值、阴性预测值及诊断正确率分别为77.4%，98.4%，92.3%，94.5%及94.2%。HPV E6/E7 mRNA检测的特异性和阳性预测值均高于HPV-DNA检测(P<0.05)。结论：将HPV E6/E7 mRNA检测纳入随访检查内容可以及时有效预测宫颈锥切术后CIN残留/复发的风险，并能减少过度检查及治疗。

Diagnostic value of human papillomavirus E6/E7 mRNA for residue and recurrence after cervical conization

Objective: To explore the diagnostic value of human papillomavirus E6/E7 mRNA for residue and recurrence of cervical intraepithelial neoplasia (CIN) patients after cervical conization.Methods: A total of 154 patients, who underwent cervical conization and possessed complete follow-up data of high-grade cervical intraepithelial neoplasia (CINII, III), were subjected to thin-prep cytology test (TCT), HPV-DNA typing and HPV E6/E7 mRNA test in 3–6 months and 12 months after cervical conization. Abnormal cytology (≥ASC-US) or high-risk HPV–DNA (+) or HPV E6/E7 mRNA (+) cases were found by colposcopy and cervical biopsy pathological diagnosis.Results: Nine patients had residue and 22 recurred. HPV-DNA detections after cervical conization in 57 patients were positive. Among them, 30 patients had residual/recurrent lesions. HPV E6/E7 mRNA detections in 26 patients were positive. Among them, 24 patients had residual/recurrent lesions. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis in the detection of HPV-DNA were 96.8%, 78%, 52.6%, 99%, and 81.8%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of diagnosis in the detection of HPV E6/E7 mRNA were 77.4%, 98.4%, 92.3%, 94.5%, and 94.2%, respectively. The specificity and positive predictive value of HPV E6/E7 mRNA test were greater than those of HPV-DNA typing test. There was a significant difference between the two groups (P<0.05).Conclusion: Detection of HPV E6/E7 mRNA during the follow-up period could timely and effectively forecast the risk of residue and recurrence of CIN after cervical conization, and reduce excessive examination and treatment.