高危型人乳头瘤病毒E6/E7 mRNA在宫颈细胞学ASCUS/LSIL/ASC-H分流中的意义

目的:比较高危型人乳头瘤病毒(HR-HPV)E6/E7 mRNA与HR-HPV DNA检测在宫颈病变筛查中的诊断性能。探讨其在宫颈细胞学ASCUS/LSIL/ASC-H分流中的意义。方法:收集2016年5月至11月就诊于清华长庚医院妇科的液基细胞学结果为ASCUS、LSIL、ASC-H的患者251例,分别行宫颈脱落细胞HR-HPV DNA、HR-HPV E6/E7mRNA检测,并行阴道镜检查及宫颈活体组织检查,以组织学病理为金标准。结果:HRHPV E6/E7 mRNA阳性率在ASCUS、LSIL和ASC-H中分别为18.34%(20/108)、28.82%(30/102)和39.51%(17/41)。宫颈活检病理结果子宫颈低级别病变(湿疣/CIN1组)与高级别病变(CIN2/3)组的HR-HPV E6/E7 mRNA阳性率比较,差异有统计学意义(P=0.0125)。以子宫颈活检的组织学诊断结果为金标准,HR-HPV E6/E7 mRNA筛查子宫颈高级别病变的特异性及阳性预测值均明显高于HPV-DNA。ASCUS/LSIL/ASC-H中,HRHPV E6/E7 mRNA检测筛查宫颈高级别病变的ROC曲线面积均大于HPV-DNA,诊断效能优于HPV-DNA。结论:HPV E6/E7 mRNA检测诊断宫颈高级别病变的特异性及阳性预测值高于HPV-DNA,能辅助宫颈细胞学筛查及HPV-DNA,提高宫颈高级别病变诊断的特异性,在细胞学检查阶段对患者做出有效分流,预测宫颈高级别病变。

Significance of high risk human papillomavirus E6/E7 mRNA in cervical cytology AS-CUS/LSIL/ASC-H

Objective:To compare the difference of HR-HPV E6/E7 mRNA and HR-HPV DNA in cervical cancer screening. To investigate the application value of human papillo-mavirus E6/E7 mRNA in the cytological screening ASCUS/LSIL/ASC-H. Methods:251 cases who suffering from ASCUS/LSIL/ASC-H in TCT were collected from Department of Gynecology outpatient in Beijing Tsinghua Changgung Hospital from May. 2016 to Nov. 2016. HR-HPV E6/E7 mRNA and HPV-DNA detection were performed on the cervical cells. The result was com-pared with the pathological result of colposcopebiopsy. Results:The positive rates of HR-HPV E6/E7 mRNA in ASCUS,LSIL and ASC-H were 18. 34％(20/108),28. 82％(30/102) and 39. 51％(17/41),respectively. Cervical exfoliated cells HR-HPV E6/E7 mRNA expression rate difference was statistically significant ( P=0 . 0125 ) between cervical low-grade lesions ( wet wart /CIN1 group ) and high level lesions ( Cin2/3 group ) , The specificity and positive predictive value of HR-HPV E6/E7 mRNA detection and diagnosis were higher than that of HPV-DNA,and the ROC curve areas of HR-HPV E6/E7 mRNA were bigger than HPV-DNA in ASCUS/LSIL/ASC-H. Conclusion:The specificity and positive predictive value of HR-HPV E6/E7 mRNA in the diagnosis of cervical high grade lesion was higher than HR-HPV detec-tion . HR-HPV E6/E7 mRNA could assist cervical cytology screening and HPV-DNA to improve the specificity of the diagnosis of high-grade cervical lesions, and make effective triage in the cytology stage to predict the possibility of high-grade cervical lesions.