液基细胞学联合 HPV mRNA 检测对宫颈癌的诊断价值

目的：探索高危型 HPV E6／E7 mRNA 和 HPV E6／E7 DNA 两种检测方法分别联合宫颈薄层液基细胞学检查（TCT）应用于宫颈癌早期诊断的临床意义。方法：选择2013年1月至2014年12月我院妇科门诊就诊行 TCT 检查的259例检测标本，对高危型 HPV E6／E7 mRNA 和 HPV E6／E7 DNA 进行检测，结合 xb 细胞病理学分级和组织病理学诊断进行统计分析。结果：纳入研究的259例患者中 HPV E6／E7 mRNA 检测阳性率为35．1％（91／259），HPV E6／E7 DNA 检测阳性率为52．1％（135／259）。NILM、ASCUS、LSIL、HSIL 四种细胞病理学分级 HPV E6／E7 mRNA 和 HPV E6／E7 DNA 检出率分别为23．5％、29．4％、64．3％、66．7％和32．4％、52．5％、61．9％、83．3％。对于正常组织，HPV E6／E7 mRNA 的敏感度、准确度和阳性预测值均低于HPV E6／E7 DNA（P ＜0．05），但特异度和阴性预测值高于 HPV E6／E7 DNA（P ＜0．001）。对于 CIN1组织， HPV E6／E7 mRNA 的敏感度、特异度和阳性预测值均低于 HPV E6／E7 DNA（P ＜0．05），但准确度和阴性预测值高于 HPV E6／E7 DNA（P ＜0．001）。在 CIN2和 CIN3组织中，HPV E6／E7 mRNA 的准确度和阴性预测值均高于 HPV E6／E7 DNA（P ＜0．001），HPV E6／E7 mRNA 的敏感度、特异度、阳性预测值与 HPV E6／E7 DNA 无统计学差异（P ＞0．05）。结论：高危型 HPV E6／E7 mRNA 检测能更准确地反映病毒感染后的活化状态，HPV宫颈薄层液基细胞学检查联合高危型 HPV E6／E7 mRNA 检测可提高宫颈癌早期筛查的准确性。

Clinical value of combination of HPV E6/E7 mRNA assay and thinprep cytologic test as-say in screening of cervical cancer

Objective:To assess the clinical value of combination of HPV E6 /E7 mRNA assay and thinprep cyto-logic test assay in screening of cervical cancer.Methods:Exfoliative cervical cells samples were collected from 259 women which carried cervical cancer screening by liquid based thinprep cytology test (TCT).Both the HPV E6 /E7 mRNA assay and the HPV E6 /E7 DNA assay were examined at the same time.The HPV E6 /E7 mRNA assay were performed by branch -DNA (bDNA)technology.The HPV E6 /E7 DNA assay were detected by HibriMax HPV -DNA genotyping.The data according to cytological pathology and histological pathology were analyzed.Results:The positive rates of HPV E6 /E7 mRNA and HPV E6 /E7 DNA were 34.7% (90 /259)and 52.1% (135 /259).The HPV E6 /E7 mRNA positive rates for NILM,ASCUS,LSIL,HSIL were 23.5%,29.4%,64.3%,66.7% respectively, and the HPV E6 /E7 DNA positive rates for NILM,ASCUS,LSIL,HSIL were 32.4%,52.5%,61.9%,83.3% re-spectively.In normal cervical tissues,the sensitivity,accuracy,positive predictive value of HPV E6 /E7 mRNA were lower than the ones of HPV E6 /E7 DNA (P <0.05),and specificity,negative predictive value of HPV E6 /E7 mRNA was higher than the ones of HPV E6 /E7 DNA (P <0.001).In CIN1 tissues,the sensitivity,specificity and positive predictive value of HPV E6 /E7 mRNA were lower than the ones of HPV E6 /E7 DNA (P <0.05),and accuracy,neg-ative predicative value of HPV E6 /E7 mRNA were higher than HPV E6 /E7 DNA (P <0.001).In CIN2 and CIN3 tissues,the accuracy,negative predicative value of HPV E6 /E7 mRNA were higher than the ones of HPV E6 /E7 DNA (P <0.001).While there was no difference between the sensitivity,specificity,positive predicative value of HPV E6 /E7 mRNA and the ones of HPV E6 /E7 DNA (P >0.05).Conclusion:The HPV E6 /E7 mRNA assay can reflect the HPV infections leading to cellular transformation.The combination of the HPV E6 /E7 mRNA assay and thinprep cyto-logic test assay is more specific than HPV E6 /E7 DNA in triage of women in detection of cervical cancer.