宫颈细胞 HPV E6／E7 mRNA 检测在宫颈病变诊断中的价值

目的：评价高危型人乳头状瘤病毒（ HPV） E6/E7 mRNA检测对宫颈病变的诊断价值。方法520例患者采用b-DNA技术检测HPV E6/E7 mRNA，并用宫颈液基细胞学（ TCT）行宫颈细胞学检查，对其中任何一项阳性者做阴道镜下宫颈活组织检查，以组织病理为金标准，计算HPV E6/E7 mRNA阳性对高级别宫颈上皮内瘤样病变（ CIN）、宫颈浸润癌诊断的灵敏度、特异度、阳性预测值、阴性预测值，并与TCT检查进行比较。结果520例患者中HPV E6/E7 mRNA阳性158例， TCT异常222例。 TCT 异常者中HPV E6/E7 mRNA阳性率较TCT 正常者中HPV E6/E7 mRNA阳性率高（P＜0．05）。146例慢性宫颈炎、CINⅠ级患者与124例高级别CIN、宫颈浸润癌患者中HPV E6/E7 mRNA阳性率比较，P＜0．05。 HPV E6/E7 mRNA阳性对高级别CIN及宫颈浸润癌诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为74．19％、83．33％、58．23％、71．43％，TCT 检查分别为81．53％、69．44％、81．45％、92．28％，两者特异度及阳性预测值比较， P均＜0．05。结论在宫颈癌筛查中检测高危型HPV E6/E7 mRNA对预测高级别CIN，尤其对评估癌症风险有重要的临床价值。

Clinical value of branch-DNA technique for human papillomavirus E6/E7 mRNA detection in cervical lesions

Objective To evaluate the clinical value of human papillomavirus （ HPV） E6/E7 mRNA detection in diagnosis of cervical lesions.Methods Totally 520 patients were examined with b-DNA technology to detect HR-HPV E6/E7mRNA and the cervical cytological examination with liquid-based cytology （TCT）.Women with cytologi-cal abnormalities or HR-HPV E6/E7 mRNA positive results underwent colposcopy and cervical biopsy .We compared the sensitivity, specificity, positive predictive value and negative predictive value between the HPV E6/E7mRNA and TCT for the detection of high-grade cervical intraepithelial neoplasias （ CIN） and cervical cancer （ CC） .Results A-mong 520 patients, 158 cases were found HPV E6/E7mRNA positive and 222 cases got TCT abnormal.The positive rate of HPV E6/E7 mRNA with abnormal results in TCT abnormal group was higher than that of the normal group （ P〈0.05） .There was difference in the positive rate of HPV E6/E7mRNA between the group who got chronic cervicitis or low-grade intraepithelial neoplasias （CINⅠ） and the group who got high-grade CIN and CC （P〈0.05）.For the detection of high-grade CIN and CC, the sensitivity of HPVE6/E7 mRNA and TCT was 74.19% and 81.53%, re-spectively; the specificity was 83.33% and 69.44%, respectively; the positive predictive value was 58.23% and 81.45%, respectively; and the negative predictive value was 71.43% and 92.28% respectively.The specificity and positive predictive value was statistically different between the two groups （all P〈0.05）.Conclusion In cervi-cal cancer screening, high-risk HPV E6/E7 mRNA detection in predicting high-grade CIN has high clinical value, es-pecially for assessing the risk of malignancy.