HPV E6/E7 mRNA检测对ASCUS患者临床分层处理价值评价

摘要

目的:探讨HPV E6/E7 mRNA检测在意义不明确的不典型鳞状细胞(ASCUS)人群进一步处理措施中的分层管理价值.方法:对112例ASCUS患者,同时行HPV E6/E7 mRNA、HPV DNA检测以及阴道镜下活检.结果:①ASCUS患者宫颈活检结果分布于宫颈炎及宫颈上皮内瘤变(CIN)Ⅰ、Ⅱ、Ⅲ病变中.②HPV E6/E7 mRNA检测ASCUS中高级别病变的敏感性(94.44％)与HPV DNA检测相比差异无统计学意义(P＞0.05).而特异性(45.74％)高于HPV DNA检测(18.89％),差异有统计学意义(P＜0.05).③随着宫颈病变级别升高,HPV E6/E7 mRNA载量增加,且各级别病变间差异有统计学意义(P ＜0.0083);HPV DNA载量在各级别病变中的差异无统计学意义(P＞0.0083).④ROC曲线确定的HPV E6/E7 mRNA诊断高级别宫颈上皮内瘤变(CINⅡ+)的最佳诊断临界点为543.64 copy/ml,曲线下面积为0.780.结论:ASCUS病理结果具有多样性,HPV E6/E7mRNA检测不仅可以检出其中的高级别宫颈病变,减少了不必要的阴道镜检查及活检,还能及时发现潜在高级别宫颈病变,避免高危患者漏诊.%Objective:To explore the layered management value of the further method dealt with in ASCUS(atypical squamous cells undetermined significance) of HPV E6/E7 mRNA Detection.Methods:112 cases who suffered from ASCUS were underwent HPV DNA test,HPV E6/E7 mRNA test,colposcopy and biopsy.Results:①The biopsy results of 112 cases of ASCUS contained cervicitis,CIN Ⅰ,CIN Ⅱ,and CIN Ⅲ.②There was no significant difference on the sensitivity for detecting high-level lesions between HPV E6/E7 mRNA(94.44％) and HPV E6/E7 mRNA(P ＞0.05).However,the specificity of HPV E6/E7 mRNA(45.74％)was significantly higher than that of HPV E6/E7 mRNA(18.89％,P ＜0.05).③The HPV E6/E7 mRNA loads increased significantly by the increasing of the level of cervical lesions(P ＜ 0.0083);there was no significant difference on the HPV DNA loads among different level of cervical lesions(P ＞ 0.0083).④The CIN Ⅱ + best diagnostic critical point was 543.64 copies/ml,which was established by receiver operating characteristic(ROC) curve,and the area under the curve was 0.780.Conclusions:Among ASCUS,the pathological diagnosis were diverse,HPV E6/E7 mRNA test can detect most high-level lesions,reduced unnecessary colposcopy and biopsy,and can timely find these patients with high-level lesions potentially and avoid misdiagnosis of high risk cases.