人乳头瘤病毒E6/E7mRNA检测在不典型鳞状细胞患者中的临床应用

摘要

目的 探讨人乳头瘤病毒(HPV)E6/E7mRNA检测在无明确诊断意义的不典型鳞状细胞(ASC-US)患者中的临床应用价值.方法 对320例ASC-US患者进行HPV E6/E7mRNA和高危型HPV(HR-HPV)DNA检测,结合病理学诊断资料进行统计学分析.结果 CINⅡ+级和CINⅢ+级的HPV E6/E7mRNA阳性率分别高于CINⅡ-级和CINⅢ-级,差异均有统计学意义(P<0.001);不同等级宫颈病变的HPV E6/E7mRNA拷贝数不同,差异有统计学意义(P<0.001),且宫颈病变级别与mRNA拷贝数之间呈正相关.HPV E6/E7mRNA与HR-HPV DNA检测CINⅡ+级和CINⅢ+级的灵敏度、阳性预测值、阴性预测值差异均无统计学意义(P>0.05);两者特异度比较,差异有统计学意义(P<0.001).结论 HPV E6/E7mRNA检测作为ASC-US的分流指标更确切有效,是目前ASC-US患者是否阴道镜转诊的较佳分流策略.%Objective To investigate the clinical value of human papillomavirus E6/E7mRNA test in patients with atypical squamous cell of undetermined significance(ASC-US). Methods Three hundred and twenty patients with ASC-US had HPVE6/E7 mRNA and high-risk(HR) HPV DNA testing.The testing results combined with pathological diagnosis were analyzed. Results The positive rate of HPV E6/E7 mRNA for cervical intraepithelial neoplasia(CIN)Ⅱ+ and CINⅢ+ were higher than that of CINⅡ- and CINⅢ-,and the difference was statistically significant (P<0.001).HPV E6/E7mRNA copy number of different grades of cervical lesions was significantly different(P<0.001).It was confirmed that there was positive correlation between the level of cervical lesion and the copies of mRNA.There were no significantly difference(P>0.05)in sensitivity, positive predictive value,negative predictive value between HPV E6/E7 mRNA test and HR-HPV DNA test for CINⅡ+ and CINⅢ+,but the specificity showed statistically significantly difference(P<0.001). Conclusion HPVE6/E7mRNA test is more effective in triage of patients with ASC-US,and is currently a better triage test for patients with ASC-US whether or not colposcopy referral.