摘要
目的:探讨人乳头瘤病毒(HPV)E6/E7 m RNA检测在CINII及以上宫颈病变(CINII+)诊断中的应用价值。方法:2014年1月至9月在温州市人民医院妇科门诊行宫颈筛查发现新柏超薄液基细胞学检查(TCT)≥未明确意义的非典型鳞状上皮细胞(ASCUS)和/或高危HPV DNA阳性的患者426例,其中TCT结果为ASCUS者156例,均行宫颈HPV E6/E7 m RNA检测和组织病理学检查。根据病理结果将病例分为5组,分析HPV E6/E7 m RNA拷贝数与病变程度的相关性。利用受试者工作特征(ROC)曲线评价HPV E6/E7 m RNA对ASCUS患者CINII+的预测价值。结果:宫颈癌组HPV E6/E7 m RNA拷贝数最高,慢性子宫颈炎组拷贝数最低。Spearman等级相关分析显示组织学病变程度与HPV E6/E7 m RNA水平与之间存在正相关性(r=0.549,P<0.001)。在CINII+中,HPV E6/E7 m RNA阳性率为91.6%,HR-HPV DNA阳性率为93.0%,差异无统计学意义(x2=0.197,P>0.05)。ROC曲线显示,HPV E6/E7 m RNA预测CINII+最佳临界值为147.965。HPV E6/E7 m RNA与HR-HPV DNA检测预测ASCUS患者CINII+的灵敏度、阴性预测值相比较,差异均无统计学意义(P>0.05);两者特异度、阳性预测值比较,差异有统计学意义(P<0.05)。结论:随着宫颈病变程度增加,HPV E6/E7 m RNA拷贝数相应增加。与HPV DNA检测方法相比,HPV E6/E7 m RNA检测对ASCUS患者CINII+的特异度、阳性预测值更高,可作为ASCUS患者分流管理的有效措施。
Objective：To evaluate the application value of detecting human papilloma virus（HPV） E6/E7 m RNA as a diagnose test for CINII＋.Methods：From January to October in 2014,a total of 426 gynecological outpatients,whose TCT≥ASCUS or/and high-risk HPV DNA positive,were found by cervical lesions screening in Wenzhou People＇s Hospital.All those outpatients performed HPV E6/E7 m RNA detection and histopathological examination.According to different histological results,samples were divided into 5 groups,the correlation between the expression of HPV E6/E7 m RNA and the severity of cervical lesions were analyzed.The ROC curve was used to assess the predictive value of HPV E6/E7 m RNA for CINII＋ of ASCUS.Results：The cervical cancer group had the highest level of HPV E6/E7 m RNA while the chronic cervical inflammation group had the lowest.Spearman rank analysis demonstrated that the severity of cervical lesions was proportional to the expression of HPV E6/E7 m RNA（r=0.549,P〈0.001）.For CINII＋,there was no significant difference between HPV E6/E7 m RNA and high-risk HPV DNA in positive rate（x2=0.197,P〈0.05）.The ROC curve showed that HPV E6/E7 m RNA147.965 were superior to any other standards to scan CINII＋.The sensitivity and negative predictive value of HPV E6/E7 m RNA and HR-HPV DNA in predicting CINII＋ of patients with ASCUS showed no statistically significant difference（P〈0.05）,while the specificity and positive predictive value showed statistically significant difference（P〈0.05）.Conclusion：The copy number of HPV E6/E7 m RNA transcripts is correlated with severe degree of epithelial cervical dysplasia.The specificity and positive predictive value of HPV E6/E7 m RNA detection are higher than those of HPV DNA for diagnosis of CINII＋ in patients with ASCUS,therefore HPV E6/E7 m RNA detection may be a valuable tool for triage and patient follow-up.
出处
《温州医学院学报》
CAS
2015年第8期583-587,共5页
Journal of Wenzhou Medical College
