HPV 病毒 E2mRNA 检测在宫颈病变筛查中的临床价值

Clinical significance of HPV -E2 mRNA detection in screening of cervical lesions

目的：探讨 HPV 病毒 E2mRNA 检测在宫颈病变筛查中的临床价值。方法收集582例 HR-HPV 阳性，TCT≤LSIL 的宫颈脱落细胞标本，应用 RT-PCR 检测 HPV 病毒 E2mRNA 的不同级别的宫颈病变表达并进行比较，评价其用于筛查宫颈病变的灵敏度、特异度、阳性预测值与阴性预测值等。结果随着宫颈病变恶性程度的升高，HPV 病毒 E2 mRNA 的表达呈下降趋势（χ2＝132．72，P ＜0．01）。细胞学结果正常／炎症组中，E2mRNA 筛查宫颈病变的灵敏度为77．2％、特异度为96．8％、阳性预测值为75．6％、阴性预测值为96.0％；ASCUS 组以上各值为：81．0％、91．7％、79．1％、92．6％；LSIL 组以上各值为：95．9％、93．4％、94．7％、95．0％。结论HPV 病毒 E2基因断裂、表达缺失在宫颈细胞癌变的早期起重要作用。在临床进行 HPV 病毒E2mRNA 检测对宫颈病变的早起筛查和预后评估有一定的价值。

Objective To investigate the expression of human papillomavirus E2 mRNA in cervical cytologi-cal specimens as well as the role of that in cervical carcinogenesis and its clinical significance in screening and evalat-ing prognosis of cervical lesions.Methods The expression of E2 mRNA in 582 cases of cervical cytological speci-mens with high risk human papillomavirus infection and cytological diagnosis of NILM,ASCUS and LSIL,was detected by RT -PCR.Thereafter,all cases were divided into the four groups by colposcopy and histopathological confirmation, including 414 cases of cervicitis,95 cases of CINⅠ,51 cases of CINⅡ,20 cases of CINⅢ and 2 cases of invasive cervical carcinoma as well.Results The expression of HPV -E2 mRNA decreased dramatically corresponding with pathological upgrading from groups of cervicitis to invasive cervical carcinoma （χ2 =132.72,P 〈0.05）.The sensitiv-ity,specificity,positive predictive value and negative predictive value of HPV -E2 mRNA for screening potential cervical lesions in group of NILM,ASCUS and LSIL were 77.2%,96.8%,75.6%,96.0% and 81.0%,91.7%, 79.1%,92.6% as well as 95.9%,93.4%,94.7%,95.0% respectively.Conclusion Deletion of HPV -E2 induced by genetic disruption played an important role in the early stage of malignant transformation of cervical epithe-lial cells.Therefore,detection of the levels of HPV -E2 mRNA expression might be clinically valuable for the screen-ing and evaluating of prognosis in cervical lesions.