HPVE6/E7mRNA和高危型HPV DNA检测在ASC-US患者中的临床应用研究

Application of HPV E6/E7 mRNA and high-risk HPV DNA tests in patients with ASC-US

【摘要】目的分析并比较人乳头瘤病毒（HPV）E6／E7mRNA和高危型HPV（HR—HPV）DNA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160倒薄层液基细胞学检查（TCT）诊断为ASC—US的患者进行HPVE6／E7mRNA和HR—HPVDNA的检测，并进行阴道镜检查和宫颈活检，结合病理学诊断结果进行统计学分析。结果（1）21～29岁年龄组HR—HPVDNA阳性率明显高于其他年龄组，差异有统计学意义（P〈005）；各年龄组HPVE6／E7mRNA的阳性率无统计学差异（P〉005）。（2）宫颈上皮内瘤变（CIN）Ⅱ＋级和CINⅢ＋级的HPVE6／E7mRNA阳性率明显高于CINⅡ一级，差异有统计学意义（P〈0．05）；CINⅡ＋级和CINⅢ＋级的HR-HPVDNA阳性率亦明显高于CINⅡ-级，差异有统计学意义（P〈0．05）；CINⅡ＋级和CIN Ⅲ＋级的HPVE6／E7mRNA阳性率和HR-HPVDNA阳性率均无统计学差异（均P〉0．05）。（3）HPVE6／E7mRNA检测诊断CINII＋级的灵敏度为692％，低于HR-HPVDNA检测的80．8％，但差异无统计学意义（P〉0．05）；特异度为73．9％．明显高于HR-HPVDNA检测的61．9％，差异有统计学意义（P〈0．05）；根据ROC曲线可见HPVE6／E7mRNA检测诊断CINⅡ＋级的效能高于HR-HPVDNA检测。结论与HR-HPVDNA检测相比，HPVE6／E7mRNA检测用于ASC-US患者分流时是否需要进一步作阴道镜检查的判断更为确切。

Objective To evaluate the application of human papillomavirus （HPV） E6/E7mRNA and high-risk HPV （HR-HPV） DNA tests in patients with atypical squamous cell of undetermined significance （ASC-US）. Methods One hun- dred and sixty patients with ASC-US cytology underwent HPVE6/E7 mRNA and HR-HPV DNA tests, colposcopy/biopsy. The clinical value of two tests was analyzed and compared. Results The positive rate of HR-HPV DNA in age group 21-29y was significantly higher than those in other age groups（P〈0.05）, but no significant difference in positive rate of HPVE6/E7mRNA was found among different age groups （P 〉0.05）. The positive rate of HPV E6/E7 mRNA and HR-HPV DNA for CINⅡ＋ and CINⅢ＋ were significantly higher than that of CINI or normal subjects （P〈0.05）. No significant differences were found in positive rate of HPV E6/E7 mRNA and HR-HPV DNA between CINⅡ＋ and CINⅢ＋ groups （P 〉0.05）. The sensitivity of HPV E6/E7mRNA and HR-HPV DNA for CINⅡ＋ was 69.2% and 80.8%, respectively（P 〉0.05）; the specificity was 73.9% and 61.9%, respectively（P〈 0.05）, According to ROC curve, the diagnostic power of HPVE6/E7mRNA test for CIN Ⅱ＋ was higher than that of HR-HPV DNA. Conclusion Compared to HR-HPV DNA test, HPVE6/E7mRNA test is more effective for colposcopy referral in triage of patients with ASC-US.