高危型HPVE6／E7mRNA检测在ASC-US分流中的诊断价值

Diagnostic Value of High- risk HPV E6 / E7 mRNA Test in Triage of ASC- US

目的探讨高危型人乳头瘤病毒(high-risk human papilloma virus,HR-HPV)E6/E7 mRNA检测在无明确诊断意义的不典型鳞状细胞(atypical squamous cell of undetermined significance,ASC-US)分流中的诊断价值。方法对320例ASCUS患者进行HR-HPV E6/E7 mRNA和HR-HPVDNA检测,同时行阴道镜检查和宫颈活检,结合病理学诊断资料进行统计学分析。结果 HR-HPV E6/E7 mRNA在宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)和宫颈癌中的阳性率与HR-HPV DNA比较,差异有统计学意义(P<0.05);CINⅡ+级和CINⅢ+级的HR-HPV E6/E7 mRNA阳性率分别高于CINⅡ-级和CINⅢ-级,差异均有统计学意义(P均<0.05)。HR-HPV E6/E7 mRNA与HR-HPV DNA检测CINⅡ+级和CINⅢ+级的敏感度、阳性预测值、阴性预测值比较,差异无统计学意义(P均>0.05);两者特异性比较,差异有统计学意义(P均<0.05);利用受试者工作特征(ROC)曲线,HR-HPV E6/E7 mRNA检测诊断CINⅡ+级和CINⅢ+级的效能比HR-HPV DNA更佳,差异均有统计学意义(P均=0.000)。<30岁组的HR-HPV DNA阳性率明显高于≥30岁组,差异有统计学意义(P<0.01);两个年龄组的HR-HPV E6/E7 mRNA阳性率差异无统计学意义(P>0.05)。结论 HR-HPV E6/E7 mRNA检测可作为ASC-US患者是否需要阴道镜转诊的更确切有效的指标,其特异性和诊断价值更佳。

Objective To investigate the diagnostic value of high - risk human papilloma virus（ HR - HPV） E6/E7 mRNA test in triage of atypical squamous cell of undetermined significance （ ASC - US）. Methods Three hundred and twenty patients with ASC - US had colposcopy and cervical biopsy, HR - HPV E6/E7 mRNA and HR - HPV DNA testing. The testing results combined with pathological diagnosis were analyzed. Results In cervical intraepithelial neoplasia（CIN） and cervical cancer, the positive rates of HR - HPV E6/E7 mRNA and HR -HPV DNA were statisticaliy significant（P 〈 0.05 ）. The positive rate of HR -HPV E6/E7 mRNA for CIN Ⅱ ＋ and CINⅢ＋ were higher than that of CIN Ⅱ- and CINⅢ - , and the difference was statistically significant（ P = 0. 000）. There was no significantly difference（P 〉 0.05） in sensitivity, positive predictive value and negative predictive value between HR- HPV E6/E7 mRNA test and HR - HPV DNA test for detection of CIN Ⅱ ＋ and CIN Ⅲ ＋. But the specificity showed statisticaliy significant difference（ P = 0. 000）. Ac- cording to ROC curve, the diagnostic power of HR - HPV E6/E7 mRNA test for CIN Ⅱ ＋ and CINⅢ ＋ was higher than that of HR - HPV DNA. The positive rate of HR - HPV DNA in the age group younger than 30 years was significantly higher than the group aged 30 years and older（ P 〈 0.05 ）. There was no statistically significance in the positive rate of HR - HPV E6/ E7mRNA between the two groups （ P 〉 0.05）. Conclusion HR - HPV E6/ E7mRNA test is a better effective triage method for colposcopy referral in women with ASC - US cytology. Because of its higher specificity and better diagnostic value.