人乳头瘤病毒E7蛋白检测子宫颈上皮内病变的价值

The application value of HPV E7 oncoprotein on detecting cervical lesions

目的探讨人乳头瘤病毒(HPV)E7蛋白检测宫颈病变的临床应用价值。方法选取180例高危型HPV阳性妇女,采用免疫细胞化学方法检测宫颈脱落细胞HPV E7蛋白。结果 (1)病理高级别宫颈上皮内病变(HSIL)及浸润癌组HPV E7蛋白阳性率(77.8%,56/72)显著高于低级别宫颈上皮内病变(LSIL)组(52.1%,25/48;P=0.003),病理LSIL组阳性率显著高于宫颈炎组(26.7%,16/60;P=0.007);(2)对于细胞学为ASCUS和LSIL的妇女,HPV E7蛋白诊断HSIL及宫颈癌的灵敏度、特异度、阳性预测值及阴性预测值分别为97.1%、52.1%、58.9%和96.2%;(3)HPV E7蛋白和TCT诊断LSIL及以上病变的灵敏度、特异度、阳性预测值、阴性预测值分别为67.5%vs 51.7%、73.3%vs 58.3%、83.5%vs 71.3%、53.0%vs 37.6%,除特异度外,E7蛋白诊断的价值优于TCT(P<0.05)。结论 HPV E7蛋白在检测宫颈病变,尤其是在细胞学轻度异常患者的分流中,具有一定的临床应用价值。

Objectives To evaluate the value of E7 oncoprotein as a method in cervical lesions detection.Methods 180 women with positive high-risk human papillomavirus（HPV） recruited in this study.TCT and HPV E7 protein were detected before colposcopy,final diagnosis was according to pathologic results.Results（1）The positive rate of HPV E7 protein test increased along with pathologic grades and positive rate of HSIL.The positive rate of HPV E7 protein in cervical cancer group（77.8%,56/72） was obviously higher than that of LSIL group（52.1%,25/48）（P=0.003）,also it was much higher in LSIL group compared to that of cervicitis group（26.7 %,16/60）（P=0.007）;（2） For women who have ASCUS,LSIL cytology results,the sensitivity,specificity,positive predictive value,negative predictive value of HPV E7 protein in the diagnosis of HSIL and more severe lesions were 97.1%,52.1%,58.9% and 96.2%,respectively.（3） The sensitivity,specificity,positive predictive value and negative predictive value of HPV E7 protein and TCT in the diagnosis of CIN and cervical cancer were 67.5% vs 51.7%,73.3% vs 58.3%,83.5% vs 71.3% and 53.0% vs 37.6%,the diagnostic value of HPV E7 protein test was superior to TCT（P〈0.05）.Conclusions HPV E7 protein test has certain application value in cervical lesion detection,especially in the triage of patients with mildly abnormal cytology results.