HPV E6/E7 mRNA检测在宫颈病变进程中的临床应用研究

Study on the clinical application of HPV E6/E7 mRNA detection in the process of cervical lesions

目的探讨人乳头瘤病毒(HPV)E6/E7 mRNA检测在宫颈病变过程中的应用价值。方法收集137例宫颈病变疑似患者的HPV DNA、HPV E6/E7 mRNA、薄层液基细胞学检测(TCT)以及组织病理检测结果,综合比较分析HPV E6/E7 mRNA检测的潜在应用价值。结果 HPV E6/E7 mRNA阳性率为77.1%,低于HPV DNA检测。而在更高病理级别样本中(≥CINⅡ),HPV E6/E7 mRNA检测灵敏度为80.3%,特异度为50.0%,阳性预测值为56.3%以及阴性预测值为76.0%。HPV E6/E7 mRNA的ROC曲线线下面积为0.652,95%CI为0.571~0.732,HPV DNA为0.630,0.547~0.713(P=0.0045)。经过长期治疗观察与跟踪研究整理,相对比HPV DNA检测,HPV E6/E7 mRNA的对CINⅠ和CINⅡ阳性病例的预测比例与病理进程更加符合。结论 HPV E6/E7 mRNA对宫颈病变的监测与诊断预测具有明显的指导意义。

Objective To explore the application value of human papillomavirus （HPV） E6/E7 mRNA detection in the process of cer- vical lesions. Methods The results of HPV DNA detection, HPV E6/E7 mRNA detection, TCT, and histopathological detection of 137 patients suspected of cervical lesions were collected, the potential application value of HPV E6/E7 mRNA detection was comprehensively compared and analyzed. Results The positive rate of HPV E6/E7mRNA detection was 77. 1% , which was lower than that of HPV DNA de- tection. Among the samples with high-grade pathological results （≥ CIN Ⅱ）, the sensitivity, specificity, positive predictive value, and negative predictive value of HPV E6/E7 mRNA detection were 80. 3% , 50. 0%, 56. 3%, and 76. 0% , respectively. The area under HPV E6/E7 mRNA detection ROC curve was 0. 652, 95% CI was 0. 571-0. 732, HPV DNA was 0. 630, 0. 547-0. 713 （P= 0. 0045） . After long-term observation and follow-up, compared with HPV DNA detection, the predictive proportions of HPV E6/E7 mRNA detection for CIN Ⅰ and CIN Ⅱ positive cases were more consistent with pathological process. Conclusion HPV E6/E7 mRNA detection has obvious guiding significance for monitoring and diagnosis of cervical lesions.