HPV E6/E7 mRNA在宫颈高级别上皮内瘤变诊断及LEEP术后中的价值

Value of HPV E6/E7 mRNA detection in diagnosis of high-grade cervical intraepithelial neoplasia and postoperative evaluation of LEEP

目的探讨HPV E6/E7 mRNA检测结合宫颈液基细胞学检测(TCT)在高级别宫颈上皮内瘤变(CIN)诊断及LEEP术后评估中的价值。方法选取2013年3月-2015年9月宁德市医院411例疑似高级别CIN患者,均接受HPV E6/E7 mRNA检测、TCT检测、HPV DNA检测及宫颈活检,Ⅱ~Ⅲ级CIN患者均接受LEEP术治疗。以病理检查结果为金标准,统计对比HPV DNA检测与HPV E6/E7 mRNA检测结合TCT检测(联合检测)的效果,并于LEEP术后3~15个月进行随访,分析不同检测方法疾病复发情况。结果 411例疑似高级别CIN患者中,共有338例Ⅱ~Ⅲ级CIN患者,联合检测敏感度(82.99%)低于HPV DNA检测(85.31%),但差异无统计学意义(P>0.05);联合检测特异度(71.23%)、准确度(91.00%)高于HPV DNA检测(34.25%、86.62%),差异有统计学意义(P<0.05)。338例Ⅱ~Ⅲ级CIN患者共41例复发,联合检测敏感度(80.49%)低于HPV DNA检测(87.80%),但差异无统计学意义(P>0.05),联合检测特异度(73.40%)、准确度(74.26%)高于HPV DNA检测(34.34%、40.83%),差异有统计学意义(P<0.05)。结论 HPV E6/E7 mRNA联合TCT检测在宫颈高级别上皮内瘤变诊断中具有较高特异度及准确度,且在LEEP术后疾病复发诊断中应用价值较高。

Objective To explore the value of HPV E6 / E7 mRNA detection combined with cervical Thinprep cytology test （TCT） in diagnosis of high - grade cervical intraepithelial neoplasia （ CIN ） and postoperative evaluation of loop electrosurgical excision procedure （LEEP） . Methods A total of 411 patients suspected of high-grade CIN were selected from Ningde Municipal Hospital from March 2013 to September 2015, then HPV E6/E7 mRNA detection, TCT, HPV DNA test, and cervical biopsy were performed, the CIN patients of grade Ⅱ-Ⅲ underwent LEEP. Taking the result of pathological examination as gold standard, the effects of HPV DNA detection and HPV DNA detection combined with TCT （joint detection） were compared statistically. All the patients were followed up at 3-15 months after LEEP. The recurrence rates of CIN detected by different methods were analyzed. Results Among 411 patients, 338 patients were diagnosed as CIN of grade Ⅱ-Ⅲ. The sensitivity of joint detection was 82.99%, which was lower than that of HPV DNA detection （85.31%）, but there was no statistically significant difference （P〉0. 05） . The specificity and accuracy of joint detection were 71.23% and 91.00%, respectively, which were statistically significantly higher than those of HPV DNA detection （34. 25%, 86. 62% ） （P〈0. 05） . Among 338 patients with CIN of grade Ⅱ-Ⅲ, recurrence occurred in 41 patients. The sensitivity of joint detection was 80. 49% , which was lower than that of HPV DNA detection （87.80%）, but there was no statistically significant difference （P〉0. 05 ） . The specificity and accuracy of joint detection were 73.40% and 74. 26%, respectively, which were statistically significantly higher than those of HPV DNA detection （34. 34%, 40. 83% ） （P〈0. 05） . Conclusion HPV E6/E7 mRNA detection combined with TCT has high specificity and accuracy in diagnosis of high-grade CIN, the application value of I-IPV E6/E7 mRNA detection in diagnosis of recurrence after LEEP is high.