HPV E6/E7 mRNA检测对于Ⅲ型转化区宫颈病变的预测价值

Predictive value of HPV E6/E7 mRNA in cervical lesions with type Ⅲ transformation zone

目的评估HPV E6/E7 mRNA检测对阴道镜下Ⅲ型转化区患者宫颈病变的预测价值。方法选取2015年1月至2017年3月在浙江省衢州市人民医院妇科就诊,TCT≥ASCUS,HR-HPV阳性,阴道镜检查为宫颈Ⅲ型转化区,活检组织病理学诊断为LSIL患者52例为研究对象,行HPV E6/E7 mRNA检测及LEEP宫颈锥切,分析术前HPV E6/E7 mRNA检测与LEEP宫颈锥切后组织病理学结果相关性,并比较不同宫颈病变的HPV E6/E7 mRNA表达量。结果 LEEP宫颈锥切术后总的病理升级率为46.15%（24/52）,其中HPV E6/E7 mRNA阴性的患者总病理升级率13.33%（2/15）,HPV E6/E7 mRNA阳性的患者总病理升级率59.46%（22/37）,两组比较差异有统计学意义（χ2=7.376,P=0.007）。病理分级与HPV E6/E7mRNA表达量成正相关（r=0.650,P=0.000）。结论Ⅲ型转化区阴道镜活检组织病理学诊断为LSIL,存在漏诊宫颈高级别病变可能。术前HPV E6/E7 mRNA阳性表达对HSIL＋具有较好的预测价值。

Objective To assess the predictive value of HPV E6/E7 mRNA test in cervical lesions with typeⅢtransformation zone. Methods From January 2015 to March 2017, 52 cases diagnosed as LSIL with type Ⅲ transformation zone by colposcopy pathological biopsy, were recruited into this study in the department of gynaecology, Quzhou People＇s Hospital. The TCT examination showed ASCUS or severe type, and HR-HPV were positive. The patient subsequently underwent HPV E6/E7 mRNA test and LEEP conization. The correlation between preoperative HPV E6/E7 mRNA test and histopathology of LEEP cervical conization were analyzed, the expression of HPV E6/E7 mRNA in different cervical lesions were compared. Results 46.15%（24/52） LSIL were graded up after LEEP cervical conization in 13.33%（2/15） HPV E6/E7 mRNA negative patients and 59.46%（22/37） HPV E6/E7 mRNA positive patients, with significant difference between the two groups（χ2=7.376, P =0.007）. A positive correlation was found between grade of cervical lesion and the expression of HPV E6/E7 mRNA（r =0.650, P =0.000）. Conclusions LSIL with type Ⅲ transformation zone by colposcopy pathological biopsy is prone to omission of high-grade intraepithelial lesion. The positive expression of HPV E6/E7 mRNA before operation has a good predictive value for high-grade intraepithelial lesion.