E6/E7 mRNA检测在高危型人乳头瘤病毒DNA阳性且细胞学轻度异常患者随访中的作用

The role of E6/E7 mRNA in the follow-up patients with high-risk human papillomavirus DNA positive and mild cytology

目的:探讨E6/E7 mRNA检测在高危型人乳头瘤病毒(HPV)DNA阳性且细胞学为无明确诊断意义的不典型鳞状细胞(ASCUS)或低度鳞状上皮内病变(LSIL)患者随访中的分流作用。方法:收集2015年1月至2015年12月余姚市人民医院门诊就诊薄层液基细胞学检测(TCT)为ASCUS或LSIL且高危型HPV DNA阳性的女性患者332例,均行HPV E6/E7 mRNA检测和阴道镜下活检及病理学检查,并对病理学为CINII-的患者进行24个月的随访,用Kaplan-Meier法分析HPV E6/E7 mRNA阳性组和阴性组的疾病进展率。结果:332例患者中277例(占83.43%)为CINII-,55例(占16.57%)为CINII+。对257例CINII-患者进行24个月随访后, E6/E7 mRNA阳性组发展为CINII+的比例(33/158,20.89%)显著高于阴性组(7/99,7.07%),差异有统计学意义(χ2=9.966,P=0.002)。HPV E6/E7 mRNA检测预测CINII+的特异性是42.4%,阳性预测值为22.4%,阴性预测值为93.2%。结论:在对高危型HPV DNA阳性、TCT为ASCUS或LSIL的患者随访中,HPV E6/E7 mRNA是有效分流此类患者的生物标志物。

Objective： To investigate the prognostic value of E6/E7 mRNA in the follow-up of patients with high-risk human papillomavirus （HPV） DNA positive and with atypical squamous cell of undetermined sig-nifcance （ASCUS） or low-grade squamous intraepithelial lesions （LSIL） in cytologic test. Methods： Altogether 332 female patients with ASCUS or LSIL detected by Thin prep cytologic test （TCT） and high-risk HPV DNA positive from January 2015 to December 2015 were collected at the outpatient of Yuyao People’s Hospital. All patients underwent HPV E6/E7 mRNA detection, colposcopic biopsy and pathological examination. The patients whose pathology was CINII- were followed up for 24 months. Kaplan-Meier method was used to analyze the dis-ease progression rate of HPV E6/E7 mRNA positive and negativegroups. Results： Of 332 patients, 277 （83.43%） were CINII- and 55 （16.57%） were CINII＋. After 24-months follow-up of 257 patients with CINII-, the percent-age of developing CINII＋ in E6/E7 mRNA positive group （33/158, 20.89%） was signifcantly higher than that in negative group （7/99, 7.07%） , and the difference of cumulative disease progression rate in 24 months was sta-tistically signifcant （χ2=9.966, P=0.002）. HPV E6/E7 mRNA detection predicted the specifcity of CINII＋ to be 42.4 %, the positive predictive value was 22.4%, and the negative predictive value was 93.2%. Conclusion： HPV E6/E7 mRNA testing may be of value to select high-risk HPV DNA positive women with mild cytology in need of immediate referral for colposcopy.