高危型HPV E6/E7 mRNA在不同年龄段宫颈病变筛查中的应用价值

Application value of high-risk human patillomatirus E6/E7 mRNA in screening cervical lesions of different ages

目的:探讨高危型HPV E6/E7 mRNA检测在女性不同年龄段宫颈病变筛查中的临床诊断价值。方法:选取2014年2月至2018年12月在株洲市中心医院妇科门诊行宫颈液基细胞学检测结果为未明确意义的非典型鳞状上皮细胞(atypical squamous cells of undetermined significance,ASCUS)或ASCUS以上的患者760例,均行HPV DNA检测、高危型HPV E6/E7 mRNA检测和阴道镜下活检组织病理学检查。按年龄段分成<30岁组、30~40岁组、41~50岁组和>50岁组,以组织病理学结果为金标准,进行统计学分析。结果:760例患者中,HPV E6/E7 mRNA阳性率68.4%,HPV DNA分型阳性率69.9%,两者差异无统计学意义(P>0.05)。E6/E7 mRNA阳性率随病理分级严重程度增高而增高,且阳性率差异有统计学意义(P<0.05)。在宫颈正常或低级别鳞状上皮内病变(<HSIL)中E6/E7 mRNA的阳性率显著低于HPV DNA的阳性率,但是各年龄组之间E6/E7 mRNA阳性率差异无明显统计学意义(P>0.05);在宫颈高级别鳞状上皮内病变(high-level squamous intradermal lesions,HSIL)和浸润癌(≥HSIL)中E6/E7 mRNA的阳性率与HPV DNA差异无统计学意义(P>0.05);各年龄组之间E6/E7 mRNA阳性率差异无统计学意义(P>0.05),但是30~40岁组中E6/E7 mRNA阳性率显著高于HPV DNA分型阳性率,差异有统计学意义(P<0.05),其余组差异均无统计学意义(P>0.05)。结论:HPV E6/E7 mRNA与宫颈病上皮内病变的关联性强,与HPV DNA检测相比,在保证宫颈HSIL检出率无差异的同时,降低了宫颈低级别鳞状上皮内病变的过诊率,适用于不同年龄段女性宫颈病变的筛查应用。此外,对30~40岁妇女人群,HPV E6/E7 mRNA较HPVDNA分型检测更为敏感,对这一人群,应更重视HPV E6/E7 mRNA的筛查。

Objective:To investigate the clinic diagnostic value of detecting high risk human patillomavirus(HPV)E6/E7 mRNA in screening cervical lesions of different age of women.Methods:A total of 760 thinprep cytologic test specimens of patients were used to detect the HPV DNA and HPV mRNA,the histopathological results by cervical colposcopy biopsy were followed-up.The patients were diagnosed with atypical squamous cells of undetermined significance(ASCUS)or over ASCUS in Gynaecological Outpatient Clinic of Zhuzhou Central Hospital from February 2014 to December 2018.And they were divided into<30 years old groups,30 to 40 years old group,41 to 50 years old group and>50 years old group according to age.Each group test results were statistical analyzed.Results:In 760 patients,the positive rate of HPV E6/E7 mRNA was 68.4%,and the positive rate of HPV DNA classification was 69.9%.There was no significant difference between the positive rate.In addition,statistical analysis showed that the positive rate of E6/E7mRNA increased with the level of pathological classification degree,and the positive rate was statistically different.The positive rate of E6/E7 mRNA in Normal or low-level scaly epithelial lesions in the cervix(<HSIL)was significantly lower than the positive rate of HPV DNA,but there was no statistical difference in the positive rate of E6/E7 mRNA in different age groups.Besides,there was also no significant difference between the positive rate of E6/E7 mRNA and HPV DNA in cervical highlevel squamous epithelial lesions and invasive carcinoma(≥HSIL),the same as the positive rate of E6/E7 mRNA in different age groups.However,in the 30–40 age group,the positive rate of E6/E7 mRNA was statistically significant higher compared with the positive rate of HPV DNA classification,and there was no statistical difference in the remaining groups.Conclusion:HPV E6/E7 mRNA has a strong correlation with intradermal lesions of cervicitis.Compared with the HPV DNA test,it can ensure that there is no difference in the detection rate of high-level squamous intradermal lesions(HSIL)of the cervix.It can also reduce the rate of diagnosis of low grade squamous epithelial lesions in the cervix,and is suitable for screening and application of cervical lesions in women of different ages.In addition,HPV E6/E7 mRNA is more sensitive than HPVDNA classification for women aged 30–40 years.For this group,more attention should be paid to HPVE6/E7 mRNA screening.