HR-HPV E6/E7 mRNA检查在宫颈癌筛查中的应用价值

The Diagnostic Performance of HR-HPV E6/E7mRNA Detection in Cervical Cancer Screening

目的探讨高危型人乳头瘤病毒(HR-HPV)E6/E7 mRNA检查在宫颈癌筛查中的应用价值。方法选择2017年11月至2019年11月于医院门诊行宫颈HPV-DNA分型检查及薄层细胞学检查(TCT)中疑似宫颈病变需转诊阴道镜的患者386例,行阴道镜下组织病理活检的同时行HR-HPV E6/E7 mRNA检查,以组织病理学为诊断“金标准”,分析HR-HPV E6/E7 mRNA检查、HPV-DNA分型检查及TCT 3种不同筛查方式检出情况,并比较3种检查方式的灵敏度、特异度、阳性预测值、阴性预测值。结果HR-HPV E6/E7 mRNA检查、HPV-DNA分型检查和TCT宫颈病变≥宫颈上皮内瘤变(CIN)Ⅱ级的灵敏度分别为86.3%、92.7%、82.3%,特异度分别为74.0%、18.3%、32.8%;HR-HPV E6/E7 mRNA检查的灵敏度低于HPV-DNA分型检查,差异有统计学意义(P<0.05);HR-HPV E6/E7 mRNA检查的特异度、阳性预测值、阴性预测值均高于HPV-DNA分型检查和TCT,差异有统计学意义(P<0.05)。结论HR-HPV E6/E7 mRNA检查宫颈病变的总体诊断效能优于HPV-DNA分型检查和TCT,可减少HPV一过性感染造成的假阳性结果,减轻患者的心理压力,降低过度治疗带来的风险,实现灵敏度和特异度的较好平衡,还可作为宫颈病变或癌变初筛的更佳选择。

Objective The diagnostic performance of HR-HPV E6/E7mRNA detection in cervical cancer screening has been investigated.Methods A total of 386 patients received in out-patient department in hospital from November 2017 to November 2019 were selected in this study.All these patients were examined with cervical HPV-DNA typing and thinprep cytologic test(TCT)and were suspected of cervical lesions.It was necessary to confirm the diagnostic results through colposcopic biopsy and HR-HPV E6/E7 mRNA detection at the same time.According to histopathology,which was considered as the diagnostic“gold standard”,the diagnostic results of HPV E6/E7 mRNA detection,HPV-DNA typing and TCT were analyzed and then the sensitivity,specificity,positive predictive value and negative predictive value of the three methods were compared.Results In terms of diagnosing cervical intraepithelial neoplasi(≥CINⅡ),the sensitivity of HR-HPV E6/E7 mRNA detection,HPV-DNA typing and TCT were 86.3%,92.7%and 82.3%respectively,and the specificity were 74.0%,18.3%and 32.8%respectively.The detection sensitivity of HPV E6/E7 mRNA was lower than that of HPV-DNA typing and the difference was statically significant(P<0.05).The detection specificity,the positive predictive value and the negative predictive value of HPV E6/E7 mRNA were all higher than that of HPV-DNA typing&TCT and the difference was statically significant(P<0.05).Conclusion The diagnostic performance of HR-HPV E6/E7 mRNA detection was better than HPV-DNA and TCT in detecting cervical lesions.It can reduce false positive results caused by transient HPV infection,alleviate patients’pressures and reduce the risks of overtreatment.Moreover,it provides a better choice for cervical lesions or cancer screening by achieving good balance between sensitivity and specificity.