E6/E7 mRNA检测用于人乳头状瘤病毒16/18型阳性患者分流的可行性

Feasibility of E6/E7 mRNA detection in shunt of patients with positive human papillomavirus type 16/18

目的探讨E6/E7 mRNA检测用于人乳头状瘤病毒61(HPV)16/18型阳性患者分流的可行性。方法选取HPV 16/18型阳性的200例患者作为研究对象。所有患者均进行E6/E7 mRNA检测、液基细胞学检查及阴道镜活检检查。以病理结果为金标准,评估E6/E7 mRNA检测、液基细胞学检查对HPV 16/18型感染者的高级别鳞状上皮内瘤变(HSIL)及以上病变的诊断效能。结果在200例HPV 16/18型感染者中,阴道镜活检HSIL及以上病变的检出率仅为29.5%(59/200)。共107例患者HPV E6/E7 mRNA阳性,56例患者液基细胞学阳性。HPV E6/E7 mRNA阳性者HSIL及以上病变检出率高于阴性者(P<0.05);随着宫颈病变病理级别的提高,HPV E6/E7 mRNA阳性率呈升高趋势(均P<0.05),但液基细胞学异常率差异无统计学意义(P>0.05)。HPV E6/E7 mRNA诊断HSIL及以上病变的灵敏度、特异度分别为86.44%、60.28%,液基细胞学的灵敏度、特异度分别为25.42%、70.92%,HPV E6/E7 mRNA的灵敏度高于液基细胞学(P<0.05)。结论E6/E7 mRNA检测对HPV 16/18型感染者的HSIL及以上病变具有较好的诊断效能,或可用于患者的进一步分流,以降低阴道镜的转诊率。

Objective To investigate the feasibility of E6/E7 mRNA detection in the shunt of patients with positive human papillomavirus(HPV)type 16/18.Methods Two hundred patients with positive HPV type 16/18 were selected as subjects.All patients underwent E6/E7 mRNA detection,Thinprep cytologic test(TCT)and biopsy under colposcope.With the pathological result as the golden standard,the diagnostic efficacy of E6/E7 mRNA detection and TCT for high-grade squamous intraepithelial lesion(HSIL)and higher grade lesions in patients with positive HPV type 16/18 was assessed.Results Among the 200 patients with positive HPV type 16/18,the detection rate of HSIL and higher grade lesions was only 29.5%(59/200)by colposcopic biopsy.Totally 107 patients were confirmed as positive HPV E6/E7 mRNA and 56 patients as positive TCT.The detection rate of HSIL and higher grade lesions in patients with positive HPV E6/E7 mRNA was higher than that in patients with negative HPV E6/E7 mRNA(P<0.05);the positive rate of HPV E6/E7 mRNA rose with the increase of pathological grade of cervical lesions(all P<0.05),while the abnormality rate of TCT showed no statistically significant difference(P>0.05).For diagnosing HSIL and higher grade lesions,HPV E6/E7 mRNA yielded a sensitivity of 86.44%and a specificity of 60.28%,TCT yielded a sensitivity of 25.42%and a specificity of 70.92%,HPV E6/E7 mRNA had a higher sensitivity than TCT(P<0.05).Conclusion E6/E7 mRNA detection obtains favorable diagnostic efficacy for HSIL and higher grade lesions in patients with positive HPV type 16/18,and may be applied to patient shunt further,thus reducing colposcopic referral rate.