人乳头瘤病毒E6/E7 mRNA检测在小于30岁宫颈癌筛查中的临床分析

Clinical analysis on the application value of human papillomavirus E6/E7 mRNA testing for screening under 30 years old

目的分析人乳头瘤病毒(HPV)E6/E7 mRNA检测在小于30岁宫颈癌筛查中的临床应用价值。方法回顾性分析2020年1月至2021年6月大连市妇女儿童医疗中心(集团)妇产院区330例行薄层液基细胞学检查(TCT)轻度异常<30岁患者的临床资料。其中,行HPV DNA分型检测165例(DNA组),行HPV E6/E7 mRNA检测165例(mRNA组)。比较两组患者宫颈上皮内瘤样病变(CIN)Ⅱ及以上(CINⅡ+)阳性情况,及不同HPV高危型患者CINⅡ+阳性情况。结果mRNA组HPV高危型阳性率明显低于DNA组[32.7%(54/165)比47.9%(79/165)],差异有统计学意义(χ^(2)=7.87,P<0.01)。DNA组与mRNA组HPV高危型阳性患者CINⅡ+发生率比较差异无统计学意义[45.6%(36/79)和59.3%(32/54),P>0.05]。DNA组与mRNA组HPV 16、18或45型阳性患者CINⅡ+发生率比较差异无统计学意义[38.5%(10/26)和6/10,P>0.05]。mRNA组非HPV 16、18或45型阳性患者CINⅡ+发生率明显高于DNA组[60.9%(28/46)比41.3%(26/63)],差异有统计学意义(P<0.05)。结论在年轻女性中,HPV E6/E7 mRNA检测在不增加漏诊率的情况下,起到重要的分流作用,且对非HPV 16、18或45感染患者的CINⅡ+预测价值更高。

Objective To evaluate the clinical value of human papillomavirus(HPV)E6/E7 mRNA testing in cervical cancer screening under 30 years old.Methods The clinical data of 330 young women(less than 30 years old)with minor abnormalities of thinprep cytologic test(TCT)screening for in Dalian Women′s and Children′s Medical Center(Group)Chunliu Region from January 2020 to June 2021 were retrospectively analyzed.Among them,165 patients underwent HPV DNA typing test(DNA group),and 165 patients underwent HPV E6/E7 mRNA typing test(mRNA group).The positive rate of cervical intraepithelial neoplasia(CIN)Ⅱand above(CINⅡ+)was compared between two groups,and the positive rates of CINⅡ+in different high risk HPV types.Results The positive rate of high risk HPV types in mRNA group was significantly lower than that in DNA group:32.7%(54/165)vs.47.9%(79/165),and there was statistical difference(χ^(2)=7.87,P<0.05).There was no statistical difference in the incidence of CINⅡ+of patients with positive of high risk HPV types between DNA group and mRNA:45.6%(36/79)and 59.3%(32/54),P>0.05.There was no statistical difference in the incidence of CINⅡ+of patients with HPV 16,18 or 45 positive between DNA group and mRNA group:38.5%(10/26)and 6/10,P>0.05.The incidence of CINⅡ+of patients without HPV 16,18 or 45 positive in mRNA group was significantly higher than that in DNA group:60.9%(28/46)vs.41.3%(26/63),and there was statistical difference(P<0.05).Conclusions Without increasing the rate of missed diagnosis,HPV E6/E7 mRNA testing plays an important shunt role in women under 30 years old,and the predicted value of CINⅡ+is higher for patients who are not infected with HPV16/18/45 with HPV E6/E7 mRNA testing.