人乳头瘤病毒E6/E7mRNA预测宫颈锥切术后病变残留或复发的价值

Value of Human Papilloma Virus E6/E7 mRNA for Predicting Residual or Recurrence Disease After Conical Cervical Resection

目的 研究并分析人乳头瘤病毒(HPV)E6/E7 mRNA预测宫颈锥切术后病变残留或复发的价值。方法 选取郑州大学第五附属医院收治的因高级别宫颈上皮内瘤变接受宫颈锥切术并切缘阴性且随访完整的196例患者,术后3、6、12个月对所有患者进行随访,随访的内容包括薄层液基细胞学检查、HPV DNA、HPV E6/E7 mRNA,必要时行阴道镜下宫颈活检术、宫颈管搔刮术,对发现残留或复发的患者终止随访,并进行相关影响因素的回顾性分析。结果 随访过程中发现病变残留或复发患者共41例,相关因素分析结果显示,年龄≥45岁、术前HPV E6/E7 mRNA阳性患者术后病变残留或复发率高于年龄<45岁、阴性患者(P<0.05);宫颈锥切术后病变残留或复发与宫颈锥切方式及是否累及腺体等因素无关(P>0.05)。术后随访过程中HPV E6/E7 mRNA检测阳性者累计36例,残留或复发29例,HPV DNA检测阳性者累计73例,残留或复发36例;HPV E6/E7 mRNA检测与HPV DNA检测特异度和阳性预测值相比,差异有统计学意义(P<0.05),灵敏度与阴性预测值比较差异无统计学意义(P>0.05)。结论 HPV E6/E7 mRNA检测比HPV DNA具有更高的特异度和阳性预测值,HPV E6/E7 mRNA检测可有效预测宫颈锥切术后疾病复发或残留的风险,对宫颈病变进展发出预警,避免过度检查及治疗。

Objective To study and analyze the value of human papilloma virus(HPV)E6/E7 mRNA in predicting residual or recurrence in patients after conical cervical resection.Methods A total of 196 cases of who were completely followed up after conical cervical resection for high grade cervical intraepithelial neoplasia and had negative margins in the Fifth Affiliated Hospital of Zhengzhou University were collected.All patients were followed up at 3,6 and 12 months after surgery,including thinprep cytologic test,HPV DNA,HPV E6/E7 mRNA.If necessary,cervical biopsy and curettage under colposcopy were performed.Follow-up was terminated for patients with residual or recurrent,and the relevant influencing factors were retrospectively analyzed.Results During follow-up,a total of 41 residual or recurrence cases were recorded after cervical conization.Correlation factors analysis showed that the residual or recurrence lesions rates in patients≥45 years old and patients with positive HPV E6/E7 mRNA were higher than those in patients<45 years old and patients with negative HPV E6/E7 mRNA(P<0.05).The residual or recurrence lesions after conical cervical resection were not related to cervical conization method and postoperative pathological involvement of glands(P>0.05).During the postoperative follow-up,a total of 36 cases were positive for HPV E6/E7 mRNA detection,29 cases were residual or recurrent,73 cases were positive for HPV DNA detection,and 36 cases were residual or recurrent.There was a statistically significant difference in specificity and positive predictive value between HPV E6/E7 mRNA detection and HPV DNA detection(P<0.05).There was no statistically significant difference between sensitivity and negative predictive value(P>0.05).Conclusion HPV E6/E7 mRNA detection has higher specificity and positive predictive value than HPV DNA.The detection of HPV E6/E7 mRNA can effectively predict the risk of disease recurrence or residual lesion after conical cervical resection,and can give an early warning of the progress of cervical lesions,avoiding excessive examination and treatment.