高危型人乳头瘤病毒阳性患者2943例阴道镜病理结果分析

Analysis of colposcopic pathologic findings in 2943 cases of high-risk human papillomavirus-positive patients

目的 探讨人乳头瘤病毒(HPV)E6/E7mRNA阳性患者是否需要直接转诊阴道镜活检。方法 回顾性分析2020年1~12月于苏州市立医院检出的高危型HPV阳性患者2943例,其中HPV DNA阳性者2464例,HPV E6/E7m RNA阳性者869例,二者均阳性者390例,比较并分析阴道镜活检后子宫颈病变的检出率。结果 (1)HPV E6/E7m RNA阳性组、HPV DNA阳性组、二者均阳性组子宫颈低级别鳞状上皮内病变(LSIL)的检出率分别为32.2%、32.9%、34.1%;子宫颈高级别鳞状上皮内病变(HSIL)的检出率分别为12.9%、13.4%、11.5%;子宫颈原位癌的检出率分别为0.8%、0.6%、0.8%;子宫颈浸润癌的检出率分别为0.6%、0.7%、0.8%。3组子宫颈病变检出构成比差异无统计学意义(P>0.05)。(2)在薄层液基细胞学检查(TCT)阴性的1889例患者中,HPV E6/E7m RNA阳性组、HPV DNA阳性组、二者均阳性组LSIL的检出率分别为28.0%、27.3%、30.8%;子宫颈HSIL的检出率分别为9.0%、8.8%、9.0%;子宫颈癌(含原位癌)的检出率分别为0.5%、0.4%、0.7%。3组子宫颈病变检出构成比差异无统计学意义(P>0.05)。(3)在非HPV16/18阳性患者中,HPV E6/E7m RNA阳性组、HPV DNA阳性组LSIL的检出率分别为32.7%、34.5%;HSIL的检出率分别为10.0%,10.2%;子宫颈癌(含原位癌)的检出率分别为1.0%、0.3%。2组子宫颈病变检出构成比差异无统计学意义(P>0.05)。(4)在HPV E6/E7m RNA阳性组内部进行比较,HPV E6/E7m RNA16/18/45亚型阳性组、HPV E6/E7m RNA其他亚型阳性组HSIL检出率分别为26.5%、10.0%,差异有统计学意义(P<0.001);2组子宫颈癌的检出率分别为3.3%、1.0%,差异有统计学意义(P<0.05)。结论 HPV E6/E7m RNA阳性组与符合阴道镜活检指征的HPV DNA阳性组之间具有相似的子宫颈病变检出率,故HPV E6/E7mRNA阳性需要转诊阴道镜活检。

Objective To explore the necessity of direct referral for colposcopic biopsy in patients positive for human papillomavirus(HPV)E6/E7mRNA.Methods A retrospective analysis was conducted at Suzhou Municipal Hospital from January 2020 to December 2020.A total of 2943 high-risk HPV positive patients were collected,of whom 2464 pa⁃tients were in HPV DNA positive group,869 patients were in HPV E6/E7mRNA positive group,and 390 patients were in both HPV DNA and E6/E7mRNA positive group.The detection rates of cervical lesions after colposcopic biopsy were compared and analyzed.Results(1)The detection rates of cervical low-grade squamous intraepithelial lesions(LSIL)in the HPV E6/E7 mRNA-positive group,HPV DNA-positive group,and both-positive group were 32.2%,32.9%,and 34.1%,respectively.The detection rates of high-grade squamous intraepithelial lesions(HSIL)in the cervix were 12.9%,13.4%,and 11.5%,respectively.The detection rates of cervical carcinoma in situ were 0.8%,0.6%,and 0.8%,respectively,and the detection rates of invasive carcinoma of the cervix were 0.6%,0.7%,and 0.8%,respective⁃ly.There was no statistically significant difference in the composition ratio of the cervical lesion detection rates among the three groups(P>0.05).(2)In-depth analysis was made in patients whose ThinPrep cytologic test(TCT)was nega⁃tive(1889 patients),and it was found that:the detection rates of pathologic LSIL in the HPV E6/E7mRNA-posi⁃tive group,HPV DNA-positive group,and both-positive group were respectively 28.0%,27.3%,and 30.8%(P>0.05),those of HSIL were 9.0%,8.8%,and 9.0%(P>0.05),respectively,and for cervical cancer(including cervical carcinoma in situ),the rates were respectively 0.5%,0.4%,and 0.7%(P>0.05).There was no statistical difference in the composition ratio of detection rates of cervical lesions among the 3 groups(P>0.05).(3)In addition,after excluding HPV 16/18 positive patients,the detection rates of LSIL,HSIL and cervical cancer(including cervical carcinoma in situ)in the HPV E6/E7 mRNA positive group and HPV DNA positive group were 32.7%and 34.5%,10.0%and 10.2%,and 1.0%and 0.3%,respectively.The difference between the 2 groups was not statistically significant(P>0.05).(4)Comparisons were made within the HPV E6/E7mRNA-positive group,the detection rates of HSIL in the HPV 16/18/45 E6/E7 mRNA-positive group and the HPV other subtypes E6/E7mRNA-positive group were respectively 26.5%and 10.0%(P<0.001),and those of cervical cancer were 3.3%and 1.0%(P<0.05).Conclusion There is a similar detection rate of cervical lesions between the HPV E6/E7mRNA-posi⁃tive group and the HPV DNA-positive group that met the indications for colposcopic biopsy.Thus,a referral to colposcop⁃ic examination is necessary for HPV E6/E7mRNA-positive patients.