AHPV及其基因分型检测在子宫颈细胞学低级别鳞状上皮内病变中的应用

Application of AHPV and Its Genotyping in Low-grade Squamous IntraepithelialLesions

目的:探讨Aptima高危人乳头瘤病毒(HR-HPV)E6/E7 mRNA(AHPV)及其基因分型(GT)检测在子宫颈细胞学低级别鳞状上皮内病变(LSIL)风险评估中的作用。方法:将529例子宫颈细胞学LSIL患者根据年龄分为30岁组、≥30岁组,均行子宫颈脱落细胞AHPV及其16、18、45基因分型(AHPV-GT)检测,同时进行第二代杂交捕获HPV(HC_2-HPV)检测、阴道镜检查及子宫颈活检。结果:①529例LSIL患者中,年龄<30岁组HC_2-HPV检测阳性率显著高于≥30岁组,差异有统计学意义(92.2%vs 83.6%,P=0.026);AHPV检测阳性率在不同年龄组间差异无统计学意义(82.5%vs 77.7%,P=0.284),进一步行AHPV-GT检测,不同年龄组间差异均无统计学意义。529例患者中组织学证实高级别鳞状上皮内病变及以上病变(HSIL^+)83例,其中AHPV检测阳性81例,占97.6%。;②与其他11型HR-HPV阳性相比,16、18、45GT中有一种或多种阳性(GT阳性)患者的HSIL^+发生率显著增加(P<0.05);在≥30岁组,AHPV16型阳性患者HSIL^+暴露风险的OR值最高141.00,显著高于18/45阳性、GT阴性、AHPV阴性,差异有统计学意义(P=0.005、0.000、0.000)。但在<30岁组,AHPV16型阳性的HSIL^+暴露风险的OR值8.50,与18/45阳性、AHPV阴性比较,差异无统计学意义(P=1.000、0.070);③在≥30岁组,AHPV检测HSIL^+的特异度高于HC_2-HPV(P<0.05),而在<30岁组,特异度比较差异无统计学意义。结论:对于年龄≥30岁细胞学LSIL患者,AHPV及其GT检测是一种可靠的阴道镜筛选及危险分层方法,尤其要重视AHPV 16型阳性。但对于年轻的女性,需寻找更理想的生物学标志物。

Objective:To investigate the application of Aptima high-risk human papillomavirus(HR-HPV)E6/E7 mRNA(AHPV)and its genotyping(GT)in the risk assessment of low-grade squamous intraepithelial lesions(LSIL).Methods:The AHPV and its genotype(AHPV-GT)incervical exfoliated cells were detectedin 529 women with LSIL.The DNA-Based Hybrid Capture 2 HPV Test(HC2-HPV),colposcopy and cervical biopsy were performedsimultaneously.Results:①In 529 patients with LSIL,the positive rate of HC2-HPV in the group of<30 years old was significantly higher than that in the group of≥30 years old(92.2%vs 83.6%,P=0.026).There was no significant difference in AHPV positive rate among different age groups(82.5%vs 77.7%,P=0.284).No significant difference of the genotyping(AHPV-GT)was detected between the two groups,either.In the 529 cases,83 cases of HSIL+were confirmed by histology.81 cases(97.6%)were AHPV positive in the patients with HSIL+;②Compared with other 11 positive types of HR-HPV,the incidence of HSIL+in GT+women increased significantly(P<0.05).In the group≥30 years old,the OR value of HSIL+exposure risk of AHPV16 positive women was the highest(141.00),which was significantly higher than that of 18/45+,GT+,AHPV+(P=0.005,0.000,0.000).However,in the group of<30 years old,the OR value of HSIL+exposure risk of AHPV16 positive women was 8.50,which showed no significant difference from that of 18/45+and AHPV-(P=1.000,0.070).③In group over 30 years old,the specificity of detecting HSIL+by AHPV was higher than that by HC2-HPV(P<0.05).There was no significant difference in detection specificity between AHPV and HC2-HPV in women under 30 years old.Conclusions:AHPV and its GT detection are reliable methods for colposcopic screening and risk stratification in women aged over 30 years old with LSIL,more attention should be focused on AHPV16 positive.Better biological markers should be explored for younger women.