Objective: To explore the clinical significance of the quantitative detection of human papillomavirus(HPV) E6/E7 mRN A in triage of patients with atypical squamous cells of undetermined significance(ASC-US) and low-gr...Objective: To explore the clinical significance of the quantitative detection of human papillomavirus(HPV) E6/E7 mRN A in triage of patients with atypical squamous cells of undetermined significance(ASC-US) and low-grade squamous intraepithelial lesion(LSIL).Methods: A cross-sectional screening study was conducted among women who underwent outpatient gynecological screening at the Obstetrics and Gynecology Hospital of Fudan University from September 2015 to July 2016. A total of 500 patients from our hospital with ASC-US or LSIL based on cytology testing were subjected to HPV DNA and HPV E6/E7 mRNA quantitative analysis.Results: The specificity of the HPV E6/E7 mRNA test for detecting ≥high-grade squamous intraepithelial lesion(HSIL+) was statistically higher than that of the HPV DNA test(61.3% vs. 40.0%, P< 0.05), whereas there was no significant difference in the sensitivity of HPV E6/E7 mRNA test and HPV DNA test(90.0% vs. 95.0%, P > 0.05). The positive rates of HPV in the participants tested by HPV E6/E7 mRNA and HPV DNA were, respectively, 42.8%(214/500) and 62.8%(314/500), with statistical significance(P < 0.05).Conclusions: The HPV E6/E7 mRNA test was slightly less sensitivity than that of the HPV DNA test for diagnosing HSIL+ in patients with ASC-US and LSIL, but the difference was not significant, although the specificity of the former was significantly higher. HPV E6/E7 mRNA detection can effectively reduce overdiagnosis and overtreatment of patients with ASC-US and LSIL and has important clinical value in triage of patients with ASC-US and LSIL.展开更多
目的探讨高危型人乳头瘤病毒（HR-HPV）E6/E7 m RNA在宫颈不能明确意义的非典型鳞状上皮细胞（ASCUS）分流诊断中的意义。方法选择2014年1月至2015年7月就诊且行液基薄层细胞学检测（TCT）结果为ASCUS的205例患者为研究对象,并且行阴道...目的探讨高危型人乳头瘤病毒（HR-HPV）E6/E7 m RNA在宫颈不能明确意义的非典型鳞状上皮细胞（ASCUS）分流诊断中的意义。方法选择2014年1月至2015年7月就诊且行液基薄层细胞学检测（TCT）结果为ASCUS的205例患者为研究对象,并且行阴道镜下活检、HR-HPV E6/E7 m RNA检测和HR-HPV分型DNA检测。结果根据阴道镜活检结果,将205例ASCUS患者分为慢性宫颈炎105例、低度宫颈鳞状上皮内病变（LSIL）48例、高度宫颈鳞状上皮内病变（HSIL）48例和宫颈鳞状细胞癌（SCC）4例。慢性宫颈炎、LSIL、HSIL和SCC组HR-HPV E6/E7 m RNA阳性检出率分别为56.2%、79.2%、85.4%和100.0%,差异有统计学意义（P〈0.01）;HSIL＋SCC组HR-HPV E6/E7 m RNA阳性检出率为86.5%,高于慢性宫颈炎＋LSIL组的63.4%（P〈0.01）。HR-HPV E6/E7 m RNA水平为SCC〉HSIL〉LSIL〉慢性宫颈炎症,4组差异有统计学意义（P〈0.01）。〈30岁组与≥30岁组HR-HPV E6/E7 m RNA水平分别为292.23（109.77~903.34）c op y/ml和175.26（0.00~1 032.90）c op y/ml,两组差异无统计学意义（P〉0.05）。HR-HPV E6/E7 m RNA水平与宫颈病变程度呈正相关（r=0.379,P〈0.01）。HR-HPV E6/E7 m RNA检测方法的AUC为0.702（0.617~0.786）,诊断阈值为185.74copy/ml,检测ASCUS患者HSIL＋SCC的灵敏度、特异度、阳性预测值、阴性预测值分别为76.9%、60.8%、40.0%和88.6%,而HR-HPV DNA的检测灵敏度、特异度、阳性预测值、阴性预测值分别为88.5%、31.3%、30.5%和88.9%;其中HR-HPV E6/E7 m RNA检测特异度明显高于HR-HPV DNA（P〈0.05）。结论 HR-HPV E6/E7 m RNA检测在ASCUS筛查中特异度较高,有望成为宫颈细胞学ASCUS分流的新方法。展开更多
基金supported by the Shanghai Science and Technology Committee Project(No.16411950200).
文摘Objective: To explore the clinical significance of the quantitative detection of human papillomavirus(HPV) E6/E7 mRN A in triage of patients with atypical squamous cells of undetermined significance(ASC-US) and low-grade squamous intraepithelial lesion(LSIL).Methods: A cross-sectional screening study was conducted among women who underwent outpatient gynecological screening at the Obstetrics and Gynecology Hospital of Fudan University from September 2015 to July 2016. A total of 500 patients from our hospital with ASC-US or LSIL based on cytology testing were subjected to HPV DNA and HPV E6/E7 mRNA quantitative analysis.Results: The specificity of the HPV E6/E7 mRNA test for detecting ≥high-grade squamous intraepithelial lesion(HSIL+) was statistically higher than that of the HPV DNA test(61.3% vs. 40.0%, P< 0.05), whereas there was no significant difference in the sensitivity of HPV E6/E7 mRNA test and HPV DNA test(90.0% vs. 95.0%, P > 0.05). The positive rates of HPV in the participants tested by HPV E6/E7 mRNA and HPV DNA were, respectively, 42.8%(214/500) and 62.8%(314/500), with statistical significance(P < 0.05).Conclusions: The HPV E6/E7 mRNA test was slightly less sensitivity than that of the HPV DNA test for diagnosing HSIL+ in patients with ASC-US and LSIL, but the difference was not significant, although the specificity of the former was significantly higher. HPV E6/E7 mRNA detection can effectively reduce overdiagnosis and overtreatment of patients with ASC-US and LSIL and has important clinical value in triage of patients with ASC-US and LSIL.
文摘目的探讨高危型人乳头瘤病毒（HR-HPV）E6/E7 m RNA在宫颈不能明确意义的非典型鳞状上皮细胞（ASCUS）分流诊断中的意义。方法选择2014年1月至2015年7月就诊且行液基薄层细胞学检测（TCT）结果为ASCUS的205例患者为研究对象,并且行阴道镜下活检、HR-HPV E6/E7 m RNA检测和HR-HPV分型DNA检测。结果根据阴道镜活检结果,将205例ASCUS患者分为慢性宫颈炎105例、低度宫颈鳞状上皮内病变（LSIL）48例、高度宫颈鳞状上皮内病变（HSIL）48例和宫颈鳞状细胞癌（SCC）4例。慢性宫颈炎、LSIL、HSIL和SCC组HR-HPV E6/E7 m RNA阳性检出率分别为56.2%、79.2%、85.4%和100.0%,差异有统计学意义（P〈0.01）;HSIL＋SCC组HR-HPV E6/E7 m RNA阳性检出率为86.5%,高于慢性宫颈炎＋LSIL组的63.4%（P〈0.01）。HR-HPV E6/E7 m RNA水平为SCC〉HSIL〉LSIL〉慢性宫颈炎症,4组差异有统计学意义（P〈0.01）。〈30岁组与≥30岁组HR-HPV E6/E7 m RNA水平分别为292.23（109.77~903.34）c op y/ml和175.26（0.00~1 032.90）c op y/ml,两组差异无统计学意义（P〉0.05）。HR-HPV E6/E7 m RNA水平与宫颈病变程度呈正相关（r=0.379,P〈0.01）。HR-HPV E6/E7 m RNA检测方法的AUC为0.702（0.617~0.786）,诊断阈值为185.74copy/ml,检测ASCUS患者HSIL＋SCC的灵敏度、特异度、阳性预测值、阴性预测值分别为76.9%、60.8%、40.0%和88.6%,而HR-HPV DNA的检测灵敏度、特异度、阳性预测值、阴性预测值分别为88.5%、31.3%、30.5%和88.9%;其中HR-HPV E6/E7 m RNA检测特异度明显高于HR-HPV DNA（P〈0.05）。结论 HR-HPV E6/E7 m RNA检测在ASCUS筛查中特异度较高,有望成为宫颈细胞学ASCUS分流的新方法。
