The shunt value of HPV E6/E7mRNA examination in cervical cytology ASCUS
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摘要:
目的 探讨人乳头瘤病毒(HPV)E6/E7 mRNA检查在宫颈细胞学检查结果为意义不明确的非典型鳞状上皮细胞(ASCUS)患者中的分流价值。 方法 收集2019年8月—2020年8月就诊于蚌埠医学院第一附属医院妇科，液基薄层细胞学(TCT)为ASCUS的患者, 行(HPV)DNA检查、(HPV)E6/E7 mRNA检查，阳性者行阴道镜检查，对检测结果及宫颈活检结果进行统计学分析, 探讨HPV E6/E7 mRNA检查在TCT结果为ASCUS患者中的分流价值。 结果 231例ASCUS患者分为宫颈慢性炎117例(50.65%)，宫颈低级别上皮内病变65例(28.14%)，宫颈高级别上皮内病变47例(20.35%)，宫颈癌2例(0.87%)。HPV E6/E7 mRNA阳性91例(39.39%)，HPV DNA阳性127例(54.98%)，二者对CINⅡ+的检出率相比，差异无统计学意义。(HPV)E6/E7 mRNA检查CINⅡ+(即HISL+SCC)特异度为69.2%，灵敏度为71.4%，阴性预测值为90.0%，阳性预测值为38.5%；HPV DNA检查CINⅡ+(即HISL+SCC)特异度是53.3%，灵敏度为85.7%，阴性预测值为93.3%，阳性预测值为33.1%。(HPV)E6/E7 mRNA检查的特异度明显高于(HPV)DNA，差异有统计学意义(χ2=26.273，P < 0.001)。灵敏度相比，差异无统计学意义。将不同宫颈病变患者的copy值进行统计与分析，随着病变级别的进展，(HPV)E6/E7 mRNA的copy值也随之增加, 差异有统计学意义(ρ=0.562，P < 0.001)。(HPV)E6/E7 mRNA检查的AUC为0.69，大于(HPV)DNA的AUC值(0.60)，与(HPV)DNA检查相比诊断效率更高。 结论 (HPV) E6/E7 mRNA检查对于TCT结果为意义不明确的非典型鳞状上皮细胞(ASCUS)患者是一种良好的分流手段，能降低阴道镜转诊率，减轻患者负担及临床医师工作量，避免漏诊和过度治疗，可成为ASCUS患者分流的新方法。 -
关键词:
- 人乳头瘤病毒E6/E7 mRNA /
- 未明确意义的非典型鳞状上皮细胞 /
- 分流价值
Abstract:Objective To explore the shunt value of human papillomavirus (HPV) E6/E7 mRNA examination in patients with atypical squamous epithelial cells (ASCUS) whose cervical cytology results are ambiguous. Methods Patients treated in the Department of Gynecology, the First Affiliated Hospital of Bengbu Medical College from August 2019 to August 2020, with liquid-based thin-layer cytology (TCT) as ASCUS, underwent (HPV) DNA examination and (HPV) E6/E7 mRNA examination were collected. The positive patients underwent colposcopy, the test results and cervical biopsy results were analyzed statistically, and the shunt value of HPV E6/E7 mRNA test in patients with ASCUS TCT results was discussed. Results The 231 ASCUS patients were divided into 117 cases of chronic cervical inflammation (50.65%), 65 cases of low-grade cervical intraepithelial lesions (28.14%), 47 cases of high-grade cervical intraepithelial lesions (20.35%), and 2 cases of cervical cancer (0.87%). 91 cases (39.39%) were HPV E6/E7 mRNA positive, 127 cases (54.98%) were HPV DNA positive, there was no significant difference in the detection rate of CINⅡ+between the two methods. (HPV) E6/E7 mRNA examination CINⅡ+(HISL+SCC) specificity was 69.2%, sensitivity was 71.4%, negative predictive value was 90.0%, positive predictive value was 38.5%. The specificity of HPV DNA examination CINⅡ+(HISL+SCC) was 53.3%, the sensitivity was 85.7%, the negative predictive value was 93.3%, and the positive predictive value was 33.1%. The specificity of (HPV) E6/E7 mRNA examination was significantly higher than that of (HPV) DNA, and the difference was statistically significant (χ2=26.273, P < 0.001). The copy value of patients with different cervical lesions was counted and analyzed. As the lesion level progresses, the copy value of (HPV) E6/E7mRNA also increased, the difference was statistically significant (ρ=0.562, P < 0.001). The AUC of E6/E7 mRNA examination is 0.69, which was greater than the value of (HPV) DNA AUC (0.60), which was more efficient than (HPV) DNA examination. Conclusion (HPV) E6/E7 mRNA examination is a good shunt for patients with atypical squamous epithelial cells (ASCUS) whose TCT results are ambiguous. It can reduce the colposcopy referral rate, reducing the burden of patients and the work of clinicians, avoiding missed diagnosis and over-treatment, becoming a new method for triage of ASCUS patients. -
表 1 不同分级的组织病理结果与HPV E6/E7 mRNA、HPV DNA检测结果及阳性检出率[例(%)]
病理结果(分级) 例数 HPVE6/E7mRNA阳性 HPV DNA阳性 χ2值 P值 正常/慢性炎 117 30(25.64) 46(39.32) 4.989 0.026 CINⅠ 65 26(40.00) 39(60.00) 5.200 0.023 CINⅡ 20 12(60.00) 16(80.00) 1.905 0.168 CINⅢ 27 21(77.78) 24(88.89) 0.533 0.465 浸润癌 2 2(100.00) 2(100.00) ≥CINⅡ+ 49 35(71.42) 42(85.71) 2.970 0.085 
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表 2 不同检查方法(HPV E6/E7 mRNA与HPV DNA)的病理结果对照(例)
病理结果 例数 HPV E6/E7 mRNA HPV-DNA 阳性 阴性 阳性 阴性 < CINⅡ 182 56 126 85 97 ≥CINⅡ+ 49 35 14 42 7 合计 231 91 140 127 104
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表 3 不同检测方法对宫颈病变诊断效能比较(%)
检测方法 灵敏度 特异度 阳性预测值 阴性预测值 约登指数 HPV E6/E7 mRNA 71.4 69.2 38.5 90.0 40.6 HPV-DNA 85.7 53.3 33.1 93.3 45.3
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表 4 不同级别宫颈病变级别患者的HPV E6/E7 mRNA检测结果水平比较
组别 mRNA阳性[例(%)] HPV E6/E7 mRNA拷贝数[M(P25，P75)，copy/mL] 正常/慢性炎 30(25.64) 802.25(512.84，1 063.90) LISL 26(40.00) 1 430.86(707.24，2 944.01) HISL 33(70.21) 4 200.31(2 894.52，7 010.69) SCC 2(100.00) 13 107.24(13 004.39, 13 210.08)
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