摘要
目的探讨人乳头瘤病毒(human papillionma virus,HPV)E6/E7 mRNA检查对妇科液基薄层细胞(thinprep cytologict,TCT)检测结果为非典型鳞状上皮细胞(atypical squamous cell of undetermined significance,ASCUS)患者的分层处理及疾病进展的预测价值。方法选取2020年3月至2022年3月就诊于郑州大学第五附属医院妇科门诊,经TCT检验结果为ASCUS患者198例,行HPV DNA及HPV E6/E7 mRNA检测,同时行阴道镜检查及活检,并且对活检结果为高度鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)以下患者进行1年随访,对检测结果及病理结果进行统计分析,进而讨论人乳头瘤病毒HPV E6/E7 mRNA检查对ASCUS患者的分层处理及疾病进展的预测价值。结果198例ASCUS患者行阴道镜下活检,比较HPV E6/E7 mRNA及HPV DNA 2种检测方法对HSIL+的检出率,差异无统计学意义(P>0.05)。对2种检查方法计算敏感度及特异性,发现HPV E6/E7 mRNA的特异性高于HPV DNA,差异有统计学意义(P<0.05)。统计各级别宫颈病变患者的HPV E6/E7 mRNA的拷贝值,随着宫颈病变级别进展,其拷贝值随之升高,差异有统计学意义(r=0.791,P<0.05)。对2种检测方法诊断HSIL+的效能行受试者操作特征曲线(receiver-operating characteristic curve,ROC)分析,HPV E6/E7 mRNA的拷贝值曲线下面积(area under the curve,AUC)最大,诊断效能最佳。1年后随访初次活检结果HSIL-的95例患者,行ROC曲线,发现HPV E6/E7 mRNA对比HPV DNA,HPV E6/E7 mRNA具有良好的预测效能。结论HPV E6/E7 mRNA的分流价值高于HPV DNA,用于ASCUS人群的分流可减少阴道镜的转诊率,对宫颈病变进展做出良好预测,控制漏诊率,减少过度诊疗。
Objective To investigate the predictive value of human papillionma virus(HPV)E6/E7 mRNA in stratification and disease progression of patients with a atypical squamous cell of undetermined significance(ASCUS)as a result of gynecological fluid based thinprep cytologic(TCT)test.Methods A total of 198 ASCUS patients admitted to the Fifth Affiliated Hospital of Zhengzhou University from March 2020 to March 2022 were collected.The results of TCT test were as follows:HPV DNA and HPV E6/E7 mRNA were detected,and colposcopy and biopsy were performed.In addition,patients with biopsy results of high-grade squamous intraepithelial lesion(HSIL)or lower were followed up for 1 year,and the test results and pathological results were statistically analyzed,so as to discuss the predictive value of HPV E6/E7 mRNA examination for stratification and disease progression of ASCUS patients.Results There was no significant difference in the detection rate of HSIL+by HPV E6/E7 mRNA and HPV DNA 198 ASCUS patients undergoing colposcopy biopsy(P>0.05).The sensitivity and specificity of HPV E6/E7 mRNA was higher than that of HPV DNA,and the difference was statistically significant(P<0.05).The copy value of HPV E6/E7 mRNA in patients with cervical lesions at all levels was calculated,and the copy value increased with the progression of cervical lesions,with statistical significance(r=0.791,P<0.05).Receiver-operating characteristic curve(ROC)analysis was performed on the diagnostic efficiency of the two detection methods for HSIL+.The area under the curve(AUC)value of HPV E6/E7 mRNA was the highest,and the diagnostic efficiency was the best.One year later,95 patients with initial biopsy results of HSIL-were followed up,and ROC curve was performed.HPV E6/E7 mRNA showed good predictive efficacy compared with HPVE6/E7 DNA.Conclusion The shunt value of HPV E6/E7 mRNA was higher than that of HPV DNA,and the shunt used for ASCUS population could reduce the colposcopy referral rate,make a good prediction of cervical disease progression,control the rat
作者
白萍
李巧云
BAI Ping;LI Qiaoyun(Department of Gynecology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中国现代医生》
2022年第26期37-41,共5页
China Modern Doctor
