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目的探讨高危型人乳头瘤病毒E6/E7 mRNA(HR-HPV E6/E7 mRNA)联合液基细胞学检查(TCT)在宫颈病变诊断中的应用价值。方法选择2015年6月至2016年5月在台州市第一人民医院妇科进行宫颈病变检查的280例女性为研究对象,其中炎症组183例,宫颈上皮内瘤变Ⅰ(CINⅠ)组42例,CINⅡ组33例,CINⅢ组15例和宫颈癌(SCC)组7例,并进行HR-HPV E6/E7 mRNA、高危型人乳头瘤病毒DNA(HR-HPV DNA)检测和病理活检,以病理活检为金标准,比较各组间HR-HPV E6/E7 mRNA和HR-HPV DNA的阳性检出率。用SPSS 16.0统计软件进行分析,组间比较用χ~2检验或Fisher确切概率法检验。结果 CIN组和SCC组HR-HPV E6/E7 mRNA、HR-HPV DNA阳性率(CINⅠ组分别为52.38%和64.29%,CINⅡ组分别为84.85%和87.88%,CINⅢ组分别为93.33%和93.33%,SCC组分别为100.00%和100.00%)均显著高于炎症组(分别为14.75%和34.97%),CINⅡ、CINⅢ和SCC组阳性率显著高于CINⅠ组,差异均有统计学意义(P<0.05)。炎症组HR-HPV DNA阳性率显著高于HR-HPV E6/E7 mRNA,差异有统计学意义(P<0.05)。HRHPV E6/E7 mRNA特异度和阳性预测值显著高于HR-HPV DNA,差异有统计学意义(P<0.01)。单独使用HR-HPV E6/E7mRNA检测宫颈病变灵敏度为73.20%,单独使用TCT检测灵敏度为81.44%,两者串联检测灵敏度为92.78%,显著高于单独检测,差异有统计学意义(P<0.05)。结论 HR-HPV E6/E7 mRNA检测在CINⅡ、CINⅢ和SCC组中具有较高的敏感度和特异度,HR-HPV E6/E7 mRNA联合TCT检测可提高宫颈病变检出率。
Objective To investigate the value of high-risk human papillomavirus E6 / E7 mRNA (HR-HPV E6 / E7 mRNA) combined with liquid-based cytology (TCT) in the diagnosis of cervical lesions. Methods A total of 280 women who underwent gynecological examinations of gynecological cervical lesions in Taizhou First People’s Hospital from June 2015 to May 2016 were selected as the research objects. Among them, 183 cases were inflammation group, 42 cases were CINⅠ group, 33 cases of CINⅡ group, 15 cases of CINⅢ group and 7 cases of cervical cancer (SCC) group. HR-HPV E6 / E7 mRNA, HR-HPV DNA and pathological biopsy were detected by pathological biopsy As the gold standard, the positive detection rate of HR-HPV E6 / E7 mRNA and HR-HPV DNA was compared between the groups. SPSS 16.0 statistical software for analysis, comparison between groups by χ ~ 2 test or Fisher exact test. Results The positive rates of HR-HPV DNA and HR-HPV DNA in CIN group and SCC group were 52.38% and 64.29% in CIN group, 84.85% and 87.88% in CINⅡ group and 93.33% and 93.33% in CINⅢ group respectively (100.00% and 100.00% in SCC group) were significantly higher than those in inflammation group (14.75% and 34.97%, respectively). The positive rates of CINⅡ, CINⅢand SCC were significantly higher than those in CINⅠgroup (P < 0.05). The positive rate of HR-HPV DNA in inflammation group was significantly higher than that of HR-HPV E6 / E7 mRNA, the difference was statistically significant (P <0.05). HRHPV E6 / E7 mRNA specificity and positive predictive value was significantly higher than HR-HPV DNA, the difference was statistically significant (P <0.01). The sensitivity of using HR-HPV E6 / E7 mRNA alone to detect cervical lesions was 73.20%, the detection sensitivity of TCT alone was 81.44%, the detection sensitivity of the two was 92.78%, which was significantly higher than that of single detection (P <0.05) . Conclusion HR-HPV E6 / E7 mRNA has high sensitivity and specificity in CINⅡ, CINⅢ and SCC. HR-HPV E6 / E7 mRNA combined with TCT can improve the detection rate of cervical lesions.