E6/E7 mRNA检测在高危型人乳头瘤病毒DNA阳性且细胞学轻度异常患者随访中的作用

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摘要目的：探讨E6/E7 mRNA检测在高危型人乳头瘤病毒（HPV）DNA阳性且细胞学为无明确诊断意义的不典型鳞状细胞（ASCUS）或低度鳞状上皮内病变（LSIL）患者随访中的分流作用。方法：收集2015年1月至2015年12月余姚市人民医院门诊就诊薄层液基细胞学检测（TCT）为ASCUS或LSIL且高危型HPV DNA阳性的女性患者332例，均行HPV E6/E7 mRNA检测和阴道镜下活检及病理学检查，并对病理学为CINII-的患者进行24个月的随访，用Kaplan-Meier法分析HPV E6/E7 mRNA阳性组和阴性组的疾病进展率。结果：332例患者中277例（占83.43%）为CINII-，55例（占16.57%）为CINII+。对257例CINII-患者进行24个月随访后，E6/E7 mRNA阳性组发展为CINII+的比例（33/158，20.89%）显著高于阴性组（7/99，7.07%），差异有统计学意义（χ2=9.966，P=0.002）。HPV E6/E7 mRNA检测预测CINII+的特异性是42.4%，阳性预测值为22.4%，阴性预测值为93.2%。结论：在对高危型HPV DNA阳性、TCT为ASCUS或LSIL的患者随访中，HPV E6/E7 mRNA是有效分流此类患者的生物标志物。

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关键词 ： E6/E7 mRNA, 人乳头瘤病毒, 无明确诊断意义的不典型鳞状细胞, 低度鳞状上皮内病变

Abstract：Objective: To investigate the prognostic value of E6/E7 mRNA in the follow-up of patients with high-risk human papillomavirus (HPV) DNA positive and with atypical squamous cell of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL) in cytologic test. Methods: Altogether 332 female patients with ASCUS or LSIL detected by Thin prep cytologic test (TCT) and high-risk HPV DNA positive from January 2015 to December 2015 were collected at the outpatient of Yuyao People’s Hospital. All patients underwent HPV E6/E7 mRNA detection, colposcopic biopsy and pathological examination. The patients whose pathology was CINII- were followed up for 24 months. Kaplan-Meier method was used to analyze the disease progression rate of HPV E6/E7 mRNA positive and negativegroups. Results: Of 332 patients, 277 (83.43%) were CINII- and 55 (16.57%) were CINII+. After 24-months follow-up of 257 patients with CINII-, the percentage of developing CINII+ in E6/E7 mRNA positive group (33/158, 20.89%) was significantly higher than that in negative group (7/99, 7.07%) , and the difference of cumulative disease progression rate in 24 months was statistically significant (χ2=9.966, P=0.002). HPV E6/E7 mRNA detection predicted the specificity of CINII+ to be 42.4 %, the positive predictive value was 22.4%, and the negative predictive value was 93.2%. Conclusion: HPV E6/E7 mRNA testing may be of value to select high-risk HPV DNA positive women with mild cytology in need of immediate referral for colposcopy.

Key words： E6/E7 mRNA humanpapillomavirus atypical squamaus cell of undetermined significance low-grade squamous intraepithelial lesions

收稿日期: 2018-03-14

基金资助:余姚市人民医院院级课题重大项目（2017ZA02）。

通讯作者: 朱雪琼，主任医师，教授，博士生导师，Email：zjwzzxq@163.com。

作者简介: 王兰英（1982-），女，浙江余姚人，主治医师，在职硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I11/818

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