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目的探讨人类乳头状瘤病毒(HPV)E6/E7mRNA检测在HPV感染阳性和液基细胞学结果异常的妇女宫颈癌筛查中的诊断性能。方法收集2013年8月-2015年6月在新疆维吾尔自治区人民医院体检中心、门诊行宫颈癌筛查的妇女6 800人,采取宫颈脱落细胞学(thinprep cytology test,TCT)检查和HPV DNA检测(hybird capture,HC-2)联合筛查,本研究选取细胞学或HPV检测结果异常的197例女性作为研究对象,对其进行宫颈HPVE6/E7mRNA检测和组织病理学检查,其中101例行HPV DNA分型检测,以病理学诊断为金标准,比较HPV DNA分型检测和HPVE6/E7mRNA检测的准确性,以及两者的并联、串联试验诊断高级别宫颈病变的准确性。结果病理学检查示,慢性宫颈炎患者80例,其中CINⅠ级16例、CINⅡ～Ⅲ级50例,宫颈癌患者51例。HPVE6/E7mRNA诊断宫颈高级别病变的ROC曲线下面积为74.95,灵敏度为85.515%,特异度为66.67%,约登指数为0.139,阳性似然比为2.555,阴性预测为81.0%,阳性预测为72.9%,均高于HPV DNA分型的诊断试验;HPVE6/E7mRNA诊断宫颈高级别病变的阴性似然比为0.222,低于HPV DNA分型的0.683,验后概率为72.9%,高于HPV DNA分型的64.6%;HPVE6/E7mRNA诊断高级宫颈病变的临床性能试验优于HPV DNA分型检测的诊断试验。两者单独检验的一致性较差(Kappa=0.1998)。结论宫颈癌的筛查手段可以选择HPVE6/E7mRNA检测,HPVE6/E7mRNA检测和HPV DNA检测、细胞学联合运用,可以提高诊断准确性。
Abstract：Objective To investigate the diagnostic performance and value of shunt value of human papillomavirus(HPV)E6/E7 mRNA in screening cervical cancer in women with abnormal HPV positive or liquid based cytological findings in cervical cancer screening.Methods A total of 6,800 women were screened in our hospital for cervical cancer by both TCT and HPV DNA testing from August 2013 to June2015.Of these,197 had abnormal cytological or HPV test results and subsequently underwent HPV E6/E7 mRNA detection and histopathological examination,while 101 underwent an HPV DNA typing test.Using pathological results as the gold standard,we compared the accuracies of HPV E6/E7 mRNA detection or HPV DNA type testing alone,in parallel,and in series for diagnosing high-grade cervical lesions.Results Pathological examination revealed 80 cases of chronic cervicitis,16 cases of cervical intraepithelial neoplasia(CIN)-Ⅰ,50 cases of CINⅡ-Ⅲ,and 51 cases of cervical cancer.The area under the receiver operating characteristic(ROC)curve(AUC)for diagnosing high-grade cervical lesions by HPV E6/E7 mRNA detection was 74.95%(sensitivity,85.15%;specificity,66.67%;Youden index,0.139;positive predictive value,72.9%;negative predictive value,81.0%;positive likelihood ratio,2.555;negative likelihood ratio,0.222;and post-test probability,72.9%).Conclusion Screening for cervical cancer can be performed by HPVE6/E7 mRNA detection.HPVE6/E7 mRNA detection and HPV DNA detection combined with cytology can improve the diagnostic accuracy of cervical cancer.
[1]CHEN W,ZHENG R,BAADE,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[2]BAUSSANO I,ELFSTROM K.Type-specific human papillomavirus biological features:Validated model-based estimates[J].PLos One,2013,8(11):e81171.
[3]MATAH M,SAREEN S.Detection of HPV by PCR-A novel step in the prevention of cancer cervix[J].Jogl,2012,62(2):188-191.
[4]BURGER E,KORNOR H,KLEMP M,et al.HPV mRNA tests for the detection of cervical intraepithelial neoplasia:a systematic review.[J].Gynecol Oncol,2011,120(3):430-438.
[5]叶凤如,黄玉玲,吴慧卿,等.人乳头瘤病毒E6/E7 mRNA检测在年轻女性宫颈癌筛查及宫颈疾病诊治中的应用研究[J].中国妇幼保健,2017,32(7):1406-1408.
[6]张博,张颖,牛力春,等.液基细胞学联合HPV mRNA检测对宫颈癌的诊断价值[J].现代肿瘤医学,2016,24(1):118-122.
[7]VIEIRA L,ALMEIDA A.The cytology and DNA detection by the Papillo Check R test in the diagnosis of human papillomavirus infection[J].Eur J Immunol,2013,3(1):61-67.
[8]BROCCOLO F,FUSETTI L,ROSINI S,et al.Comparison of oncogenic HPV type-specific viral DNA load and E6/E7mRNA detection in cervical samples:results from a multicenter study[J].J Med Virol,2013,85(3):472-482.
[9]SOLOMON D,DAVEY D,KURMAN R,et al.The 2001BethesdaSystem:terminology for reporting results of cervical cytol-ogy[J].Jama,2002,287(16):2114-2119.
[10]BOULET G,HORVATH C,BERGHMANS S,et al.Human papil-lomavirus in cervical cancer screening:important role asbiomarker[J].Cancer Epidem Biomar,2008,17(4):810-817.
[11]HOVLAND S,MULLER S,SkOMEDAL H,et al.E6/E7mRNA expression analysis:a test for the objective assessment of cervical adenocarcinoma in clinical prognostic procedure[J].Int J Oncol,2010,36(6):1533-1539.
[12]RONCO G,DILLNER E.Efficacy of HPV-based screening for prevention of invasive cervical canc-er:follow-up of four European randomised controlled trials[J].Lancet,2014,383(9916):524-532.
[13]ISIDEAN S,FRANCO E.Embracing a new era in cervical cancer screening[J].Lancet,2014,383(9916):493-494.
[14]LEE H,LEE E.HPV infection and p16promoter methylation as predictors of ASC-US/LSIL progression[J].Cancer Cytopathol,2016,124(1):58-65.
[15]姜俊,陈宜刚,王华,等.人乳头瘤病毒E6/E7m RNA的检测在宫颈癌筛查中的初步评价[J].南京医科大学学报,2013,33(9):1261-1264.
[16]MOLDEN T,KRAUS I,SKOMEDAL H,et al.Pretect HPVProfer:real-time detection and typing of E6E7m RNA from carcinogenic human papillomaviruses[J].J Virol Methods,2007,142(1):204-212.
[17]IFTNER T,BECKER S.Head-to-head comparison of the RNA-based aptima human papillomavirus(HPV)assay and the DNA-based hybrid capture 2 HPV test in a routine screening population of women aged 30to 60years in germany[J].J Clin Microbiol,2015,53(8):2509-2516.
[18]SRBYE S,ARBYN M,FISMEN S,et al.HPV E6/E7mRNA testing is more specific than cytology in post-colposcopy follow-up of women with negative cervical biopsy[J].PLoS One,2011,6(10):e26022.
[19]MONSONEGO J,HUDGENS M,ZERAT L,et al.Evaluation of oncogenic human papillomavirus rna and dna tests with liquid-based cytology in primary cervical cancer screening:the fase study[J].Int J Cancer,2011,129(3):691-701.
基本信息:
中图分类号:R737.33
引用信息:
[1]韩莉莉,刘玉华,米合日尼沙·买买体,等.HPVE6/E7 mRNA检测在宫颈癌筛查中的意义[J],2018,41(09):1128-1132.
基金信息:
新疆维吾尔自治区自然科学基金(2016D01C111)