核酸分子杂交-流式细胞术检测HPV E6/E7 mRNA初步研究

doi:10.3969/j.issn.1673-8640.2023.01.009

摘要/Abstract

摘要：

目的探讨核酸分子杂交-流式细胞术检测HPV E6/E7 mRNA的可靠性和应用价值。方法收集2018年10月—2019年10月广东省妇幼保健院和中山大学附属第一医院妇科普通门诊常规宫颈癌筛查结果异常的361例已婚女性患者的子宫颈上皮脱落细胞样本，并进行新柏氏液基细胞学检测（TCT）、HPV DNA检测、HPV E6/E7 mRNA检测和组织病理学检查。结果 HPV E6/E7 mRNA检测阳性率随组织病理学检查结果严重级别的升高而增加。与HPV DNA比较，HPV E6/E7 mRNA有较高的特异性（72.73%）和阳性预测值（47.06%）。当TCT结果为ASCUS时，依据HPV E6/E7 mRNA结果进行阴道镜检分流的正确率为66%。结论 HPV E6/E7 mRNA检测与组织病理学检查有较高的一致性，且阴道镜镜检分流正确率和判断子宫颈组织高度病变的特异性、阳性预测值均较高。

关键词: 人乳头瘤病毒, E6/E7 mRNA, 宫颈癌, 核酸分子杂交, 流式细胞术

Abstract:

Objective To investigate the reliability and application value of determining human papillomavirus（HPV） E6/E7 mRNA by nucleic acid molecular hybridization-flow cytometry. Methods Totally，361 samples of cervical epithelial exfoliated cells collected from gynecological departments of Guangdong Maternal and Child Health Hospital and the First Affiliated Hospital of Sun Yat-sen University from October 2018 to October 2019 were collected，and thinprep cytologic test（TCT），HPV DNA，biopsy histopathology and HPV E6/E7 mRNA determinations were performed. Results The proportion of positive HPV E6/E7 mRNA results was increased with the severity of pathological biopsy results. Compared with HPV DNA，HPV E6/E7 mRNA had higher specificity（72.73%）and positive predictive value（47.06%）. According to HPV E6/E7 mRNA results，the accuracy of colposcopy shunt of atypical squamous cell of undetermined significance（ASCUS） in abnormal TCT results was 66%. Conclusions HPV E6/E7 mRNA has high consistency with histopathological examination，and the accuracy of colposcopy shunt，specificity and positive predictive value for high-grade lesions are high.

Key words: Human papillomavirus, E6/E7 mRNA, Cervical cancer, Nucleic acid molecular hybridization, Flow cytometry

中图分类号:

R373.9

张亚旭, 崔延伟, 刘紫烟. 核酸分子杂交-流式细胞术检测HPV E6/E7 mRNA初步研究[J]. 检验医学, 2023, 38(1): 46-50.

ZHANG Yaxu, CUI Yanwei, LIU Ziyan. Preliminary research for the determination of HPV E6/E7 mRNA by nucleic acid molecular hybridization-flow cytometry[J]. Laboratory Medicine, 2023, 38(1): 46-50.

图/表 5

参考文献 15

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CIN分级	例数	E6/E7 mRNA阴性/例	E6/E7 mRNA阳性/例	E6/E7 mRNA阳性率/%
炎症等	39	32	7	17.95
CIN 1级（或LSIL）^①	66	45	21	31.82
CIN 2级	21	13	8	38.10
CIN 2/3级（或HSIL）^②	23	14	9	39.13
CIN≥3级	9	1	8	88.89
合计	158	105	53

CIN分级	例数	E6/E7 mRNA阴性/例	E6/E7 mRNA阳性/例	E6/E7 mRNA阳性率/%
炎症等	39	32	7	17.95
CIN 1级（或LSIL）^①	66	45	21	31.82
CIN 2级	21	13	8	38.10
CIN 2/3级（或HSIL）^②	23	14	9	39.13
CIN≥3级	9	1	8	88.89
合计	158	105	53

TCT结果	例数	HPV E6/E7 mRNA阳性			HPV E6/E7 mRNA阴性
		样本数/例	组织病理学检查		样本数/例	组织病理学检查
		样本数/例	CIN≤1级或LSIL/例	CIN≥2级/例	样本数/例	CIN≤1级或LSIL/例	CIN≥2级/例
NILM	34	9	8	1	25	22	3
ASCUS	50	18	10	8	32	25	7
ASCH	5	1	1	0	4	1	3
LSIL	48	15	7	8	33	27	6
HSIL	19	9	1	8	10	2	8
AGC	1	0	0	0	1	0	1
合计	157	52	27	25	105	77	28

TCT结果	例数	HPV E6/E7 mRNA阳性			HPV E6/E7 mRNA阴性
		样本数/例	组织病理学检查		样本数/例	组织病理学检查
		样本数/例	CIN≤1级或LSIL/例	CIN≥2级/例	样本数/例	CIN≤1级或LSIL/例	CIN≥2级/例
NILM	34	9	8	1	25	22	3
ASCUS	50	18	10	8	32	25	7
ASCH	5	1	1	0	4	1	3
LSIL	48	15	7	8	33	27	6
HSIL	19	9	1	8	10	2	8
AGC	1	0	0	0	1	0	1
合计	157	52	27	25	105	77	28

组织病理学检查	HPV E6/E7 mRNA	分析或预测
阴性（炎症或CIN≤1级或LSIL）	阳性	HPV E6/E7 mRNA检测更敏感，可作为早期HPV感染的筛查方法
阳性（CIN≥2级）	阴性	可能会维持现状或转化为正常
	阳性	病情有恶化，可能存在原位癌或浸润癌
阴性（炎症或完全正常）	阴性	HPV感染可能性小，患宫颈癌的可能性较小