内科

目的探讨宫颈脱落细胞人乳头瘤病毒（HPV）基因E6/E7 mRNA检测诊断宫颈高危病变及宫颈癌的临床价值。方法选择2019年1月至2020年5月来本院进行宫颈癌筛查的300例女性作为研究对象，分别进行宫颈脱落细胞液基细胞学检测（TCT）、HPV E6/E7 mRNA 检测和宫颈病理组织学检测，比较不同宫颈病理组织分级女性宫颈脱落细胞HPV E6/E7 mRNA和TCT的阳性率；以宫颈病理组织学检测结果作为诊断金标准，分析女性宫颈脱落细胞HPV E6/E7 mRNA和TCT检测诊断宫颈高危病变及宫颈癌的特异性、敏感性、阳性预测值和阴性预测值；检测不同宫颈病理分级女性宫颈脱落细胞的HPV E6/E7 mRNA载量水平，分析女性宫颈病理组织学分级与其宫颈脱落细胞HPV E6/E7 mRNA拷贝数水平的关系。结果在300例接受筛查的女性中，宫颈脱落细胞HPV E6/E7 mRNA阳性210例（70.0%）、TCT阳性184例（61.3%），HPV E6/E7 mRNA阳性率随宫颈病理组织学分级的升高而增高，不同宫颈病理组织学分级女性的阳性率比较差异有统计学意义（P＜0.05），但不同宫颈病理组织学分级女性的TCT阳性率比较差异无统计学意义（P＞0.05）。以宫颈病理组织学检查结果作为诊断金标准，根据女性宫颈脱落细胞HPV E6/E7 mRNA检测结果诊断宫颈癌的灵敏度为89.0%、特异度为73.6%、阳性预测值为88.6%、阴性预测值为74.4%；根据女性宫颈脱落细胞TCT检测结果诊断宫颈癌的灵敏度为71.8%、特异度为62.6%、阳性预测值为81.5%、阴性预测值为49.1%。女性宫颈脱落细胞HPV E6/E7 mRNA载量水平随其宫颈病理组织学分级升高而增高，Spearman相关分析结果显示，女性宫颈病理分级与其宫颈脱落细胞HPV E6/E7 mRNA拷贝数水平呈正相关（r=0.612，P=0.009）。结论女性宫颈脱落细胞HPV E6/E7 mRNA的表达水平与其宫颈病变的严重程度密切相关，HPV E6/E7 mRNA检测诊断宫颈癌的效能优于TCT检测。

ObjectiveTo explore the clinical value of the detection of cervical exfoliated cells human papillomavirus (HPV) gene E6/E7 mRNA in the diagnosis of high-risk cervical lesions and cervical cancer. MethodA total of 300 women screened at our hospital for cervical cancer from January 2019 to May 2020 were selected as the research subjects, and cervical exfoliated cells thinprep cytology test (TCT), HPV E6/E7 mRNA detection and cervical histopathological examination were performed to them, respectively. The positive rates of HPV E6/E7 mRNA and TCT in female cervical exfoliated cells with different cervical histopathological classifications were compared. Using the results of the cervical histopathological test as the gold standard of diagnosis, the specificity, sensitivity, positive predictive value and negative predictive value of cervical exfoliated cells HPV E6/E7 mRNA and TCT tests in diagnosing high-risk cervical lesions and cervical cancer were analyzed, the load levels of female cervical exfoliated cells HPV E6/E7 mRNA with different cervical histopathological classifications were detected, and the relationship between the female cervical histopathological classifications and cervical exfoliated cells HPV E6/E7 mRNA copy number levels was analyzed. ResultsAmong 300 women who were screened, 210 cases (70.0%) of cervical exfoliated cells HPV E6/E7 mRNA were positive, and 184 cases (61.3%) of TCT were positive. The positive rate of HPV E6/E7 mRNA increased with the increase of cervical histopathological classifications. The positive rates of women with different cervical histopathological classifications were significantly different (P＜0.05). However, there was no statistically significant difference in the positive rate of TCT among women with different cervical histopathological classifications (P＞0.05). Using the results of the cervical histopathological examination as the gold standard of diagnosis, the sensitivity was 89.0%, the specificity was 73.6%, the positive predictive value was 88.6%, and 74.4% in the negative predictive value according to the results of female cervical exfoliated cells HPV E6/E7 mRNA detection in the diagnosis of cervical cancer. According to the TCT results of female cervical exfoliated cells in the diagnosis of cervical cancer, the sensitivity was 71.8%, the specificity was 62.6%, the positive predictive value was 81.5%, and the negative predictive value was 49.1%. The female cervical exfoliated cells HPV E6/E7 mRNA load levels increased with the increase of cervical histopathological classifications. The results of the Spearman correlation analysis showed that the female cervical histopathological classification was positively correlated with the cervical exfoliated cells HPV E6/E7 mRNA copy number levels (r=0.612, P=0.009). ConclusionThe expression of HPV E6/E7 mRNA in female cervical exfoliated cells is closely related to the severity of cervical lesions. HPV E6/E7 mRNA detection is superior to TCT in the diagnosis of cervical cancer.