沈晓斌 王宁 侯明生 詹莹

[摘要] 目的 探討HR-HPV E6/E7 mRNA和HPVL1蛋白在早期宫颈癌及宫颈上皮病变中的临床意义。 方法 收集2018年6月至2019年5月本院150例患者资料，按宫颈病变程度分为低级别组（n=69）、高级别组（n=29）、宫颈癌组（n=9）和正常组（n=43）四组，同时检测患者HR-HPV E6/E7 mRNA和HPVL1蛋白表达情况，观察两者的相关性，并比较多种筛查方案的优越性。 结果 低级别组（81.16%）、高级别组（86.21%）、宫颈癌组（100.00%）HR-HPV E6/E7 mRNA阳性率均高于正常组（11.63%），且HR-HPV E6/E7 mRNA阳性率随着病变的级别升高而递增，呈显著正相关（r=0.736，P<0.05）。同时，低级别组（36.23%）、高级别组（31.03%）、宫颈癌组（11.11%）HPVL1蛋白阳性率均低于正常组（74.42%），发现HPVL1蛋白阳性率随着病变级别升高而递减，呈显著负相关（r=-0.521，P<0.05）。统计并分析液基细胞学、HR-HPV E6/E7 mRNA、HPVL1蛋白检测方法及联合检测在宫颈病变中的诊断价值。发现联合检测特异度最高（93.02%），且敏感度较高（74.76%）。 结论 HR-HPV E6/E7 mRNA检测是宫颈癌筛查的有效措施之一，HPVL1蛋白检测在宫颈癌筛查中有重要意义。比较HR-HPV E6/E7 mRNA和HPVL1蛋白检测结果在宫颈癌筛查中有重要的指导作用，可避免过度治疗。

[关键词] 乳头状瘤病毒科;宫颈肿瘤;HPVL1蛋白;HR-HPV E6/E7 mRNA

[中图分类号] R737.33          [文献标识码] B          [文章编号] 1673-9701（2021）36-0128-05

Investigation of the detection value of HR-HPV E6/E7 mRNA and HPVL1 protein in diagnosis of early cervical cancer

SHEN Xiaobin   WANG Ning   HOU Mingsheng   ZHAN Ying

Department of Pathology， Shaoxing Hospital of Traditional Chinese Medicine in Zhejiang Province， Shaoxing   312000， China

[Abstract] Objective To investigate the clinical significance of HR-HPV E6/E7 mRNA and HPVL1 protein in early cervical cancer and cervical epithelial lesions. Methods The data of 150 patients in our hospital from June 2018 to May 2019 were collected and divided into the low-grade group （n=69）， the high-grade group （n=29）， the cervical cancer group （n=9） and the normal group （n=43） according to the degree of cervical lesions. At the same time， the patients′ expressions of HR-HPV E6/E7 mRNA and HPVL1 protein were detected， and the correlation between them was observed， and the advantages of various screening schemes were compared. Results The positive rates of HR-HPV E6/E7 mRNA in the low-grade group （81.16%）， the high-grade group （86.21%） and the cervical cancer group （100.00%） were higher than that in the normal group （11.63%）， and the positive rate of HR-HPV E6/E7 mRNA increased with the increase of pathological grade， showing a significant positive correlation （r=0.736， P<0.05）. Meanwhile， the positive rate of HPVL1 protein in the low-grade group （36.23%）， the high-grade group （31.03%） and the cervical cancer group （11.11%） was all lower than that in the normal group （74.42%）. It was found that the positive rate of HPVL1 protein decreased with the increase of pathological grade， showing a significant negative correlation （r=-0.521， P<0.05）. The diagnostic value of liquid-based cytology， HR-HPV E6/E7 mRNA， HPVL1 protein detection method and combined detection in cervical lesions was counted and analyzed. It was found that the combined detection had the highest specificity （93.02%） and higher sensitivity （74.76%）. Conclusion Detection of HR-HPV E6/E7 mRNA is one of the effective measures in cervical cancer screening， and detection of HPVL1 protein is of great significance in cervical cancer screening. Comparing the detection results of HR-HPV E6/E7 mRNA and HPVL1 protein plays an important guiding role in cervical cancer screening， which can avoid over-treatment.

[Key words] Papillomaviridae; Cervical cancer; HPVL1 protein; HR-HPV E6/E7 mRNA

宫颈癌仍然是当代发展中国家女性的第三大常见恶性肿瘤，居女性癌症死因第4位，85%以上新发及死亡病例出现在发展中国家。近年来，我国的临床宫颈癌发病率呈现上升趋势，其发病的年龄也愈发趋于年轻化。我国占全球宫颈年度发病率的14%，死亡率的12%[1-3]。2015年，全国城市平均宫颈癌筛查率仅为31.5%，其中沿海经济发达地区约为35.9%[4]。HPV感染是全球最常见的性传播疾病，高危型HPV的持续性感染是宫颈癌的主要病因[5-6]。……