【摘要】 目的 探讨HPV E6/E7 mRNA是否可作为低级别子宫颈鳞状上皮内病变（lowgrade squamous intraepithelial lesion,LSIL）患者处理的分流指标。方法 选取2019年3月至2021年11月在珠海市香洲区人民医院就诊、阴道镜下活检为LSIL的非妊娠患者218例，所有患者都进行E6/E7 m RNA检测，按照治疗方案分为非手术患者（178例）及手术患者（40例），观察非手术患者2年内的子宫颈病变发展趋势及手术患者的术后病理情况，并进一步按照E6/E7mRNA检查结果进行分层分析。结果 非手术患者178例中，E6/E7 m RNA阴性72例，阳性106例，E6/E7 m RNA阴性组和阳性组在2年内子宫颈病变消退的比例分别为97.2%(70/72)和78.3%(83/106)，差异有统计学意义（χ~2=11.195,P=0.000 8）。在106例E6/E7 mRNA阳性的非手术患者中，2年内病变消退组和病变持续存在组的E6/E7 m RNA平均拷贝数分别为3 870.55和8 034.61，差异有统计学意义（χ~2=17.991,P<0.001）；拷贝数在4 442.23以下的病变消退机率高，灵敏度为0.913，特异度为0.807,ROC曲线下面积（AUC）为0.852,AUC95%置信区间为0.777～0.927。采取手术治疗的40例LSIL患者中，E6/E7 mRNA阴性21例，E6/E7 mRNA阳性19例，E6/E7 mRNA阴性组和阳性组在术后病理检查结果发现高级别子宫颈鳞状上皮内病变（high-grade cervical squamous intraepithelial lesion,HSIL）的比例分别为0(0/21)和21.1%(4/19)，差异具有统计学意义（χ~2=0.0424,P<0.05）。结论 HPV E6/E7mRNA阴性及拷贝数在4442.23以下的组织病理学确诊LSIL患者病变在2年内消退机率高，HPV E6/E7 mRNA检测可对LSIL进行初步分流。更多还原

【Abstract】 Objective To explore whether HPV E6/E7 mRNA can be a triage indicator for patients with low-grade squamous intraepithelial lesion(LSIL). Methods The colposcopy biopsy specimens of non-pregnant patients(n = 218)with LSIL diagnosed by colposcopy biopsy who were treated in Xiangzhou District People’s Hospital of Zhuhai City from March 2019 to November 2021were selected for E6/E7 mRNA detection. The patients were divided into surgical group(n = 178)and non-surgical group(n = 40),the development trend of cervical lesions in non-surgical patients within2 years and postoperative pathological conditions of surgical patients were observed and further analyzed according to E6/E7 m RNA results. Results There were 72 E6/E7 m RNA negative patients and 106 E6/E7 m RNA positive among non-surgical LSIL patients. Among 178 non-surgical patients,the proportion of cervical lesion regression within 2 years in the E6/E7 m RNA negative group and positive group was 97.2%(70/72)and 78.3%(83/106),indicating a significant difference between the two groups（χ~2= 11.195,P = 0.000 8）. Among the 106 E6/E7 m RNA positive non-surgical LSIL patients, the mean copy numbers of E6/E7 m RNA in the lesion regression group and the lesion persistence group within 2 years were 3 870.55 and 8 034.61, respectively, with a significant difference（χ~2= 17.991, P<0.001）. Lesions with a copy number below 4 442.23 had a high probability of regression,with a sensitivity of 0.913,a specificity of 0.807,an area under the ROC curve(AUC)was 0.852,and the 95% confidence interval of AUC of 0.777 ～ 0.927. Among the 40LSIL patients who underwent surgical treatment, of which 21 cases were E6/E7 m RNA negative patients and 19 were E6/E7 m RNA positive, the proportion of high-grade cervical squamous intraepithelial lesion(HSIL)was also significantly different between the E6/E7 m RNA negative group and the positive group（χ~2= 0.042 4, P<0.05）, which were 0(0/21) and 21.1%(4/19),respectively. Conclusions Histopathologically confirmed LSIL patients with HPV E6/E7 m RNA negative and copy number below 4 442.23 had a high probability of remission within 2 years. HPV E6/E7 mRNA detection can initially triage LSIL.更多还原