Yang Yong-Mei, Wang Shi-Jun, Wang Feng-Ying, Chen Rui, Xiao Qun, Kang Ning, Liao Qing-Ping
Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China.
Ann Transl Med. 2021 Sep;9(18):1428. doi: 10.21037/atm-21-4026.
Detection of E6 and E7 mRNA load of high-risk human papillomavirus (HR-HPV) infection during pregnancy was compared with conventional cytopathology and DNA detection by pathological examination as colposcopy to evaluate the application of E6 and E7 mRNA detection in the diagnosis and management in HR-HPV infection for high -grade cervical lesions during pregnancy.
From January 2014 to June 2019, 1,058 pregnant women of childbearing age who were filed for regular obstetrics in the Department of Obstetrics and Gynecology, Xuanwu Hospital of Capital Medical University, were separately assessed using cervical liquid-based cytology and HPV DNA detection. If the results were abnormal, colposcopy was performed as a follow-up. The presence of HR-HPV E6/E7 mRNA fragments was detected through the HR-HPV E6/E7 mRNA test, and monitored at the same time as colposcopy. The diagnostic efficacy of the HR-HPV DNA test versus the HR-HPV E6/E7 mRNA test for high-grade cervical lesions during pregnancy was compared.
The positive rate of HR-HPV E6/E7 mRNA detection in the overall cervical intraepithelial neoplasia (CIN) and above during pregnancy was lower than that with HR-HPV DNA detection, and there was a significant statistical difference between the two methods. In CIN I and normal or inflammatory results, the positive rate of HR-HPV E6/E7 mRNA detection was lower than that of HR-HPV DNA detection, while in the results of CIN II and CIN III, the positive rate of the two was not significantly different. HR-HPV E6/E7 mRNA detection is the same as HR-HPV DNA detection, both of which increased with the severity of cervical lesions, and the positive rate increased. In cases of maintenance or progression of cervical lesions, the positive rate of HR-HPV E6/E7 mRNA detection during pregnancy can reach 81.8%. High-grade cervical lesions during pregnancy had a higher rate of reversal to a lower level after delivery.
The results suggested that the use of HR-HPV E6/E7 mRNA detection in cases of positive HR-HPV DNA detection can significantly improve the diagnostic specificity of CIN II and above high-grade cervical lesions.
比较孕期高危型人乳头瘤病毒（HR-HPV）感染的E6和E7 mRNA载量检测与传统细胞病理学及病理检查（如阴道镜检查）中的DNA检测，以评估E6和E7 mRNA检测在孕期HR-HPV感染导致的高级别宫颈病变诊断和管理中的应用。
2014年1月至2019年6月，首都医科大学宣武医院妇产科登记建档的1058例育龄孕妇分别接受宫颈液基细胞学检查和HPV DNA检测。若结果异常，则进行阴道镜检查作为随访。通过HR-HPV E6/E7 mRNA检测来检测HR-HPV E6/E7 mRNA片段的存在情况，并与阴道镜检查同时进行监测。比较HR-HPV DNA检测与HR-HPV E6/E7 mRNA检测对孕期高级别宫颈病变的诊断效能。
孕期总体宫颈上皮内瘤变（CIN）及以上病变中，HR-HPV E6/E7 mRNA检测的阳性率低于HR-HPV DNA检测，两种方法之间存在显著统计学差异。在CIN I以及正常或炎症结果中，HR-HPV E6/E7 mRNA检测的阳性率低于HR-HPV DNA检测，而在CIN II和CIN III结果中，两者的阳性率无显著差异。HR-HPV E6/E7 mRNA检测与HR-HPV DNA检测情况相同，二者均随宫颈病变严重程度增加而升高，阳性率上升。在宫颈病变维持或进展的病例中，孕期HR-HPV E6/E7 mRNA检测的阳性率可达81.8%。孕期高级别宫颈病变在产后逆转至较低级别病变的发生率较高。
结果表明，在HR-HPV DNA检测呈阳性的病例中使用HR-HPV E6/E7 mRNA检测可显著提高CIN II及以上高级别宫颈病变的诊断特异性。
