| Objective Persistent infection of HPV is the most important reason for women to suffer from cervical cancer.This study analyzed the age characteristics and type distribution of HPV infection among women in Hefei to explore the predictive value of HPV E6/E7 m RNA detection in cervical lesions and cervical cancer progression.Methods Through retrospective analysis,330 patients with suspected cervical squamous intraepithelial lesions were selected from the Affiliated Maternal and Child Health Hospital of Anhui Medical University(Anhui Maternal and Child Health Hospital)from June 1,2021 to May 31,2022,who visited the outpatient and inpatient departments due to factors such as increased vaginal discharge,bleeding after sexual intercourse,cervical erosion,and cervical polyps.Thin layer liquid based cytology test(TCT)was performed HPV DNA typing detection and HPV E6/E7 m RNA detection,and record the results.At the same time,patients with HR-HPV positive and TCT results of cervicitis or above should undergo colposcopy examination.Biopsy should be performed on suspected lesions and the results recorded.If the patient’s TCT results are normal but HPV16/18 type is positive,colposcopy examination is also required.Results The distribution frequency of HPV infection in this study is HPV52 type:16.21%(66/407),HPV58 type: 12.78%(52/407),HPV16 type: 11.78%(51/407),HPV53 type: 9.33%(38/407),HPV33 type: 7.62%(31/407),HPV51 type: 6.88%(28/407),and HPV18 type: 6.63%(27/407)The positivity rate of E6/E7 m RNA in patients aged 30 was significantly higher than that in patients of other age groups,and the positivity rate of HPV DNA testing was the highest in patients aged 31 to 40,with statistically significant differences(all P<0.05)The positive rates of HPV E6/E7 m RNA detection in patients aged 30,31-40,41-50,and>51 were higher than those in HPV DNA typing detection,and the differences were statistically significant(all P<0.05).The positive rates of HPV E6/E7 m RNA detection in the normal or inflammatory group,LSIL,HSIL,and cervical cancer group were 43.53%,70.52%,82.14%,and 100.00%,respectively.It can be seen that the positive rate of HPV E6/E7 m RNA detection is increasing with the increase of pathological grade,and the difference is statistically significant(P<0.05).The positive rate of HPV DNA typing test showed an upward trend with the increase of pathological grade,and the difference was statistically significant(P<0.05).Using cervical biopsy pathology as the gold standard,the sensitivity of individual screening is generally higher than that of combined screening.The sensitivity of the three screening methods combined is the lowest(50.40%),and there is a statistically significant difference in results(P<0.05).When comparing the specificity of various screening methods,it can be seen that the specificity of HPV E6/E7 m RNA detection(63.78%)is significantly higher than that of TCT(17.48%)and HPV DNA typing detection(22.02%).Overall,the specificity of individual screening is lower than that of combined screening,with the highest specificity(71.76%)achieved by the combination of the three screening methods.The difference in results was statistically significant(P<0.05).The positive predictive value level of combined screening was slightly higher than that of individual screening,with TCT+HPV E6/E7 m RNA detection(72.45%)and the combination of three screening methods(72.41%)taking the lead,but the difference was not statistically significant(P>0.05).When comparing negative predictive values,it can be seen that the negative predictive value of HPV E6/E7 m RNA detection is in the leading position(71.05%),which is statistically significant(P<0.05)compared to other screening methods used alone or in combination.The median(quartile P25,P75)expression of HPV E6/E7 m RNA in normal or inflammatory group,low grade squamous intraepithelial lesion(LSIL)group,and high grade squamous intraepithelial lesion(HSIL)group was 0.00(0.00-1.93),0.00(0.00-6.01),4.48(2.41-9.81),respectively,showing an upward trend,The difference was statistically significant(H-value=21.52,P<0.05).Pairwise comparison between patients with different pathological grades showed significant differences in the expression of HPV E6/E7 m RNA between the normal or inflammatory group and the HSIL group,as well as between the LSIL group and the HSIL group(all P<0.05).Taking the occurrence of cervical lesions as a node,the maximum area under the ROC curve is 0.615(95% CI 0.538-0.692).When the cutoff value is 3.435,i.e.the expression level of HPV E6/E7 m RNA is 3.435,its sensitivity for predicting the occurrence of cervical lesions can reach 42.40%,and its specificity can reach 83.50%.There was a statistically significant difference in expression levels between normal or inflammatory patients and patients with cervical lesions(Z=-3.167,P<0.05).Conclusions There are regional differences in the distribution of HPV infection,with the highest infection rates in Hefei being 52 and 58 types,followed by 16 types.There is a trend of gradual youthfulness,with patients aged 31 to 40 having the highest infection rate.With the progression of cervical lesions,the positive rate and expression level of HPV E6/E7 m RNA detection show an increasing trend.According to the receiver operating characteristic curve(ROC),when the expression level of HPV E6/E7 m RNA reaches 3.435,its sensitivity in predicting whether patients will develop cervical lesions can reach 42.40%,and its specificity can reach 83.50%.The diagnostic value of HPV E6/E7 m RNA detection for cervical lesions is higher than that of TCT and HPV DNA typing detection.Its single or combined detection can comprehensively evaluate the risk of cervical lesions and invasive cervical cancer progression,providing clinical basis for hierarchical management of cervical lesions. |
PDF Full Text Request