荧光定量PCR与全自动生物芯片法检测人乳头瘤病毒的一致性研究

Agreement between fluorescent quantitative PCR and automatic Bio-chips method in detection of human papillomaviruses

  • 摘要:
      背景  人乳头瘤病毒(human papillomaviruses,HPV)分型检测是宫颈癌筛查的重要手段之一,但技术人员短缺及实验室硬件设施不足对其应用造成了不利影响。
      目的  以荧光定量聚合酶链式反应(PCR)为参考,考察全自动生物芯片法在HPV分型检测中的诊断性能。
      方法  针对常规进行荧光定量PCR检测的临床样本,每一种型别均采用抽签法进行简单随机抽样,选中的样本使用全自动生物芯片法检测,采用Kappa检验比较两种方法的检测结果是否存在差异。针对不一致结果,通过E6/E7区的扩增产物测序进行确认。
      结果  从4589例样本中选择124例,其中HPV阴性50例,HPV阳性74例,按照阳性型别计算共99个测试。按照样本阴性、阳性计算,两种方法的结果完全一致,Kappa值为1.000(P<0.0001)。按照样本型别计算,全自动生物芯片法的敏感度、特异度、阳性预测值、阴性预测值和总体符合率分别为98.0%、92.6%、96.0%、96.2%和96.1%,Kappa值为0.913(P<0.0001),提示两种方法的结果一致性良好。两种方法不一致的结果集中在6例阳性样本之中,39型和59型各1例,52型和68型各2例,在重复验证及测序分析中均得到了确认。此外,全自动生物芯片法还发现了18例不被荧光定量PCR方法涵盖的型别,能够为临床治疗提供更丰富的信息。
      结论  全自动生物芯片法与荧光定量PCR法在HPV的分型检测中具有很好的一致性,对于技术人员短缺及不具备标准PCR实验室的医疗机构,全自动生物芯片法具有良好的应用前景。

     

    Abstract:
      Background  Human papillomaviruses (HPV) genotyping is an important method for cervical cancer screening, but the insufficient technician and unqualified lab is not favorable for its application.
      Objective  To evaluate the sensitivity, specificity and overall agreement of an automatic bio-chips in detecting HPV by comparing it with fluorescent quantitative polymerase chain reaction (PCR) method.
      Methods  For clinical samples that undergoing routine fluorescence quantitative PCR testing, a simple random sampling method is used for each type. Then selected samples were tested by automatic bio-chips method, and Kappa test was used to compare the detection results of the two methods for any differences. The inconsistent results were confirmed by direct sequencing to the amplicon of E6/E7 region.
      Results  Totally 124 samples were selected randomly from 4 589 samples, including 50 negative samples and 74 positive samples (99 tests counting by cases of types). If counting by samples, the two methods were completely consistent (Kappa=1.000, P<0.0001). If counting by types, the sensitivity, specificity, positive predictive value, negative predictive value and overall agreement of automatic bio-chips was 98.0%, 92.6%, 96.0%, 96.2% and 96.1%, respectively (Kappa=0.913, P<0.0001). The inconsistent results were found in 6 positive samples (1 case each for type 39 and 59, 2 cases each for type 52 and 68), which were all confirmed in duplicate test and direct sequencing. Besides, additional 18 positive cases were found by automatic bio-chips, whose HPV types were not covered by fluorescent quantitative PCR method, thus providing more information for the treatment.
      Conclusion  Automatic bio-chips shows excellent agreement with fluorescent quantitative PCR in HPV genotyping, which has good prospect to be applied in medical institutions with insufficient technician and unqualified PCR lab.

     

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