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    PAX1甲基化联合HR-HPV分型检测在宫颈疾病中的应用

    Application of PAX1 Methylation Combined with HR-HPV Typing Detection in Cervical Diseases

    • 摘要: PAX1甲基化定量检测在宫颈疾病中的临床应用价值,通过对比PAX1甲基化、HR-HPV、TCT与临床病理结果的相关性,为宫颈癌早期诊断及筛查提供理论依据。方法 选择2016年6月至2018年5月在徐州市妇幼保健院宫颈科就诊的患者108例,以病理结果为诊断标准,将患者分四组:慢性宫颈炎组22例,LSIL组30例,HSIL组31例,宫颈癌组25例。所有患者均行宫颈脱落细胞采集,经甲基化荧光定量PCR检测PAX1甲基化状态及水平,并且同时进行HR-HPV分型、TCT检测。三项指标任一阳性者,均行阴道镜下行活检术,对检测结果进行统计分析,比较三种筛查方法中,单独或联合筛查方案的灵敏度、特异度、诊断符合率。结果 宫颈癌组PAX1甲基化水平明显高于其他各组,组间差异有统计学意义(P<0.001)。PAX1甲基化检测在高级别宫颈病变及以上病变的灵敏度、特异度、诊断符合率分别为 76.79% 、90.38% 、83.33% ;高危HPV分型检测在高级别宫颈病变及以上病变的灵敏度、特异度、诊断符合率分别为 87.50% 、75.00% 、81.48% ;TCT检测在高级别宫颈病变及以上病变的灵敏度,特异度,诊断符合率分别为 58.93%、73.08% 、65.74% ;单独筛查:HPV灵敏度最高,PAX1特异度最高,联合筛查:PAX1+ HPV灵敏度为最高94.64% ,特异度为75.00%,诊断符合率为85.19%。结论 PAX1甲基化检测在高级别宫颈病变及以上病变具有较高的特异度,尤其是PAX1联合HR-HPV检测对高级别宫颈病变及以上病变筛查具有较高的临床价值,可作为宫颈癌筛查的临床新途径。

       

      Abstract: Objective: To investigate the clinical value of PAX1 methylation quantitative detection in cervical diseases. By comparing the correlation between PAX1 methylation, HR-HPV, TCT and clinicopathological results, it provides a theoretical basis for early diagnosis and screening of cervical cancer. Methods: A total of 108 patients from June 2016 to May 2018 in the Department of Cervical Medicine of Xuzhou Maternity and Child Health Care Hospital were selected. The pathological results were used as the diagnostic criteria. The patients were divided into four groups: 22 cases in chronic cervicitis group, 30 cases in LSIL group, 31 cases in HSIL group and 25 cases in cervical cancer group. Cervical exfoliated cells were collected from all patients. The status and level of methylation of PAX1 were detected by methylation fluorescence quantitative PCR, and HR-HPV typing and TCT were detected simultaneously. If any of the three indicators was positive, colposcopic biopsy was conducted, and then the test results were analyzed statistically to compare the sensitivity, specificity, diagnostic coincidence rate of single or combined screening program in the three screening methods. Results: The methylation level of PAX1 in cervical cancer group was significantly higher than that in other groups, and the difference among the groups was statistically significant (P<0.001). The sensitivity, specificity and diagnostic coincidence rate of PAX1 methylation detection in high-grade cervical lesions and above lesions were 76.79%, 90.38%, and 83.33%, respectively; the sensitivity, specificity and diagnostic coincidence rate of high-risk HPV typing detection in high-grade cervical lesions and above lesions were 87.50%, 75.00%, and 81.48%, respectively; the sensitivity, specificity, and diagnostic coincidence rate of TCT detection in high-grade cervical lesions and above lesions were 58.93%, 73.08%, and 65.74%, respectively. Screening alone: the sensitivity of HPV was the highest and the specificity of PAX1 was the highest. The combined screening: the sensitivity of PAX1 + HPV was the highest (94.64%), and the specificity was 75.00%, and the diagnostic coincidence rate was 85.19%.Conclusion: The PAX1 methylation detection has high specificity in high-grade cervical lesions and above lesions, especially PAX1 combined with HR-HPV detection has high clinical value for screening of high-grade cervical lesions and above lesions, which can be used as the clinical new way of cervical cancer screening.

       

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