宫颈分泌物中Stat3和Survivin的测定在宫颈病变筛查中的价值

Values of determinating Stat3 and survivin protein in cervical secretions in cervical lesions screening in less developed areas

目的探讨宫颈分泌物中信号转录与活化因子3(Stat3)和生存素(Survivin)蛋白测定在宫颈病变筛查中的价值,为经济欠发达地区的宫颈病变筛查提供新方法。方法采集2016年12月至2017年10月常熟市第二人民医院妇科门诊薄层液基细胞学(TCT)和/或高危型人乳头瘤病毒(hr-HPV)初筛结果异常行宫颈活检的192例女性患者的宫颈分泌物,双抗体夹心(ELISA)法测定宫颈分泌物中Stat3和Survivin蛋白含量,将Stat3和Survivin单独和联合筛查方案的效能与TCT、hr-HPV和TCT+hr-HPV方案比较。结果 (1)Stat3方案的灵敏度与TCT和hr-HPV比较差异无统计学意义(χ2=2.57,P>0.05),特异度(73.00%)和阳性预测值(75.89%)较高,误诊率和阴道镜转诊率比TCT降低32.55%和13.21%、比hr-HPV降低47.36%和19.83%;在ASCUS分流中虽灵敏度低于hr-HPV方案(Fisher确切概率法检验,P=0.24),但误诊率和阴道镜转诊率比hr-HPV降低33.33%和16.35%。(2)Survivin+Stat3方案灵敏度略低于TCT+hr-HPV方案(χ2=3.18,P>0.05),具有更高的特异度(83.76%)和阳性预测值(84.00%),误诊率和阴道镜转诊率比TCT+hr-HPV方案降低18.81%和11.08%。该方案在ASCUS分流中灵敏度低(66.67%),漏诊率高达33.33%,不宜作为ASCUS分流方案。(3)Stat3与Survivin+Stat3方案比较灵敏度和特异度差异均无统计学意义(χ2值分别为0.51、3.22,均P>0.05)。Survivin+Stat3方案特异度(83.76%)和阳性预测值(84.00%)较高,误诊率和阴道镜转诊率低,适合作为诊断方案。Stat3方案灵敏度(92.40%)和阴性预测值(91.25%)较高,漏诊率低,适合作为筛查方案。结论 ELISA法宫颈分泌物中Stat3和Survivin蛋白检测有望作为经济欠发达地区宫颈病变筛查的新方法。

Objective To explore the values of signal transcription and activation factor 3（Stat3）and survivin protein detection in cervical secretions in cervical lesions screening and to provide new methods for cervical lesion screening in less developed areas.Methods Cervical secretions of 192 female patients with abnormal results of thinprep cytology test（TCT）and/or high risk human papillomavirus（HR-HPV）primary screening and receiving cervical biopsy in gynecology outpatient department in Second People＇s Hospital of Changshu City from December 2016 to October 2017 were collected.Stat3 and survivin protein contents in cervical secretions were detected with enzyme-linked immunosorbent assay（ELISA）method.Performances of separate and combined screening of Stat3 and survivin were compared with TCT,hr-HPV,TCT＋hr-HPV respectively to find approach suitable for cervical lesions screening in less developed areas.Results Differences in sensitivities of Stat3,TCT and hr-HPV had no statistical significance（χ2=2.57,P〉0.05）.Specificity（73.00%）and positive predictive value（75.89%）of Stat3 were higher,and its misdiagnosis rate and colposcopy referral rate decreased by 32.55% and 13.21% respectively compared with TCT and 47.36%,19.83% respectively compared with hr-HPV.Although sensitivity of Stat3 was lower than that of hr-HPV for ASCUS women triage（fisher exact test,P=0.24）,its false positive rate and colposcopy referral rate declined by 33.33%and 16.35%respectively compared with hr-HPV.Compared with TCT＋hr-HPV,sensitivity of survivin＋Stat3 scheme was slightly lower（χ2=3.18,P〉0.05）,but it had better specificity（83.76%）and positive predictive value（84.00%）and its false positive rate and colposcopy referral rate dropped by 18.81% and 11.08% respectively compared with TCT＋hr-HPV.Sensitivity of survivin＋Stat3 scheme（66.67%）was low and its missed diagnosis rate was as high as 33.33%in ASCUS triage,so it could not be used for ASCUS triage.Differences in sensitivity and specificity of Stat3 and survivin＋Stat3 were not statistically significant（χ2 value was 0.51 and 3.22 respectively,both P〉0.05）.Specificity（83.76%）and positive predictive value（84.00%）of survivin＋Stat3 were high,and its false positive rate and colposcopy referral rate were low,so it was proper for cervical lesions diagnosis.Sensitivity（92.40%）and negative predictive value（91.25%）of Stat3 were high,and its miss diagnosis rate was low,so it was propitious for cervical lesions screening.Conclusion Stat3 and survivin protein determination in cervical secretions using ELISA assay is expected to be a new method for cervical lesions screening in less developed areas.