HPV联合SCCA检测在子宫颈癌筛查和预后监测中的临床意义

Clinical significance of combination detection of HPV with SCCA in screening and prognosis monitoring of cervical cancer

目的研究人乳头瘤病毒(human papilloma virus,HPV)联合鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)检测在子宫颈癌筛查和预后监测中的临床意义。方法选取子宫颈癌筛查结果为阴性的患者78例作为健康组,子宫颈癌患者92例为患病组。患病组治疗后定期随访,动态监测HPV-DNA和血浆SCCA,并根据3年随访结果将患病组分为复发组与未复发组,比较2组患者的HPV-DNA和SCCA的变化,分析HPV联合SCCA检测在子宫颈癌筛查和预后监测中的临床价值。结果患病组40例患者治疗后3年内复发,复发率为43.48%。健康组患者的血浆SCCA均在正常阈值之内,患病组的SCCA阳性率为85.87%,2组SCCA阳性率差异有统计学意义(P=0.000)。患病组的HPV感染率(96.74%)远高于健康组(1.28%),差异有统计学意义(P=0.000)。复发组的SCCA阳性率(92.50%)显著高于未复发组(1.92%),差异有统计学意义(P=0.000)。复发组的HPV感染率(95.00%)明显高于未复发组(1.92%),差异有统计学意义(P=0.000)。HPV和SCCA检测在子宫颈癌诊断中的曲线下面积分别为0.864和0.820,两者联合检测的曲线下面积为0.940。HPV联合SCCA在子宫颈癌患者的预后监测中的曲线下面积为0.954,大于SCCA和HPV单独检测的曲线下面积(0.851和0.856)。结论 HPV感染是子宫颈癌发生的主要原因,HPV-DNA检测具有高敏感性;血浆SCCA是子宫颈癌重要的血清学标志物,SCCA检测具有高特异性;HPV联合SCCA检测在子宫颈癌筛查和预后监测中有重要的临床价值。

Objective To investigate the clinical significance of combination detection of human papilloma virus(HPV)with squamous cell carcinoma antigen(SCCA)in screening and prognosis monitoring of cervical cancer.Methods A total of 78 subjects with negative results of cervical cancer screening were enrolled as control group,and the other 92 patients with cervical cancer were enrolled as cervical cancer group.The patients in cervical cancer group were followed up regularly for 3 years after being treated,and the levels of HPV-DNA and plasma SCCA were dynamically monitored.Moreover the cervical cancer group was subdivided into relapse group and the non-relapse group according to the the results of the follow up,and the changes of HPV-DNA and plasma SCCA were observed and compared among groups,finally,the clinical value of combination detection of HPV and plasma SCCA in screening and prognosis monitoring of cervical cancer was analyzed.Results The 40 patients in cervical cancer group had relapse after 3-year treatment,with the relapse rate being 43.48%.The positive rate of plasma SCCA in cervical cancer group was 85.87%,however,the plasma levels of SCCA in control group were within the normal threshold,there was a significant difference in the SCCA positive rate between cervical cancer group and control group(P<0.01).The HPV infection rate in cervical cancer group was significantly higher than that in control group(96.74%vs 1.28%,P<0.01).The SCCA positive rate(92.50%)in relapse group was significantly higher than that(1.92%)in non-relapse group(P<0.01).The HPV infection rate in relapse group was significantly higher than that in non-relapse group(95.00%vs 1.92%,P<0.01).Moreover the area under curve of HPV and SCCA in diagnosis of cervical cancer was 0.864 and 0.820,respectively,however,which by combination detection HPV with SCCA was 0.940.In addition the area under curve of HPV combined with SCCA was 0.954 in prognosis monitoring of cervical cancer,which was significantly larger than that(0.851 and 0.856)by simple detection of HPV or SCCA.Conclusion The HPV infection is main pathogenesis of cervical cancer,and HPV-DNA detection is quite sensitive.The plasma SCCA is important serological marker of cervical cancer,and SCCA detection is very specific.The combination detection of HPV with SCCA has an important clinical value in screening and prognosis monitoring of cervical cancer.