经阴道彩色多普勒超声联合血清miRNA-18a和miRNA-92a诊断宫颈癌的价值研究

Clinical Values of Transvaginal Color Doppler Sonography Combined with Serum mi RNA-18a and mi RNA-92a in the Diagnosis of Cervical Carcinoma

背景宫颈癌(CC)的筛查和早期诊断包括超声、阴道镜检、人类乳头瘤病毒(HPV)-DNA检测、液基薄层细胞检测等。而如何选择适宜的检查方式以获取最大的诊断效能,同时又具有经济、便捷、创伤小的特点,是临床密切关注的问题。目的探索经阴道彩色多普勒超声(TVCDS)联合血清miRNA-18a、miRNA-92a诊断CC的价值。方法选择2015年3月—2017年7月首都医科大学附属北京朝阳医院妇产科经术后病理诊断为CC的患者122例为CC组;选取病理确诊为宫颈上皮内瘤变(CIN)的患者120例为CIN组;选择同期本院确诊为子宫良性病变的患者120例为正常组。比较3组一般资料、TVCDS检查结果及血清miRNA-18a、miRNA-92a;采用多因素Logistic回归分析分析CC的影响因素;以术后病理诊断结果为金标准,绘制各指标诊断CC的ROC曲线。结果 CIN组、CC组高危型人类乳头瘤病毒(HR-HPV)感染发生率高于正常组,CC组HR-HPV感染发生率高于CIN组(P<0.05);CIN组绝经发生率低于正常组、CC组(P<0.05)。CC组和CIN组均可见疑似癌变的宫颈表现,宫颈边缘不整;CC组较CIN组血流更为丰富。CIN组、CC组血流阻力指数(RI)均低于正常组(P<0.05);CC组血流RI低于CIN组(P<0.05)。3组宫体、卵巢及宫旁各组织均为正常生理表现。CIN组、CC组血清miRNA-18a、miRNA-92a高于正常组(P<0.05);CC组血清miRNA-18a、miRNA-92a高于CIN组(P<0.05)。多因素Logistic回归分析结果显示,年龄、HR-HPV感染、绝经、血流RI、血清miRNA-18a、血清miRNA-92a是CC发生的影响因素(P<0.05)。血流RI、血清miRNA-18a、血清miRNA-92a、血流RI联合血清miRNA-18a、血流RI联合血清miRNA-92a及血流RI联合血清miRNA-18a、miRNA-92a诊断CC的ROC曲线下面积分别为0.844、0.880、0.763、0.936、0.886、0.940,灵敏度分别为80.8%、78.7%、64.8%、87.7%、82.8%、94.3%,特异度分别为68.0%、83.7%、81.8%、85.8%、78.3%、81.3%。结论 CC患者TVCDS的血流RI降低,血清miRNA-18a、miRNA-92a升高;TVCDS的血流RI联合血清miRNA-18a、miRNA-92a对CC的诊断效能高于其单独诊断效能,且具有易操作的特点,可提高CC的早期诊断率,值得临床推广使用。

Background Approaches for the screening and early diagnosis of cervical carcinoma(CC)include ultrasound,colposcopy,HPV-DNA testing,and thin-layer liquid-based cytology.How to choose an inexpensive,easy-to-use and mini-invasive examination with ideal diagnostic accuracy for CC,is a closely watched clinical issue.Objective To explore the clinical values of transvaginal color Doppler sonography(TVCDS)combined with serum miRNA-1 8a and miRNA-9 2a in the diagnosis of CC.Methods We enrolled 362 cases from Department of Obstetrics and Gynecology,Beijing Chaoyang Hospital, Capital Medical University,from March 2015 to July 2017,inc luding 122 with a postoperative pathological diagnosis of CC(CC group),120 with a pathological diagnosis of cervical intraepithelial neoplasia(CIN)(CIN group),and 120 with benign uterine lesions(normal group).Three groups' general data,TVCDS test results and serum miRNA-18a,miRNA-92a were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of CC.ROC curves of blood flow resistance index(RI),miRNA-18a,and miRNA-92a,either alone or in combination,for the diagnosis of CC were drawn and analyzed.And their diagnostic accuracy was evaluated by comparing the gold standard,postoperative pathological diagnosis results.Results The incidence of HR-HPV infection in CIN group and CC group was higher than that in normal group (P<0. 05), and it was higher in CC group than that in CIN group(P<0. 05).Th e incidence of menopause in CIN group was lower than that of other two groups(P<0. 05).Cervica l manifestations of suspected carcinogenesis were observed in both CC and CIN groups. The margin of the cervix was not complete.The blood flow was richer in CC group than those of the CIN group.The blood flow RI in CIN group and CC group was lower than that in the normal group(P<0. 05),an d it was lower in CC group than that of the CIN group(P<0.05).There were no pathological manifestations in the uterine body,ovary and para-uterine tissues among three groups.The serum miRNA-18a and miRNA-92a in CIN group and CC group were higher than those in the normal group (P<0. 05). The serum miRNA-1 8a and miRNA-9 2a in CC group were higher than those of the CIN group(P<0. 05).Multiva riate Logistic regression analysis showed that age,HR-HPV infection,menopause,blood flow RI,serum miRNA-1 8a,an d serum miRNA- 92a were the influencing factors of CC(P<0. 05).The area under the ROC curve of blood flow RI,serum miRNA-1 8a,serum miRNA-9 2a,blood flow RI combined with serum miRNA-1 8a,b lood flow RI combined with serum miRNA-9 2a and blood flow RI combined with serum miRNA-18a and miRNA-92a in diagnosing CC was 0. 844, 0. 880, 0. 763, 0. 936, 0. 886,an d 0. 940, respectively.The sensitivities were 80.8%,78.7%,64.8%,87.7%,82.8%,and 94.3%,respectively.And the specificities were 68.0%,83.7%,81.8%,85.8%,78.3%,and 81.3%,respectively.Conclusion The blood flow RI of TVCDS in CC patients decreased, and serum microRNA-18a and microRNA-92a increased.The blood flow RI of TVCDS combined with serum miRNA-18a and miRNA-92a has higher diagnostic accuracy for CC than the blood flow RI of TVCDS,serum miRNA-18a and miRNA-92a alone,and it is easy to perform,which can improve the early diagnosis rate of CC,and is worthy of clinical promotion.