血浆硫氧还蛋白还原酶水平检测对宫颈癌早期诊断的价值研究

Study on the Value of Plasma Thioredoxin Reductase Level in the Early Diagnosis of Cervical Cancer

目的检测和分析血浆硫氧还蛋白还原酶(thioredoxin redyctase,TrxR)在宫颈癌和宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)患者中的水平变化,探讨其在宫颈癌早期辅助诊断中的价值。方法选取2018年1～9月在南通市肿瘤医院确诊的78例宫颈癌和18例CIN患者及同期20例健康对照者的血浆,记录患者临床资料。运用酶联免疫吸附法(enzyme-linked immunosorbnent assay,ELISA)检测血浆TrxR浓度;同时对以上实验者的血浆用电化学发光法(electrochemical luminescence immunoassay,ECL)检测鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)。统计分析二者对宫颈癌早期诊断的价值以及血浆TrxR与宫颈癌临床病理参数间的关系。结果健康对照组、CIN组和宫颈癌组TrxR水平分别为2.46(0.98,4.21)μg/L,4.38(1.26,6.37)μg/L和5.98(4.02,15.01)μg/L,CIN组TrxR水平较健康对照组显著升高(U=33.5),宫颈癌组TrxR水平较健康对照组也显著升高(U=17.0),差异均有统计学意义(P<0.001)。健康对照组、CIN组和宫颈癌组SCCA水平分别为1.34(0.52,2.06)μg/L,1.61(0.72,2.34)μg/L和7.12(2.76,20.53)μg/L,CIN组较健康对照组SCCA水平升高,差异有统计学意义((U=48.1,P<0.01),宫颈癌组SCCA水平较健康对照组显著升高,差异有统计学意义(U=27.2,P<0.001)。受试者工作曲线(receiver operating characteristic curve,ROC)显示血浆TrxR诊断宫颈癌的曲线下面积(aera under curve,AUC)是0.840(95%CI:0.761～0.902),敏感度和特异度分别为92.3%和68.4%,约登指数为60.7%。而血浆SCCA诊断宫颈癌的AUC是0.822(95%CI:0.740～0.886),敏感度和特异度分别为65.4%和86.8%,约登指数为52.2%。病理分期I/II期与III/IV期相比,TrxR水平差异无统计学意义(U=662.0,P=0.500 4),SCCA水平两组间差异有统计学意义(U=452.0,P=0.004 8)。宫颈癌患者TrxR水平与年龄、病理类型和FIGO分型无关(均P>0.05),而与细胞分化程度相关(U=496.0,P=0.034)。结论 TrxR水平的检测有助于宫颈癌及宫颈上皮内瘤变的早期诊断,对于宫颈癌的早期预警和及早干预有着积极的意义。

Objective To discuss the clinical significance of plasma TrxR in the early diagnosis of cervical cancer by testing and analyzing its level in cervical intraepithelial neoplasia(CIN)and cervical cancer.Methods Plasma samples were collected from 78patients with cervical cancer and 18patients with cervical cancer in Nantong Tumor Hospital from January 2018and September 2018,at the same time plasma from 20healthy controls were collected.The clinical data of patients were recorded.The level of plasma TrxR was measured by enzyme-linked immunosorbnent assay(ELISA),while SCCA was measured by electrochemical luminescence immunoassay(ECL)method.Their diagnostic significance was evaluated.The relationship between TrxR and clinical parameters of cervical cancer was analyzed.Results The levels of TrxR in healthy control group,CIN group and cervical cancer group were 2.46(0.98,4.21)μg/L,4.38(1.26,6.37)μg/L and 5.98(4.02,15.01)μg/L,respectively.The level of TrxR in CIN group were significantly higher than those in healty control group(U=33.5),and TrxR levels in cervical cancer groupat were also significantly higher than those in healthy control group(U=17.0),both the difference was ststistically significant(P<0.001).The SCCA levels in healthy control group,CIN group and cervical cancer group were 1.34(0.52,2.06)μg/L,1.61(0.72,2.34)μg/L and 7.12(2.76,20.53)μg/L,respectively,the level of SCCA in CIN group was higher than those in healthy control group(U=48.1),and the difference was statistically significant(P<0.01).The level of SCCA in cervical cancer group was significantly higher than those in healthy control group(U=27.2),and the difference was statistically significant(P<0.001).Receiver operating characteristic(ROC)curve showed that the area under curve(AUC)of plasma TrxR was 0.840(95%CI:0.761~0.902),the sensitivity and specificity was 92.3%and 68.4%,and the Youden index was 60.7%.The AUC of plasma SCCA was 0.822(95%CI:0.740~0.886),the sensitivity and specificity was 65.4%and 86.8%,and the Youden index was 52.2%.Plasma TrxR in patients with cervical cancer was no difference betweenⅠ/Ⅱstages andⅢ/Ⅳstages(U=662.0,P=0.500 4),while plasma SCCA had significance difference betweenⅠ/Ⅱstages andⅢ/Ⅳstages(U=452.0,P=0.004 8).The level of plasma TrxR was no correlated with ages,histological type and FIGO stages(P>0.05);while there was significant association with cell differentiation(U=496.0,P=0.034).Conclusion Detection of plasma TrxR level contributes to the early diagnosis of cervical cancer and CIN,what’s more,it has positive significance for early warning and early intervention of cervical cancer.