PAX1甲基化检测对于非16/18型高危型人乳头瘤病毒感染人群的临床研究

The Clinical Study of PAX1 Methylation Detection for Non-16/18 High-risk Human Papillomavirus Infection

目的探讨宫颈癌甲基化检测对于非16/18型高危人乳头瘤病毒(high risk human papillomavirus,HR-HPV)感染人群的临床价值。方法方便选取2016年6月—2020年6月就诊于福州市第一医院的267例非16/18型HR-HPV阳性的女性患者,所有研究对象均进行PAX1检测、TCT检测,并以病理学检查结果为诊断金标准,分析两种筛查方法的诊断效能、转诊阴道镜检出率。结果PAX1检测的灵敏度为92.50%,特异度为43.90%,阳性预测值为28.99%,阴性预测值为95.92%,差异有统计学意义(Kappa=0.200,P<0.05);TCT检测的灵敏度为96.20%,特异度为14.00%,阳性预测值为21.70%,阴性预测值为93.75%,差异有统计学意义(Kappa=0.045,P<0.05)。两种筛查方法比较TCT的灵敏度高于PAX1检测,PAX1检测的特异度高于TCT检测,PAX1检测与金标准的Kappa值大于TCT与金标准的Kappa值,PAX1检测与金标准的一致性优于TCT与金标准;TCT检测阳性转诊阴道镜检率为88.01%(235/267),PAX1检测阳性转诊阴道镜检率为63.30%(169/267),PAX1检测与TCT检测比较,阴道镜检率减少24.72%。结论对于非16/18型HR-HPV感染人群采用PAX1检测,可以降低长期随访人群的恐慌,避免过度医疗。

Objective To investigate the clinical value of cervical cancer methylation detection for non-16/18 high-risk human papillomavirus(HR-HPV)infected people.Methods 267 female patients with non-16/18 HR-HPV positive who were admitted to Fuzhou First Hospital from June 2016 to June 2020 were conveniently selected.All study subjects were tested for PAX1 and TCT,and with pathological examination results as the diagnostic gold standard,the diagnostic efficacy of the two screening methods and the detection rate of referral colposcopy were analyzed.Results The sensitivity of PAX1 detection was 92.50%,the specificity was 43.90%,the positive predictive value was 28.99%,and the negative predictive value was 95.92%,the difference was statistically significant(Kappa=0.200,P<0.05);the sensitivity of TCT detection was 96.20%,the specificity was 14.00%,the positive predictive value was 21.70%,and the negative predictive value was 93.75%,the difference was statistically significant(Kappa=0.045,P<0.05).The two screening methods compare the sensitivity of TCT higher than PAX1 detection and the specificity of PAX1 detection was higher than TCT detection.The Kappa value of the PAX1 test and the gold standard was greater than the Kappa value of the TCT and the gold standard,and the consistency of the PAX1 test and the gold standard was better than that of the TCT and the gold standard;the positive referral colposcopy rate of TCT test was 88.01%(235/267),and the positive referral colposcopy rate of PAX1 test was 63.30%(169/267),compared with TCT test,the colposcopy rate of PAX1 test decreased by 24.72%.Conclusion The use of PAX1 testing for non-16/18 HR-HPV infected people can reduce the panic of the long-term follow-up population and avoid excessive medical treatment.