超声弹性成像参数联合血清CYFRA21-1、FER、IGF-Ⅱ检测对宫颈癌的诊断价值及其与肿瘤侵袭、转移的关系

Diagnostic value of ultrasound elastography parameters combined with serum CYFRA21-1,FER,IGF-Ⅱin cervical cancer and its relationship with tumor invasion and metastasis

目的探讨超声弹性成像参数联合血清细胞角蛋白19片段(CYFRA21-1)、铁蛋白(FER)、胰岛素生长因子-Ⅱ(IGF-Ⅱ)表达检测对宫颈癌的诊断价值及其与肿瘤侵袭、转移的关系。方法选取2018年6月至2021年2月于该院行切除术的86例宫颈癌患者为恶性组,同期行切除术的86例宫颈良性病变患者为良性组。比较两组超声弹性成像参数(弹性应变比值、弹性图像压放指数),血清CYFRA21-1、FER、IGF-Ⅱ水平,以及组织标本中侵袭基因(Rab11、PRPS2、GRP94、EZH2、GOLPH3)的相对表达量,并分析恶性组不同病理特征患者超声弹性成像参数、血清各指标水平。绘制受试者工作特征(ROC)曲线分析超声弹性成像参数、血清各指标单独及联合诊断宫颈癌的效能,采用Pearson相关分析超声弹性成像参数、血清各指标与组织标本中侵袭基因相对表达量的关系。结果恶性组弹性应变比值、弹性图像压放指数、CYFRA21-1、FER、IGF-Ⅱ及组织标本中Rab11、PRPS2、GRP94、EZH2、GOLPH3相对表达量均高于良性组(P<0.05),有淋巴结转移、临床分期Ⅲ期、浸润深度>1/2肌层宫颈癌患者弹性应变比值、弹性图像压放指数、CYFRA21-1、FER、IGF-Ⅱ水平均高于无淋巴结转移、临床分期Ⅰ~Ⅱ期、浸润深度≤1/2肌层(P<0.05)。Pearson相关分析显示,宫颈癌患者弹性应变比值、弹性图像压放指数、CYFRA21-1、FER、IGF-Ⅱ与组织标本中Rab11、PRPS2、GRP94、EZH2、GOLPH3相对表达量均呈正相关(P<0.05);ROC曲线分析发现,弹性应变比值、弹性图像压放指数、CYFRA21-1、FER、IGF-Ⅱ5项联合诊断宫颈癌的曲线下面积(AUC)最大,为0.919,灵敏度为79.07%,特异度为94.19%。结论超声弹性成像参数、血清CYFRA21-1、FER、IGF-Ⅱ水平与宫颈癌临床病理参数及肿瘤侵袭、转移密切相关,联合诊断可显著提升诊断效能,为临床诊治提供可靠支持。

Objective To investigate the diagnostic value of ultrasound elastography parameters combined with serum cytokeratin 19 fragment(CYFRA21-1),ferritin(FER),insulin growth factor-Ⅱ(IGF-Ⅱ)expression in cervical cancer and its relationship with tumor invasion and metastasis.Methods A total of 86 patients with cervical cancer underwent resection in our hospital from June 2018 to February 2021 were selected as the malignant group,and 86 patients with benign cervical lesions underwent resection during the same period were selected as the benign group.Ultrasound elastography parameters and serum indexes of patients with different pathological features in malignant group were analyzed.Ultrasound elastography parameters(elastic strain ratio,elastic image compression index),serum CYFRA21-1,FER,IGF-Ⅱlevels and relative expression of invasion genes(Rab11,PRPS2,GRP94,EZH2 and GOLPH3)in tissue specimens were compared between the two groups.Ultrasound elastography parameters and serum indexes of patients with different pathological features in the malignant group were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the effectiveness of ultrasound elastography parameters and serum indicators in the diagnosis of cervical cancer alone and in combination.Pearson correlation analysis was used to analyze the relationships between ultrasound elastography parameters,serum indicators and relative expression levels of invasive genes in tissue specimens.Results The elastic strain ratio,elastic image compression index,serum CYFRA21-1,FER,IGF-Ⅱlevels and the expression levels of Rab11,PRPS2,GRP94,EZH2 and GOLPH3 in the malignant group were higher than those in the benign group(P<0.05).Cervical cancer patients with lymph node metastasis,clinical stageⅢ,invasion depth>1/2 muscle layer,elastic strain ratio,elastic image compression index,serum CYFRA21-1,FER,IGF-Ⅱlevels were higher than those without lymph node metastasis,clinical stageⅠ-Ⅱ,invasion depth≤1/2 muscle layer(P<0.05).Pearson correlation analysis showed that cervical cancer patients′elastic strain ratio,elastic image compression index,serum CYFRA21-1,FER,IGF-Ⅱlevels positively correlated with relative expression levels of Rab11,PRPS2,GRP94,EZH2 and GOLPH3 in tissue specimens(P<0.05).ROC curve analysis showed that the area under curve(AUC)of the combination of elastic strain ratio,elastic image compression index,CYFRA21-1,FER and IGF-Ⅱwas 0.919,the sensitivity was 79.07%and the specificity was 94.19%.Conclusion Ultrasound elastography parameters,serum CYFRA21-1,FER and IGF-Ⅱlevels are closely related to the clinicopathological parameters,tumor invasion and metastasis of cervical cancer.Combined diagnosis could significantly improve the diagnostic efficiency and provide reliable support for clinical diagnosis and treatment.