P16自身抗体联合HPV检测诊断HSIL及预后价值

Value of P16 autoantibody level combined with HPV detection for diagnosing high-grade squamous intraepithelial lesion and the prognosis evaluation of the women

目的:探究P16自身抗体(P16 IgG)联合人类乳头瘤病毒(HPV)检测对高度鳞状上皮内病变(HSIL)诊断和预后评估价值。方法:选取2019年3月-2020年3月在本院手术治疗的HSIL患者85例为观察组,行宫颈组织检查的健康女性85例为对照组,于观察组术前及对照组体检时检测血清P16 IgG、HPV-DNA水平,观察组术后随访12个月,根据病情进展与否分为进展组和稳定组。分析各组术前血清P16 IgG和HPV-DNA水平对HSIL诊断及预后评估价值。结果:观察组术前血清P16 IgG水平(1.26±0.30)和HPV-DNA含量(2.12±0.69)均高于对照组(1.06±0.18、0.41±0.17),术后血清P16 IgG水平(1.11±0.20)及HPV-DNA含量(0.85±0.24)均低于术前但仍高于对照组(1.06±0.18、0.41±0.17)(均P<0.05);术后随访12个月有28例进展或复发,进展组术前血清P16 IgG水平和HPV-DNA含量均高于稳定组,术后血清低于术前但高于对照组(P<0.05)。观察组和术后进展组患者血清P16 IgG水平与HPV-DNA含量均呈正相关性(r=0.784、0.803,P<0.001)。P16 IgG和HPV-DNA诊断HSIL的曲线下面积(AUC)分别为0.878、0.736,最佳截断值1.21、2.11,灵敏度91.3%、81.4%,特异度78.8%、69.6%;两者联合检测诊断HSIL的AUC为0.933,灵敏度97.7%、特异度92.6%。P16 IgG和HPV-DNA检测对HSIL预后评估的AUC分别为0.771、0.704,最佳截断值为1.10、0.86,灵敏度为86.5%、79.4%,特异度为71.7%、66.8%;二者联合检测对HSIL预后评估的AUC为0.897,灵敏度91.7%、特异度90.1%。结论:P16 IgG和HPV-DNA水平异常升高与HSIL病变相关,P16 IgG和HPV检测可作为HISL早期诊断及预后评估的辅助指标。

Objective:To explore the value of P16 autoantibody(P16 IgG)level combined with HPV detection for diagnosing high-grade squamous intraepithelial lesion(HSIL),and to evaluate the prognosis of these women.Methods:A total of 85 women with HSIL who wanted surgery treatment were selected in observation group,and 85 healthy women who wanted cervical examination were selected in control group from March 2019 to March 2020.The serum P16 IgG and HPV-DNA levels of the women in the observation group were detected before operation,and which of the women in the control group were detected during physical examination,respectively.The women in the observation group were followed up for 12 months after operation and were divided into group A(women with progression of HSIL)and group B(women with stabilization of HSIL).The values of the serum P16 IgG and HPV-DNA levels of the women in the observation group for diagnosing their HSIL and for evaluating their prognosis were analyzed.Results:The levels of preoperative serum P16 IgG(1.26±0.30)and HPV-DNA(2.12±0.69)of the women in the observation group were significantly higher than those(1.06±0.18 and 0.41±0.17)of the women in the control group.The serum P16 IgG level(1.11±0.20)and the HPV-DNA level(0.85±0.24)of the women in the observation group after operation had decreased significantly,and which were significantly higher than those(1.06±0.18 and 0.41±0.17)of the women in the control group after operation(all P<0.05).There were 28 women with progression or reoccurrence of HSIL in the observation group during the follow up for 12 months after operation.The serum P16 IgG and HPV-DNA levels of the women in group A were significantly higher than those of the women in group B.The serum P16 IgG and HPV-DNA levels of the women in group A after operation had decreased significantly,and which were significantly lower than those of the women in group B after operation(P<0.05).There was a positive correlation between the serum P16 IgG level of the women in observation group and their HPV-DNA level(r=0.784,0.803,P<0.001).The area under curve(AUC)of the P16 IgG level and HPV-DNA level for diagnosing HSIL were 0.878 and 0.736,the best cut-off values of the P16 IgG level and HPV-DNA level for diagnosing HSIL were 1.21 and 2.11,the sensitivity of the P16 IgG level and HPV-DNA level for diagnosing HSIL were 91.3%and 81.4%,and the specificity of the P16 IgG level and HPV-DNA level for diagnosing HSIL were 78.8%and 69.6%.The AUC,the sensitivity and the specificity of the combined detection of P16 IgG and HPVDNA levels for diagnosing HSIL were 0.933,97.7%,and 92.6%,respectively.The AUC of P16 IgG and HPV-DNA levels of the women for assessing prognosis of HSIL were 0.771 and 0.704,the best cut-off values of P16 IgG and HPV-DNA levels of the women for assessing prognosis of HSIL were 1.10 and 0.86,the sensitivity of P16 IgG and HPV-DNA levels of the women for assessing prognosis of HSIL were 86.5%and 79.4%,and the specificity of P16 IgG and HPVDNA levels of the women for assessing prognosis of HSIL were 71.7%and 66.8%.The AUC,the sensitivity and the specificity of the combined detection of P16 IgG and HPV-DNA levels for assessing prognosis of HSIL were 0.897,91.7%,and 90.1%,respectively.Conclusion:The abnormally elevated levels of P16 IgG and HPV-DNA are related to the cervix HSIL lesions of the women,and the detections of P16 IgG and HPV levels can be used as auxiliary indicators for the early diagnosis and prognosis evaluation of the cervix HISL.