外周血肿瘤异常蛋白、CRP在HPV感染及宫颈病变预判中的价值

The value of abnormal protein and C-reactive protein levels in predicting human papillomavirus infection and cervical lesions in patients with peripheral blood tumors

目的探讨外周血肿瘤异常蛋白(TAP)、C反应蛋白(CRP)检测在人乳头瘤病毒(HPV)感染及宫颈病变预判中的价值。方法采用横断面研究,选取单县中心医院2019年6月至2021年5月收治的宫颈病变患者216例,根据HPV检查结果,将患者分为高危型HPV感染组(122例)、低危型HPV感染组(76例)及未感染HPV组(18例),检测患者外周血TAP、CRP水平并进行分析。结果高危型HPV感染组TAP、CRP分别为(243.29±19.43)μm^(2)、(37.49±10.50)mg/L,分别为低危型HPV感染组分别为(125.46±10.37)μm^(2)、(26.27±7.28)mg/L、未感染HPV组分别为(74.51±9.29)μm^(2)、(74.51±9.29)mg/L,三组差异有统计学意义(F=12.40、6.34,均P<0.001);低危型HPV感染组TAP、CRP水平较未感染HPV组显著升高,差异均有统计学意义(t=4.02、3.26,均P<0.05)。慢性宫颈炎组患者外周血TAP、CRP分别为(63.25±5.80)μm^(2)、(13.37±5.29)mg/L,与宫颈上皮内瘤变(CIN)、宫颈癌组差异有统计学意义(F=21.35、8.26,均P<0.05),其中CINⅡ和CINⅢ患者外周血TAP、CRP较CINⅠ明显升高,而宫颈癌组外周血TAP、CRP高于CIN各亚组,差异均有统计学意义(均P<0.05)。Pearson相关性分析结果显示,高危型人乳头瘤病毒-去氧核糖核酸(HPV-DNA)负荷量与血TAP、CRP均呈正相关(r=0.64、0.24,均P<0.001);外周血TAP、CRP联合检测的曲线下面积(AUC)为0.927(95%CI:0.873~0.967),敏感度、特异度分别为91.0%、93.6%。结论外周血TAP、CRP可反映HPV感染及宫颈病变病情,与HPV感染类型、宫颈病变程度密切相关,两者联合检测可提高宫颈癌诊断效能,值得临床推广。

Objective To investigate the value of abnormal protein(TAP)and C-reactive protein(CRP)levels in the prediction of human papillomavirus(HPV)infection and cervical lesions in patients with peripheral blood tumors.Methods A total of 216 patients with cervical lesions who received treatment in Shan County Central Hospital from June 2019 to May 2021 were included in this cross-sectional study.According to HPV results,these patients were divided into a high-risk HPV infection group(n=122),a low-risk HPV infection group(n=76),and an HIV-uninfected group(n=18).TAP and CRP levels in peripheral blood were determined in each group and analyzed.Results TAP and CRP levels in the high-risk HPV infection group were(243.29±19.43)μm^(2) and(37.49±10.50)mg/L,respectively,and they were(125.46±10.37)μm^(2) and(26.27±7.28)mg/L in the low-risk HPV infection group,and(74.51±9.29)μm^(2) and(74.51±9.29)mg/L in the HIV-uninfected group.There were significant differences in TAP and CRP levels among the three groups(F=12.40,6.34,both P<0.001).TAP and CRP levels in the low-risk HPV infection group were significantly higher than those in the HIV-uninfected group(t=4.02,3.26,both P<0.05).TAP and CRP levels in the peripheral blood of patients with chronic cervicitis were(63.25±5.80)μm^(2) and(13.37±5.29)mg/L,which were significantly different from those in patients with cervical intraepithelial neoplasia or cervical cancer(F=21.35,8.26,both P<0.05).TAP and CRP levels in the peripheral blood of patients with cervical intraepithelial neoplasia grade II and cervical intraepithelial neoplasia grade III were significantly higher than those in patients with cervical intraepithelial neoplasia grade I(both P<0.05).TAP and CRP levels in the peripheral blood of patients with cervical cancer were significantly higher than those in patients with various grades of cervical intraepithelial neoplasia(all P<0.05).The Pearson correlation analysis results showed that the load of high-risk human papillomavirus deoxyribonucleic acid(HPV-DNA)was positively correlated with blood TAP and CRP levels(r=0.64,0.24,both P<0.001).The area under the curve regarding the combined detection of TAP and CRP levels was 0.927(95%CI:0.873-0.967),with sensitivity and specificity of 91.0%and 93.6%,respectively.Conclusion TAP and CRP levels in peripheral blood can reflect HPV infection and cervical lesion and are closely related to the type of HPV infection and the degree of cervical lesion.Combined detection of the two can improve the diagnostic efficiency of cervical cancer and deserves clinical promotion.