血清CYFRA21-1、CA125联合HPV DNA检测在宫颈癌早期筛查中的价值及病理特征研究

The value and pathological characteristics of serum CYFRA21⁃1 and CA125 combined with HPV DNA detection in early screening of cervical cancer

目的分析血清细胞角蛋白19片段(CYFRA21-1)、糖类抗原125(CA125)联合HPV DNA检测在宫颈癌早期筛查中的价值及病理特征。方法选取2019年8月至2023年6月沧州市中心医院收治的宫颈癌患者152例为观察组,另选取同期在本院行体检且各项正常女性80名为对照组;对比两组血清CYFRA21-1、CA125水平以及HPV DNA检测结果;对比观察组不同手术病理结果及血清CYFRA21-1、CA125表达水平以及HPV DNA检测结果;以病理学检查为金标准,分析血清CYFRA21-1、CA125水平以及HPV DNA检测单独以及联合诊断宫颈癌的一致性;绘制ROC曲线,分析血清CYFRA21-1、CA125联合HPV DNA单独检测及联合检测宫颈癌的效能。结果152例患者中,鳞状细胞癌104例,腺癌患者48例;其中轻度不典型增生66例、中度不典型增生57例、重度不典型增生29例。观察组血清CYFRA21-1、CA125水平以及HPV DNA阳性率均高于对照组,差异有统计学意义(P<0.05);血清CYFRA21-1、CA125水平:鳞状细胞癌<腺癌,轻度不典型增生<中度不典型增生<重度不典型增生,差异均有统计学意义(P<0.05)。观察组不同分期、不同肿瘤增生类型的HPV DNA阳性率比较,差异无统计学意义(P>0.05);血清CYFRA21-1、CA125水平、HPV DNA检测单独以及联合诊断宫颈癌与病理学检查结果的一致性Kappa值分别为0.677、0.731、0.756、0.902;CA125+CYFRA21-1+HPV DNA联合检测的AUC为0.894,高于CA125、CYFRA21-1、HPV DNA单独检测(P>0.05)。结论血清CYFRA21-1、CA125联合HPV DNA检测的诊断效能高于单一检测,提示三指标联合检测可显著提高宫颈癌早期筛查的诊断价值,可为制定临床治疗方案提供参考资料。

Objective To analyze the value and pathological characters of serum cytokerantin⁃19⁃fragment(CYFRA21⁃1),carbohydrate antigen 125(CA125)combined with HPV DNA detection in the early clinical diagnosis of cervical cancer.Methods 152 patients with cervical cancer admitted to Cangzhou Central Hospital from August 2019 to June 2023 were selected as the observation group.Another 80 normal women who underwent physical examinations in our hospital during the same period were chosen as the control group.The serum levels of CYFRA21⁃1 and CA125,as well as the detection results of HPV DNA were compared between the two groups.Furthermore,the different surgical pathological results,the expression levels of serum CY⁃FRA21⁃1 and CA125,and the detection results of HPV DNA were compared within the observation group.Path⁃ological examination served as the gold standard,and the consistency of serum CYFRA21⁃1,CA125 levels,HPV DNA detection,and combined detection in the diagnosis of cervical cancer were analyzed.Finally,ROC curves were used to analyze the value of serum CYFRA21⁃1,CA125 combined with HPV DNA detection for di⁃agnosing cervical cancer.Results Among the 152 patients,104 cases of squamous cell carcinoma and 48 cas⁃es of adenocarcinoma were found;There were 66 cases of mild dysplasia,57 cases of moderate dysplasia and 29 cases of severe dysplasia.Among the 152 cases,121 cases(80.13%)were positive for HPV DNA,of which 53 cases(43.80%)were positive for HPV16,39 cases(32.23%)were positive for HPV18 and 88 cases(72.73%)were positive for other 12 samples.The serum CYFRA21⁃1,CA125 levels and HPV DNA positive rate in the observation group were higher than those in the control group(P<0.05).Serum CYFRA21⁃1 and CA125 levels:squamous cell carcinoma<adenocarcinoma,mild atypical hyperplasia<moderate atypical hyper⁃plasia<severe atypical hyperplasia,the differences were statistically significant(P<0.05).There was no signifi⁃cant difference in the HPV DNA positive rate between the observation group and different stages and types of tu⁃mor hyperplasia(P>0.05).The consistency Kappa values for serum CYFRA21⁃1,CA125 levels,and HPV DNA detection alone and combined in the diagnosis of cervical cancer and pathological examination results were 0.677,0.731,0.756,and 0.902 respectively.The AUC of the combined detection of CA125+CYFRA21⁃1+HPV DNA was 0.894,which was higher than the separate detection of CA125,CYFRA21⁃1,and HPV DNA(P>0.05).Conclusion The diagnostic efficiency of serum CYFRA21⁃1,CA125 combined with HPV DNA de⁃tection is higher than that of single detection.This suggests that the combined detection of three indicators can sig⁃nificantly improve the diagnostic value of early screening for cervical cancer.This is not only beneficial for cervi⁃cal cancer disease control,but also provides valuable information for the formulation of clinical treatment plans.