PAX1基因启动子甲基化用于子宫颈癌临床应用价值探讨

Clinical application of promoter methylation level of PAX1 gene in cervical cancer

目的探讨PAX1基因甲基化、宫颈液基细胞学(LBC)、高危型人乳头瘤病毒(hrHPV)与HPV16或HPV18型阳性在妇女宫颈脱落细胞中筛查宫颈鳞状上皮内病变的临床应用价值。方法选取2016年1月至2016年12月就诊于福州市第一医院的妇女103例,收集宫颈脱落细胞并行PAX1基因甲基化、LBC、hrHPV检测、HPV16或HPV18型检测,以阴道镜下活检病理诊断为金标准,比较子宫颈脱落细胞中不同检测方法学。结果 PAX1基因甲基化的灵敏度、特异度与准确度分别为78.6%、97.8%和95.1%。PAX1基因甲基化作为非典型鳞状上皮细胞(ASCUS)与hrHPV分流生物标记时具有最佳临床应用结果。以hrHPV作为第一线筛查时,PAX1基因甲基化较LBC细胞学法减少20.6%阴道镜检率,以LBC、hrHPV、PAX1基因甲基化比较医院机会性筛查的经济分析中得到PAX1基因甲基化挽救一个寿命成本较其他两种方法学筛查成本低,为11 942元。结论 PAX1基因甲基化可用于监测宫颈癌病变,并具较低筛查的经济成本,可作为细胞学ASCUS与hrHPV筛查分流的临床应用。

Objective To explore the clinical application of PAX1 methylated gene(PAX1 m)in cervical intraepithelial neoplasia of women by determining PAX1 m,liquid-based cytology(LBC),high-risk HPV(hrHPV),and HPV16/18 typing tests in cervical cells.Methods Totally 103 women enrolled in Fuzhou First Hospital from January 2016 to December 2016 were selected.We performed PAX1 m,LBC,hrHPV and HPV 16/18 typing tests followed by colposcopy.Biopsies were taken if found abnormal or suspicious colposcopical.Results The sensitivity,specificity,and accuracy of PAX1 m were 78.6%,97.8%,and 95.1%,respectively.PAX1 m still showed good results in clinical application on atypical squamous cell of undetermined significance(ASCUS)and hrHPV triage in the study.PAX1 m test reduced about 20.6%colposcopy referral rate than LBC when hrHPV was used as primary screening method.Economic analysis of LBC,hrHPV and PAX1 m in hospital opportunistic screening showed that the life saving cost of PAX1 m was 11 942 yuan,lower than those of the other two screening methods.Conclusion PAX1 m testing may be used in the cervical cancer detection and triage for ASCUS and hrHPV.