PAX1甲基化检测对细胞学异常(ASCUS、LSIL和ASC-H)患者的分流作用  

Shunt effect of PAX1 methylation detection on patients with cytological abnormalities(ASCUS,LSIL and ASC-H)

作　　者：李碧军 郭瑞霞[1] 刘媛媛 马迪蒙 来天骄 毛萌[1] 白晶[1] 赵孟玲 Li Bijun;Guo Ruixia;Liu Yuanyuan(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院妇科,郑州450052

出　　处：《现代妇产科进展》2021年第3期184-188,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金面上项目(No:31670844);河南省医学科技攻关计划项目(省部共建)(No:SBGJ2018005)。

摘　　要：目的:探讨配对盒基因家族1(PAX1)甲基化检测在细胞学异常女性中的分流作用。方法:选取212例宫颈细胞学(TCT)诊断为意义未明的不典型鳞状细胞(ASCUS)、不除外高度鳞状上皮内病变(ASC-H)、低度鳞状上皮内病变(LSIL)的病例进行PAX1甲基化检测和高危HPV检测,进行阴道镜检查和宫颈活检。以组织病理结果为金标准,比较PAX1和高危HPV检出HSIL+(HSIL和宫颈鳞癌)效能。结果:LSIL组(慢性宫颈炎和LSIL)的PAX1阳性率为7.25%(10/138),显著低于HSIL+组86.49%(64/74)(P<0.05)。LSIL组的HPV阳性率为69.57%(96/138)显著低于HSIL+组89.19%(66/74)(P<0.05)。PAX1诊断HSIL+的敏感性(86.49%)与高危HPV(89.19%)相比,无显著差异(P>0.05);特异性、准确性和AUC(92.75%、90.56%、0.896)均显著高于高危HPV(30.43%、50.94%和0.598)(P均<0.05)。使用PAX1甲基化代替HPV检测对细胞学进行分流时,阴道镜转诊率可降至34.91%。细胞学结果分别为ASCUS、LSIL、ASC-H时,PAX1诊断HSIL+准确性(84.21%、91.30%、100.00%)均显著高于高危HPV(63.15%、34.78%、63.64%)(P均<0.05)。结论:PAX1基因的甲基化具有较高的灵敏度和特异度,在细胞学异常(ASCUS、LSIL、ASC-H)女性中通过PAX1甲基化检测分流可提高对HSIL+的检出率,其诊断效能优于高危HPV检测,并且能降低一定的阴道镜转诊率。Objective:To investigate the shunt effect of PAX1 methylation detection in women with abnormal cytology.Methods:212 patients with atypical squamous cell(ASCUS),high-grade squamous intraepithelial lesion(ASC-H)or low-grade squamous intraepithelial lesion(LSIL)diagnosed by cytological(TCT)were examined by PAX1 methylation and high-risk HPV,followed by colposcopy and cervical biopsy.Using pathological biopsy as the gold standard,the efficacy of PAX1 and high-risk HPV in detecting HSIL+(HSIL and cervical squamous cell carcinoma)was compared.Results:The positive rate of PAX1 in the LSIL group(chronic cervicitis and LSIL)was 7.25%(10/138),which was significantly lower than that in the HSIL+group(86.49%)(64/74)(P<0.05).The positive rate of HPV in LSIL group was 69.57%(96/138),which was significantly lower than that in HSIL+group(89.19%)(66/74)(P<0.05).The sensitivity of PAX1 in diagnosing HSIL+(86.49%)was not significantly different from that of high-risk HPV(89.19%),but the specificity,accuracy and AUC(92.75%,90.56%,0.896)were significantly higher than those of high-risk HPV(30.43%,50.94%and 0.598)(P<0.05).When PAX1 methylation was used instead of HPV test for cytological shunt,the colposcopy referral rate can be reduced to 34.91%.When the cytological results were ASCUS,LSIL and ASC-H,the diagnostic accuracy of HSIL+by PAX1(84.21%,91.30%,100%)was significantly higher than that of high risk HPV(63.15%,34.78%,63.64%)(P<0.05).Conclusion:The methylation of PAX1 gene has high sensitivity and specificity.In women with cytological abnormalities(ASCUS,LSIL,ASC-H),PAX1 methylation detection can improve the detection rate of HSIL+,and its diagnostic efficiency is better than that of high risk HPV detection,and can reduce the referral rate of colposcopy.

关 键 词：PAX1 甲基化 宫颈癌 ASCUS HPV LSIL ASC-H 

分 类 号：R737.33[医药卫生—肿瘤]