ATP10a甲基化检测对高危型HPV感染患者的分流作用  

The shunting effect of ATP10a methylation detection on patients with high-risk HPV infection

作　　者：陈思思 姜晓丹 金海红[1] 宗梦麟 王慧芳[1] 孙咏梅[1] 龚姗[1] 韩琨 Chen Sisi;Jiang Xiaodan;Jin Haihong(The First Hospital of Qinhuangdao,Qinhuangdao 066000;Hebei North University,Zhangjiakou 075000)

机构地区：[1]秦皇岛市第一医院,秦皇岛066000 [2]河北北方学院,张家口075000 [3]河北医科大学,石家庄050000

出　　处：《现代妇产科进展》2023年第7期498-503,共6页Progress in Obstetrics and Gynecology

基　　金：河北省重点研发计划项目卫生健康创新专项(No:21377708D)。

摘　　要：目的:探讨ATP10a甲基化检测对高危型人乳头瘤病毒(HPV)感染患者的分流作用。方法:选取145例高危型HPV分型检测提示阳性患者,取子宫颈脱落细胞进行ATP10a甲基化检测,同时进行阴道镜检查和宫颈活检。以活检组织病理结果为金标准,对比ATP10a甲基化检测、TCT、HPV16/18分型在此类人群中诊断HSIL+(HSIL+SCC)的效能。结果:LSIL-组(炎症+LSIL)TCT结果异常概率、HPV16/18阳性率、ATP10a阳性率分别为46.15%、28.21%、19.23%,均显著低于HSIL+组(HSIL+SCC)(74.63%、55.22%、68.66%),差异有统计学意义(P均<0.05)。HR-HPV感染人群中,ATP10a诊断HSIL+的特异性、阳性预测值(PPV)、AUC(80.77%、75.41%、0.747)均高于TCT(53.85%、58.14%、0.642),差异有统计学意义(P<0.05);敏感性、阴性预测值(NPV)(68.66%、75.00%)与TCT(74.63%、71.19%)相比,差异无统计学意义(P>0.05)。ATP10a甲基化诊断HSIL+的AUC显著高于HPV16/18分型检测(0.747、0.635),差异有统计学意义(P=0.033),敏感性、特异性、PPV、NPV(68.88%、80.77%、75.41%、75.00%)均高于HPV16/18分型检测(55.22%、71.79%、62.71%、65.12%),但差异均无统计学意义(P均>0.05)。采取ATP10a甲基化检测代替TCT进行分流,阴道镜转诊率降低17.24%。HR-HPV(除HPV16/18)阳性的亚组分析中,ATP10a甲基化诊断HSIL+的特异性(80.36%)明显高于TCT(48.21%)且差异有统计学意义(P<0.05),而两者的敏感性、阴性预测值、阳性预测值、AUC比较差异无统计学意义(P<0.05)。结论:ATP10a甲基化检测在HR-HPV感染患者中诊断HSIL+的效能不劣于TCT及HPV16/18分型检测,有望成为早期诊断宫颈癌的手段。Objective:To investigate the shunting effect of ATP10a methylation detection on patients with high-risk HPV infection.Methods:A total of 145 patients with positive HPV typing were selected.Cervical exfoliated cells were collected for ATP10a methylation detection,and colposcopy and cervical biopsy were performed at the same time.To compare the efficacy of ATP10a methylation detection,TCT and HPV16/18 genotyping in the diagnosis of HSIL+(HSIL+SCC)in such population with the pathological results of biopsy as the gold standard.Results:The TCT abnormal probability,HPV16/18 positive,ATP10a positive rate were 46.15%,28.21%,19.23%in LSIL-group(inflammation+LSIL),which were significantly lower than those in HSIL+group(HSIL+SCC)(74.63%,55.22%,68.66%)(P<0.05).The specificity,positive predictive value and AUC(80.77%,75.41%,0.747)of HSIL+in the diagnosis of ATP10a were higher than those of TCT(53.85%,58.14%,0.642),and the differences were statistically significant(P<0.05).There was no significant difference in sensitivity and negative predictive value(68.66%,75.00%)compared with TCT(74.63%,71.19%)(P>0.05).The AUC of HSIL+in ATP10a methylation diagnosis was significantly higher than that in HPV16/18 typing(0.747,0.635)(P=0.033).The sensitivity,specificity,PPV,NPV(68.88%,80.77%,75.41%,75.00%)were higher than those of HPV16/18 typing(55.22%,71.79%,62.71%,65.12%),but the differences were not statistically significant(P>0.05).Using ATP10a methylation test instead of TCT for shunt would reduce the colposcopy referral rate by 17.24%.In the HR-HPV(except HPV16/18)positive subgroup analysis,the specificity of ATP10a methylation for HSIL+(80.36%)was significantly higher than that of TCT(48.21%),and the difference was statistically significant(P<0.05).There was no significant difference in sensitivity,negative predictive value,positive predictive value and AUC between the two groups(P<0.05).Conclusion:The efficacy of ATP10a methylation detection in the diagnosis of HSIL+in patients with HR-HPV infection is not inferior to that of TCT an

关 键 词：ATP10a 甲基化 HPV 宫颈上皮内病变 宫颈癌 

分 类 号：R737.33[医药卫生—肿瘤]