宫颈病变与阴道灌洗液炎性因子的关系及宫颈癌变列线图预测模型构建  

Relationship between cervical lesions and inflammatory factors in vaginal lavage fluid and establishment of nomogram prediction model for cervical carcinogenesis

作　　者：刘质斌 申鑫鑫 豆贝贝 焦亚楼[1] 张凤英[1] LIU Zhi-bin;SHEN Xin-xin;DOU Bei-bei;JIAO Ya-lou;ZHANG Feng-ying(Xingtai People's Hospital,Xingtai,Hebei 054000,China)

机构地区：[1]邢台市人民医院产科,河北邢台054000

出　　处：《中华医院感染学杂志》2024年第13期2027-2031,共5页Chinese Journal of Nosocomiology

基　　金：河北省医学科学研究基金资助项目(20221872)。

摘　　要：目的分析不同宫颈病变患者阴道灌洗液辅助性T(Th)细胞与调节性T(Treg)细胞细胞因子差异性,并建立宫颈癌变列线图预测模型。方法选取2022年1月一2022年12月于邢台市人民医院就诊的高危型人乳头瘤病毒(HR-HPV)16感染患者200例为研究对象,根据宫颈癌变情况分为宫颈癌组35例和非宫颈癌组165例,其中非宫颈癌组根据宫颈病变程度分为无病变组52例、低级别鳞状上皮内病变(LSIL)组58例、高级别鳞状上皮内病变(HSIL)组55例。另外选取同期健康体检者100名为对照组。比较各组受试者阴道灌洗液Th与Treg细胞因子表达水平情况。应用R软件建立预测宫颈癌变的列线图模型,采用受试者操作特征(ROC)曲线分析该模型预测宫颈癌变的效能。结果5组受试者阴道灌洗液肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)、干扰素(IFN-)、白细胞介素(IL)-2、IL-6、IL-10、IL-17表达水平差异有统计学意义(P<0.05),且随着疾病进展,IL 6、IL-10、IL-17、TGF-β呈增加趋势,而TNF-α、IFN-γ、IL-2呈降低趋势(P<0.05)。宫颈癌组IL-6、IL-10、IL-17、TGF-β高于非宫颈癌组,TNF-α、IFN-γ、IL-2水平低于非宫颈癌组(P<0.05)。ROC曲线分析显示,列线图模型预测宫颈癌变的曲线下面积(AUC)为0.818(95%CI0.736~0.900),敏感度、特异度分别为77.14%、78.79%。结论阴道灌洗液Th与Treg细胞因子与宫颈癌变密切关联,以各细胞因子建立的列线图模型具有良好的宫颈癌变风险预测效能。OBJECTIVE To analyze the differences in helper T(Th)cells and regulatory T(Treg)cells of vaginal lavage fluid of the patients with different degree of cervical lesions and establish the nomogram prediction model for cervical carcinogenesis.METHODS Totally 200 patients with high-risk human papillomavirus(HR-HPV)16 infection who were treated in Xingtai People's Hospital from Jan 2022 to Dec 2022 were recruited as the research subjects and were divided into the cervical cancer group with 35 cases and the non-cervical cancer group with 165 cases according to the status of cervical cancerization.The patients of the non-cervical cancer group were divided into the no lesion group with 52 cases,the low-grade squamous intraepithelial lesions(LSIL)group with 58 cases and the high-grade squamous intraepithelial lesions(HSIL)group with 55 cases according to the degree of cervical lesion.Meanwhile,1oo healthy people who received physical examination were chosen as the control group.The expression levels of Th and Treg cytokines in vaginal lavage fluid were compared among the groups of subjects.The nomogram model for prediction of cervical cancerization was established by R software,and the efficiency of the model in prediction of cervical cancerization was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS There were significant differences in the expression levels of tumor necrosis factor-α(TNF-α),transforming growth factor-β(TGF-β),interferon-(IFN-),interleukin(IL)-2,IL-6,IL-10 and IL-17 in vaginal lavage fluid among the 5 groups of subjects(P<0.05).With the progress of disease,the IL-6,IL-10,IL-17 and TGF-βshowed upward trends,while the TNF-α,IFN-γ and IL-2 showed downward trends(P<0.05).The levels of IL-6,IL-10,IL-17 and TGF-βof the cervical cancer group were significantly higher than those of the non-cervical cancer group,while the levels of TNF-α,IFN-γ and IL-2 of the cervical cancer group were significantly lower than those of the non-cervical cancer group(P<0.05).ROC curve analysis sho

关 键 词：高危型人乳头瘤病毒 宫颈病变 宫颈癌 阴道灌洗液 辅助性T细胞 调节性T细胞 细胞因子 列线图 

分 类 号：R737.33[医药卫生—肿瘤]