感染HR-HPV的CIN与宫颈癌患者阴道微生态、血清肿瘤标志物变化及预测价值分析  

The changes of vaginal microecology and serum tumor marker in CIN and cervical cancer patients with HR⁃HPV infection and their predictive value for cervical cancer

作　　者：温静 朱慧娟[3] 吕晓芳 Wen Jing;Zhu Huijuan;Lv Xiaofang(Department of Laboratory,Shijiazhuang Maternal and Child Health Hospital;The First Department of Gynecology,Shijiazhuang Maternal and Child Health Hospital;Infection Control and Public Health Department of Hebei Provincial Traditional Chinese Medicine Hospital,Shijiazhuang Hebei 050000,P.R.China)

机构地区：[1]石家庄市妇幼保健院检验科,河北石家庄050000 [2]石家庄市妇幼保健院妇一科 [3]河北省中医院感染控制与公共卫生处

出　　处：《中国计划生育和妇产科》2024年第9期93-97,102,F0003,共7页Chinese Journal of Family Planning & Gynecotokology

基　　金：2024年度河北省医学科学研究课题计划(项目编号:20240548)。

摘　　要：目的分析感染高危型人乳头瘤病毒(HR-HPV)的宫颈上皮内瘤变(CIN)患者与宫颈癌(CC)患者的阴道微生态、血清肿瘤标志物变化及对宫颈癌的预测价值。方法选取2022年7月至2023年9月石家庄市妇幼保健院50例感染HR-HPV的CIN患者作为CIN组,另选同期、同年龄段50例感染HR-HPV的CC患者作为CC组。比较两组基础资料、阴道微生态失衡率、血清肿瘤标志物水平,并比较CIN组不同CIN分级患者阴道微生态失衡率、血清肿瘤标志物水平,分析阴道微生态失衡率、血清肿瘤标志物水平与CIN分级的相关性,并分析CIN进展为CC的影响因素及阴道微生态失衡、血清肿瘤标志物预测CIN进展为CC的价值。结果CC组自然流产次数≥1次占比(38.00%)、初潮年龄>13岁占比(78.00%)、阴道微生态失衡率(68.00%)均高于CIN组(14.00%、50.00%、30.00%)(P<0.05);CC组血清糖类抗原199(CA199)、鳞状上皮细胞癌抗原(SCCA)、糖类抗原125(CA125)、癌胚抗原(CEA)水平高于CIN组(P<0.05);CIN组CIN分级Ⅲ级患者阴道微生态失衡率、血清SCCA、CEA、CA199、CA125水平高于Ⅱ级、Ⅰ级患者,Ⅱ级患者高于Ⅰ级患者(P<0.05);CIN组阴道微生态失衡率、血清SCCA、CEA、CA199、CA125水平与CIN分级呈正相关(P<0.05);自然流产次数≥1次、初潮年龄>13岁、阴道微生态失衡、血清SCCA、CEA、CA199、CA125水平均为CIN进展为CC的独立危险因素(P<0.05);阴道微生态失衡、血清SCCA、CEA、CA199、CA125预测CIN进展为CC的曲线下面积(AUC)分别为0.706、0.750、0.784、0.828、0.724,联合预测的AUC最大,为0.901(P<0.05);阴道微生态失衡、血清SCCA、CEA、CA199、CA125联合预测CIN进展为CC方面拥有良好的临床效能。结论阴道微生态失衡、血清SCCA、CEA、CA199、CA125均为CIN进展为CC的独立危险因素,阴道微生态、血清SCCA、CEA、CA199、CA125联合检测对CIN进展为CC具有较高的预测效能。Objective To analyze the changes of vaginal microecology,serum tumor marker in cervical cancer(CC)and CIN patients with high⁃risk human papillomavirus(HR⁃HPV)infection and their predictive value for cervical cancer.Methods A total of 50 patients with CIN infected with HR⁃HPV from Shijiazhuang City Maternal and Child Health Care Hospital from July 2022 to September 2023 were selected as CIN group,and 50 patients with HR⁃HPV infected CC in the same age group were selected as CC group.The basic data,vaginal microecological imbalance rate and serum tumor marker level of the two groups were compared,and the vaginal microecological imbalance rate and serum tumor marker level of patients with different CIN grades in the CIN group were compared,and the correlation between the vaginal microecological imbalance rate and serum tumor marker level and CIN grade was analyzed.The factors influencing the progression of CIN to CC and the value of vaginal microecological imbalance and serum tumor markers in predicting the progression of CIN to CC were analyzed.Results The proportion of spontaneous abortion≥1 time(38.00%),the proportion of menarche>13 years old(78.00%)and the rate of vaginal microecological imbalance(68.00%)in CC group were higher than those in CIN group(14.00%,50.00%,30.00%)(P<0.05).The serum levels of carbohydrate antigen 199(CA199),squamous cell carcinoma antigen(SCCA),carbohydrate antigen 125(CA125)and carcinoembryonic antigen(CEA)in CC group were higher than those in CIN group(P<0.05).The vaginal microecological imbalance rate,serum SCCA,CEA,CA199 and CA125 levels of CIN gradeⅢpatients in CIN group were higher than those of gradeⅡand gradeⅠpatients,and those of gradeⅡpatients were higher than those of gradeⅠpatients(P<0.05).Vaginal microecological imbalance rate,serum SCCA,CEA,CA199,CA125 levels were positively correlated with CIN grade(P<0.05).Spontaneous abortion≥1 time,menarche age>13 years,vaginal microecological imbalance,serum SCCA,CEA,CA199,CA125 levels were all independent risk fa

关 键 词：宫颈上皮内瘤变 宫颈癌 阴道微生态 癌胚抗原 鳞状上皮细胞癌抗原 糖类抗原199 糖类抗原125 

分 类 号：R737.33[医药卫生—肿瘤]