宫颈组织HPV DNA与血清Chemerin,Leptin水平联合检测对宫颈癌早期诊断的价值分析

目的 探讨人乳头状瘤病毒(human papillomavirus,HPV)DNA联合趋化素(chemerin)、瘦素(leptin)检测用于宫颈癌早期诊断的特异度与敏感度。方法 以2015年3月～2018年3月期间于珠海市第二人民医院诊治的82例宫颈癌患者、78例宫颈上皮瘤变(cervical intraepithelial neoplasias,CIN)患者分别为宫颈癌组和CIN组,76例同期于珠海市第二人民医院体检正常者为对照组。分析HPV DNA,Chemerin和Leptin单独及联合检测的敏感度及特异度。结果 宫颈癌组、CIN组和对照组的血清Chemerin水平依次降低,差异均具有统计学意义(P<0.05); 三组的HPV DNA阳性率差异具有统计学意义(P<0.05),经两两比较显示,宫颈癌组高于CIN组和对照组(P<α'); 宫颈癌组的中位Leptin浓度高于CIN组和对照组,差异具有统计学意义(P<0.05)。HPV DNA+Chemerin+Leptin平行联合检测的敏感度、特异度、准确度分别为47.56%,75.64%和61.25%,其中特异度和准确度均高于其中任意两者平行联合检测。HPV DNA+Chemerin+Leptin系列联合检测的敏感度、特异度、准确度分别为74.39%,74.36%和74.38%,均高于任意两者系列联合检测。HPV DNA+ Chemerin,Chemerin+ Leptin,HPV DNA+ Leptin和HPV DNA+ Chemerin+ Leptin平行联合检测的受试者工作特征(receiver operating characteristic curve,ROC)曲线下面积依次为0.735,0.717,0.654和0.818,(P<0.05),系列联合检测的ROC曲线下面积依次为0.709,0.697,0.650和0.860,(P<0.05)。结论 HPV DNA+Chemerin+Leptin系列联合检测可提高宫颈癌诊断的灵敏度、特异度、准确度和ROC曲线下面积,与平行联合检测相比,特异度仅略有下降,因此系列联合检测可有效提高诊断效能,利于宫颈癌的早期发现,及早干预。

Value of Combined Detection of HPV DNA and Serum Levelsof Chemerin and Leptin in Early Diagnosis of Cervical Cancer

Objective To study the specificity and sensitivity analysis of HPV DNA combined with Chemerin and Leptin detection in early diagnosis of cervical cancer.Methods From March 2015 to March 2018,82 patients with cervical cancer and 78 patients with cervical intraepithelial neoplasia were treated in Zhuhai Hospital of Inegrated Traditional Chinese and Western Medicine,and 76 cases of normal physical examination in ZhuhaiHospital of Inegrated Traditional Chinese and Western Medicine in the same periodwere selected as the control group.The sensitivity and specificity of HPV DNA,Chemerin and Leptin separately and combined detection were analyzed.Results The level of serum Chemerin in cervical cancer group,CIN group and control group decreased in turn,and the difference was statistically significant(P<0.05).The positive rate of HPV DNA in the three groups was statistically different(P<0.05).The two-two comparison showed that the cervical cancer group was higher than the CIN group and the control group(P<α').The median concentration of Leptin in cervical cancer group was higher than that in CIN group and control group(P<0.05).The sensitivity,specificity and accuracy of HPV DNA+ Chemerin+Leptin parallel combined detection were 47.56%,75.64% and 61.25% respectively,and the specificity and accuracy were higher than the parallel combined detection of any two of them.The sensitivity,specificity and accuracy of HPV DNA+ Chemerin+Leptin series combined detection were 74.39%,74.36% and 74.38% respectively,and they were higher than the series combined detection of any two of them.The areas under the ROC curve of HPVDNA+ Chemerin,Chemerin+ Leptin,HPV DNA+ Leptin and HPV DNA+ Chemerin+ Leptin parallel combined test were 0.735,0.717,0.654 and 0.818,respectively(P<0.05),and that under the ROC curve of the serial combined test were 0.709,0.697,0.650 and 0.860,respectively(P<0.05).ConclusionHPV DNA+ Chemerin+ Leptin series combined detection can improve the sensitivity,specificity,accuracy and area under the ROC curve of cervical cancer diagnosis.Compared with parallel combined detection,the specificity was onlyslightly decreased.Therefore,the combined detection of HPV DNA+ Chemerin+ Leptin series can effectively improve the diagnostic efficiency,facilitate the early detection of cervical cancer,and early intervention.