| 王捷,丁玲,吕元婧,孟丹,刘虹,宋丽,祁卓,贾海霞,裴蕊欣,田志强,郝敏,王金桃.高危型HPV感染状态下阴道微环境因子联合检测对低度宫颈上皮内瘤变诊断的优化模式研究[J].中华流行病学杂志,2021,42(6):1108-1112 |
| 高危型HPV感染状态下阴道微环境因子联合检测对低度宫颈上皮内瘤变诊断的优化模式研究 |
| The optimal model of diagnosis to low-grade cervical intraepithelial neoplasia by combined detecting vaginal micro-environmental factors, based on the high-risk HPV infection |
| 收稿日期:2020-08-08 出版日期:2021-06-29 |
| DOI：10.3760/cma.j.cn112338-20200808-01045 |
| 中文关键词: 低度宫颈上皮内瘤变 阴道微环境因子 高危型人乳头瘤病毒 优化模式 |
| 英文关键词: Low-grade cervical intraepithelial neoplasia Vaginal micro-environmental factors High-risk human papillomavirus Optimization model |
| 基金项目:国家自然科学基金（81872705，81473060，81703313）；国家卫生和计划生育委员会公益性行业科研专项（201402010） |
| 作者 | 单位 | E-mail | | 王捷 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 丁玲 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 吕元婧 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 孟丹 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 刘虹 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 宋丽 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 祁卓 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 贾海霞 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 裴蕊欣 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | | | 田志强 | 山西医科大学口腔医院, 太原 030001 | | | 郝敏 | 山西医科大学第二医院妇产科, 太原 030001 | | | 王金桃 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001 | wangjt59@163.com |
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| 中文摘要: |
| 目的 探讨高危型HPV（HR-HPV）感染状态下阴道微环境因子联合检测对低度宫颈上皮内瘤变（CINⅠ）的诊断价值，并确定最优检测组合模式。方法 从课题组前期建立的社区队列中选取正常宫颈（NC）女性623人和CINⅠ患者303人作为研究对象，应用需氧菌性阴道炎/细菌性阴道病联合检测方法检测阴道微环境因子，采用导流杂交法进行HPV分型检测。采用SAS 9.2及SPSS 23.0软件进行资料分析。结果 在经主成分分析获得阴道清洁度、pH值、唾液酸苷酶和白细胞酯酶为阴道微环境主要代表性因子的基础上，对以上4种因子基于logistic回归原理进行受试者工作特征曲线（ROC曲线）分析，结果显示，单项检测灵敏度以pH值最高（76.2%），特异度以唾液酸苷酶最高（90.9%），联合检测以唾液酸苷酶+白细胞酯酶、pH值+唾液酸苷酶+白细胞酯酶、阴道清洁度+唾液酸苷酶+白细胞酯酶和pH值+阴道清洁度+唾液酸苷酶+白细胞酯酶4种组合的ROC曲线下的面积较高，分别为0.714、0.719、0.713和0.709。进一步结合HR-HPV感染状况，通过逼近理想排序法对4种组合模式的诊断效果进行优化分析后显示，HR-HPV阳性组以pH值+唾液酸苷酶+白细胞酯酶的联合检测最佳（Ci=0.585），而HR-HPV阴性组则为阴道清洁度+唾液酸苷酶+白细胞酯酶（Ci=0.641）。结论 阴道微环境因子的联合检测可用于CIN Ⅰ的辅助诊断，pH值、唾液酸苷酶、白细胞酯酶联合检测对HR-HPV阳性女性CIN Ⅰ的诊断价值较大，而阴道清洁度、唾液酸苷酶和白细胞酯酶的联合检测对HR-HPV阴性的CIN Ⅰ诊断意义更大。 |
| 英文摘要: |
| Objective To investigate the diagnostic value of different vaginal micro-environmental factors in low-grade cervical intraepithelial neoplasia (CIN Ⅰ) and determine the optimal model in high-risk human papillomavirus (HR-HPV) infection. Methods A total of 926 women, including 623 with normal cervical (NC) condition and 303 CINⅠ patients, had undergone pathological examinations, and were enrolled in the study. All the women were from a community previously established cohort. Vaginal cleanliness, pH, H2O2, β-glucuronidase, coagulase, sialidase, and leukocyte esterase (LE) were detected by the combined detection method aerobic vaginitis/bacterial vaginosis in vaginal secretions. HPV genotyping was performed by using the flow-through hybridization technology. The data were analyzed by SAS 9.2 and SPSS 23.0. Results The vaginal cleanliness, pH, sialidase, and LE were determined as the representative vaginal micro-environment factors by principal component analysis. Based on logistic regression theory to analyze the ROC curve, the results showed that the highest sensitivity was with pH value (76.2%), and the highest specificity was with sialidase (90.9%). The area under ROC curve were higher in combination detection modes of sialidase+LE (0.714), pH+sialidase+LE (0.719), vaginal cleanness+sialidase+LE (0.713) and pH+vaginal cleanness+sialidase+LE (0.709). According to HR-HPV infection status, the TOPSIS method was used to analyze the combined detection optimal model. Specifically, we found that the best diagnostic model was pH+sialidase +LE (Ci=0.585) in the HR-HPV positive group and vaginal cleanness+sialidase+LE (Ci=0.641) in the negative group.Conclusions The combined detection of vaginal microenvironment factors could be used for auxiliary diagnosis for CINⅠ. It would be more effective when detecting pH, sialidase, and LE in HR-HPV positive women while vaginal cleanness, sialidase, and LE in HR-HPV negative women at the same time. |
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