伴HR-HPV感染的CIN Ⅲ级患者血清CD105水平变化及临床意义探讨

Changes of serum CD105 level in CIN grade III patients with HR-HPV infection and clinical significance

摘要:

目的 探讨伴高危型人乳头瘤病毒（HR-HPV）感染的宫颈上皮内瘤变（CIN）Ⅲ级患者血清内皮糖蛋白（CD105）水平变化及临床意义。方法 选取2018年1月至2022年2月在河南省荣军医院接受宫颈环形电切术（LEEP）治疗的352例CIN Ⅲ级患者为疾病组，另同期选取在河南省荣军医院体检的健康女性352例为对照组，检测并比较两组血清CD105水平。根据疾病组患者HPV感染情况将其分为HR-HPV感染组、非HR-HPV感染组，比较HR-HPV感染组、非HR-HPV感染组血清CD105水平。术后对CIN Ⅲ级患者随访1年，随访期间根据伴HR-HPV感染的CIN Ⅲ级患者复发情况将其分为复发组和未复发组，比较复发组和未复发组血清CD105水平及一般资料；采用多因素Logistic回归分析法分析伴HR-HPV感染的CIN Ⅲ级患者术后复发的影响因素，并绘制受试者工作特征（ROC）曲线分析血清CD105水平对伴HR-HPV感染的CIN Ⅲ级患者术后复发的的预测价值。结果 疾病组术前血清CD105水平高于对照组（P<0.05）；HR-HPV感染组术前血清CD105水平高于非HR-HPV感染组（P<0.05）；疾病组共脱落24例，328例CIN Ⅲ级患者中有35例术后复发，术后复发率为10.67%，289例伴HR-HPV感染的CIN Ⅲ级患者中有32例术后复发，术后复发率为11.07%。复发组多个性伴侣、绝经、术前HR-HPV载量高负荷、手术切缘阳性、累及腺体占比及术前血清CD105水平、术后6个月血清CD105水平均高于未复发组（P<0.05）；多因素Logistic回归分析结果显示，绝经、术前HR-HPV载量高负荷、手术切缘阳性、累及腺体及术前、术后6个月高水平的血清CD105均为伴HR-HPV感染的CIN Ⅲ级患者术后复发的危险因素（P<0.05）；ROC结果显示，术后6个月血清CD105水平预测伴HR-HPV感染的CIN Ⅲ级患者术后复发的灵敏度、特异度、曲线下面积（AUC）分别为87.50%、72.76%、0.841，术前血清CD105水平预测伴HR-HPV感染的CIN Ⅲ级患者术后复发的灵敏度、特异度、AUC分别为81.25%、71.98%、0.808。结论 伴HR-HPV感染的CIN Ⅲ级患者血清CD105水平异常升高，且血清CD105水平是此类患者术后复发的影响因素，对术后复发具有较好的预测价值，可作为预测伴HR-HPV感染的CIN Ⅲ级患者预后的重要生化指标。

关键词:宫颈上皮内瘤变Ⅲ级;高危型人乳头瘤病毒;内皮糖蛋白;预后

Abstract:

Objective To investigate the changes and clinical significance of serum endoglin (CD105) level in cervical intraepithelial neoplasia (CIN) grade III patients with high-risk human papillomavirus (HR-HPV) infection.Methods A total of 352 CIN III patients who underwent loop electrosurgical excision procedure (LEEP) in Henan Veterans Hospital from January 2018 to February 2022 were selected as the disease group, and 352 healthy women who underwent physical examination in the hospital during the same period were selected as the control group. The serum CD105 levels were measured and compared between the two groups. According to the HPV infection of patients in the disease group, they were divided into HR-HPV infection group and non-HR-HPV infection group. The serum CD105 levels between HR-HPV infection group and non-HR-HPV infection group were compared. The CIN III patients were followed up for 1 year after surgery. During the follow-up period, the CIN III patients with HR-HPV infection were divided into recurrence group and non-recurrence group according to the recurrence. The serum CD105 levels and general information were compared between the recurrence group and the non-recurrence group. The influencing factors of postoperative recurrence in CIN III patients with HR-HPV infection was analyzed by using multivariate logistic regression analysis, and the predictive value of serum CD105 level for postoperative recurrence in CIN III patients with HR-HPV infection was analyzed by drawing receiver operating characteristic (ROC) curve.Results The preoperative serum CD105 level in the disease group was higher than that in the control group (P<0.05). The preoperative serum CD105 level in the HR-HPV infection group was higher than that in the non-HR-HPV infection group (P<0.05). A total of 24 cases were lost in the disease group, and 35 cases had postoperative recurrence among the 328 CIN III patients, and the postoperative recurrence rate was 10.67%. Among the 289 CIN III patients with HR-HPV infection, 32 cases had postoperative recurrence, and the postoperative recurrence rate was 11.07%. The proportions of multiple sexual partners, menopause, high preoperative HR-HPV load, positive surgical margin, involved glands and serum CD105 level before surgery, serum CD105 level 6 months after surgery in the recurrence group were higher than those in the non-recurrence group (P<0.05). Multivariate logistic regression analysis showed that menopause, high preoperative HR-HPV load, positive surgical margin, involvement of glands and high serum CD105 levels before and 6 months after surgery were risk factors for postoperative recurrence in CIN III patients with HR-HPV infection (P<0.05). The ROC results showed that the sensitivity, specificity and area under curve (AUC) of serum CD105 level 6 months after surgery in predicting postoperative recurrence of CIN III patients with HR-HPV infection were 87.50%, 72.76% and 0.841 respectively. The sensitivity, specificity and AUC of preoperative serum CD105 level in predicting postoperative recurrence of CIN III patients with HR-HPV infection were 81.25%, 71.98% and 0.808 respectively.Conclusion The serum CD105 level in CIN III patients with HR-HPV infection is abnormally elevated, and the serum CD105 level is a influencing factor for postoperative recurrence in such patients, and it has a good predictive value for postoperative recurrence and can be used as an important biochemical indicator for predicting the prognosis of CIN III patients with HR-HPV infection.

Key words:cervical intraepithelial neoplasia grade III;high-risk human papillomavirus;endoglin;prognosis