血清游离DNA定量检测对宫颈癌临床诊断的价值

摘要

Objective To investigate the value of quantitative detection of serum cf-DNA in the early diagnosis and prognosis of cervical cancer.Methods It is a case-control study.40 cases of cervical cancer patients were collected from November 2010 to June 2012 in Affiliated Hospital of Nantong University.Among them 36 were squamous cell carcinoma,and 4 were adenocarcinoma.32 CIN Ⅲ patients and 58 healthy controls were chosed.Branched DNA (bDNA) assay taken to detect the concentration of cf-DNA in patients and healthy controls.Chemiluminescence analysis was squamous cell carcinoma antigen (SCC),ferritin (FER),carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9).Statistical analysis were performed using Mann-Whitney U test,Kruskal Wallis test and Spearman correlationtest.Results The concentration of serum cf-DNA in cervical cancer,CIN Ⅲ patients and healthy controls were 1373.17 (976.13-2337.08),225.15 (106.89-313.59) and 188.80 (111.30-314.15) ng/ml,respectively.The concentration of serum cf-DNA in cervical cancer patients were significantly higher than CINⅢ patients and healthy controls (Z =-6.312,-7.351,P ＜ 0.001),while CIN Ⅲ group and the healthy control group (Z =-0.438,P =0.661).Among cervical cancer patients,the serum cf-DNAconcentration of Stage Ⅱ-Ⅲ patients was 2490.26 (1407.86-4326.12) ng/ml,much higher than that of Stage Ⅰ 1267.54 (633.01-1586.43) ng/ml (Z =-3.394,P =0.001).Serum cf-DNA in cervical cancer patients with different differentiation degree and histological type showed no significant difference.There were no correlation among serum cf-DNA and SCC,FER,CA125,CA19-9.For cf-DNA,the AUC (0.938) was higher than traditional serum indicators such as SCC (0.772),FER (0.721),CA125 (0.615),CA19-9(0.601).Conclusions The level of serum cf-DNA may benefit the early aided diagnosis of cervical cancer and may play a role in the prognostic judgment.The aided diagnostic value of serum cf-DNA was higher than traditional tumor markers such as SCC,FER,CA125,CA19-9.%目的 探讨血清cf-DNA定量检测在宫颈癌早期辅助诊断及预后判断中的价值.方法 病例对照研究.收集南通大学附属医院2010年11月至2012年6月收治的40例宫颈癌患者,均经组织病理学证实;其中鳞癌患者36例,腺癌患者4例.选择同期CINⅢ患者32例,门诊体检健康妇女58名.采用分支DNA(bDNA)技术检测血清cf-DNA含量,采用化学发光法检测血清中鳞状细胞癌抗原(SCC)、铁蛋白(FER)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)的含量.统计学分析采用Mann-Whitney U检验、Kruskal Wallis检验及Spearman相关检验.结果 宫颈癌患者、CINⅢ患者和健康对照者血清cf-DNA含量分别为1373.17 (976.13 ～ 2337.08)、225.15(106.89 ～ 313.59)、188.80(111.30～314.15) ng/ml,宫颈癌患者血清cf-DNA含量显著高于CINⅢ患者及健康对照者(Z=-6.312,-7.351,P均＜0.001),而CINⅢ组和正常对照组之间差异无统计学意义(Z=-0.438,P=0.661).其中,Ⅱ～Ⅲ期患者的血清cf-DNA水平2490.26(1407.86 ～ 4326.12) ng/ml明显高于Ⅰ期1267.54(633.01 ～ 1586.43) ng/ml(Z=-3.394,P=0.001).宫颈癌患者血清cf-DNA含量在不同分化程度、病理类型分组间无统计学差异.血清cf-DNA浓度与SCC(r=-0.160,P=0.324)、FER(r=0.032,P =0.842)、CA125(r=0.077,P =0.638)、CA19-9 (r=0.135,P =0.406)没有相关性.使用ROC曲线分析血清cf-DNA浓度对宫颈癌患者的诊断效能,其曲线下面积(0.938)高于传统指标血清SCC (0.772)、FER (0.721)、CA125 (0.615)、CA19-9(0.601).结论 血清cf-DNA水平有助于宫颈癌的早期辅助诊断及预后判断.血清cf-DNA对宫颈癌的辅助诊断价值要优于传统肿瘤标志物SCC、FER、CA125、CA19-9.