标题：血清Th1/Th2、Hmga1、PKM2表达水平及其联合HPV诊断宫颈癌的价值

      作者：张艳敏，王海颖，李登州，夏晴    河南省中医院检验科，河南 郑州 450002

      卷次： 2024年35卷9期

      【摘要】 目的 探讨辅助性T细胞 1 (Th1)/辅助性T细胞 2 (Th2)、高迁移率族蛋白A1 (Hmga1)、丙酮酸激酶M2型(PKM2)水平及联合人乳头状瘤病毒(HPV)对宫颈癌的诊断价值。方法 选取2022年3月至2023年3月在河南省中医院就诊的186例宫颈疾病患者作为研究对象，根据疾病类型分为宫颈炎组(n=62)、宫颈癌前病变组(n=58)和宫颈癌组(n=66)，另选取60例同期健康体检者作为对照组，比较四组及宫颈癌前病变组和宫颈癌组合并、未合并HPV感染患者入院时Th1/Th2因子[血清干扰素γ (IFN-γ)、白细胞介素-2 (IL-2)、白细胞介素-4 (IL-4)、白细胞介素-10 (IL-10)]、Hmga1、PKM2水平，分析血清 Th1/Th2、Hmga1、PKM2水平表达与肿瘤病理特征的关系及联合HPV对宫颈癌合并HPV感染的诊断价值。结果 四组受检者入院(体检)时的血清 IFN-γ、IL-2、IL-4、IL-10、Hmga1、PKM2水平比较，宫颈癌组>宫颈癌前病变组>宫颈炎组>对照组，差异均有统计学意义(P<0.05)；与未合并HPV感染患者比较，宫颈癌前病变组、宫颈癌组合并HPV感染患者入院时的血清 IFN-γ、IL-2、IL-4、IL-10、Hmga1、PKM2水平较高，差异均有统计学意义(P<0.05)；不同肿瘤分化程度、临床分期、有无淋巴结转移宫颈癌合并HPV感染患者入院时的血清 IFN-γ、IL-2、IL-4、IL-10、Hmga1、PKM2水平比较差异均有统计学意义(P<0.05)；HPV感染对宫颈癌诊断灵敏度为84.85% (54/66)，特异度为72.41% (16/28)，准确度为56.45% (70/124)；血清 IFN-γ、IL-2、IL-4、IL-10、Hmga1、PKM2、HPV感染对宫颈癌、宫颈癌前病变诊断AUC分别为 0.761、0.730、0.745、0.806、0.819、0.707、0.786，HPV感染联合各血清指标诊断 AUC为 0.908，大于单一指标诊断。结论 血清 Th1/Th2、Hmga1、PKM2水平检测对宫颈癌具有一定的诊断价值，临床可通过其联合HPV感染情况早期辅助诊断宫颈病变，为临床针对性制定干预方案提供参考。
      【关键词】 宫颈癌；宫颈癌前病变；人乳头状瘤病毒；辅助性T细胞；高迁移率族蛋白A1；丙酮酸激酶M2型
      【中图分类号】 R737.33 【文献标识码】 A 【文章编号】 1003—6350（2024）09—1293—06

Expression levels of serum Th1/Th2, Hmga1, and PKM2 and their diagnostic value in combination with HPV forcervical cancer.
ZHANG Yan-min, WANG Hai-ying, LI Deng-zhou, XIA Qing. Department of Clinical Laboratory, HenanProvincial Hospital of Traditional Chinese Medicine, Zhengzhou 450002, Henan, CHINA
【Abstract】 Objective To investigate the levels of Th1/Th2, Hmga1, PKM2 and their value in combinationwith human papillomavirus (HPV) in the diagnosis of cervical cancer. Methods A total of 186 patients with cervicaldiseases who were treated in Henan Provincial Hospital of Traditional Chinese Medicine from March 2022 to March2023 were selected as the research subjects. They were divided into cervicitis group (n=62), cervical precancerous le-sions group (n=58), and cervical cancer group (n=66) according to the type of disease. In addition, 60 healthy individualswho underwent physical examination during the same period were selected as the control group. The levels of Th1/Th2factors [serum interferon γ (IFN-γ), interleukin-2 (IL-2), interleukin-4 (IL-4), interleukin-10 (IL-10)], Hmga1, andPKM2 were compared among the four groups, as well as between the patients of cervical precancerous lesions groupwith and without HPV infection, and between the patients of cervical cancer group with and without HPV infection at ad-mission. The relationship between serum Th1/Th2, Hmga1, PKM2 expression levels and tumor pathological featureswas analyzed, and the diagnostic value of these indicators combined with HPV for cervical cancer complicated withHPV infection. Results The serum IFN-γ, IL-2, IL-4, IL-10, Hmga1, and PKM2 levels at admission (physical exami-nation) decreased successively in cervical cancer group, cervical precancerous lesions group, cervicitis group, controlgroup, and the differences were statistically significant (P<0.05). Compared with patients without HPV infection, the se-rum IFN-γ, IL-2, IL-4, IL-10, Hmga1, and PKM2 levels in both patients of cervical precancerous lesions group and pa-tients of cervical cancer group with HPV infection were significantly higher at admission (P<0.05). The serum IFN-γ,IL-2, IL-4, IL-10, Hmga1, and PKM2 levels showed statistically significant differences among patients of cervical can-cer complicating HPV infection with different tumor differentiation degrees, different clinical stages, and with or withoutlymph node metastasis at admission (P<0.05). The sensitivity of HPV infection was 84.85% (54/66), the specificity was72.41% (16/28), and the accuracy was 56.45% (70/124). The AUC of serum IFN-γ, IL-2, IL-4, IL-10, Hmga1, PKM2,HPV infection for diagnosing cervical cancer and cervical precancerous lesions were 0.761, 0.730, 0.745, 0.806, 0.819,0.707, 0.786, respectively, while the AUC of HPV infection combined with the serum indexes was 0.908, which was larg-er than that of each index alone. Conclusion The detection of serum Th1/Th2, Hmga1, and PKM2 levels has certain di-agnostic value for cervical cancer. Clinically, their combination with HPV infection can assist in the early diagnosis ofcervical lesions, providing reference for the development of targeted intervention plans in clinical practice.
      【Key words】 Cervical cancer; Cervical precancerous lesions; Human papillomavirus; T helper cells; High mobili-ty group protein A1; Pyruvate kinase M2