杆状病毒凋亡抑制蛋白5和胱氨酸天冬氨酸蛋白酶9表达水平对尖锐湿疣患者的诊断价值

Diagnostic value of baculoviral inhibitor of apoptosis repeat-containing 5 and cysteine-aspartic acid protease 9 expression levels in condyloma acuminatum

摘要:

目的 探讨杆状病毒凋亡抑制蛋白5（BIRC5）和胱氨酸天冬氨酸蛋白酶9（CASP9）表达水平对尖锐湿疣（CA）患者的诊断价值。方法 选取2021年9月—2023年10月在河北北方学院附属第一医院就诊的78例CA患者作为CA组，另选取同期该院50例皮肤健康者作为对照组。比较各组皮损组织BIRC5、CASP9相对表达量，分析两者表达水平与CA患者临床病理参数的关系。采用Spearman法分析CA患者皮损组织BIRC5与CASP9表达水平的相关性。采用受试者工作特征（ROC）曲线评估皮损组织BIRC5、CASP9表达水平对CA的诊断效能。结果 CA组皮损组织BIRC5相对表达量高于对照组（P <0.05），CASP9相对表达量低于对照组（P <0.05）。HPV混合感染患者皮损组织BIRC5相对表达量高于HPV单一型感染患者（P <0.05），CASP9相对表达量低于HPV单一型感染患者（P <0.05）；疣体团体直径≥ 10 mm患者皮损组织BIRC5相对表达量高于疣体团体直径< 10 mm患者（P <0.05），CASP9相对表达量低于疣体团体直径< 10 mm患者（P <0.05）；病程≥ 3个月患者皮损组织BIRC5相对表达量高于病程< 3个月患者（P <0.05），CASP9相对表达量低于病程< 3个月患者（P <0.05）。不同性别、年龄、BMI、皮损部位、疣体数目患者BIRC5、CASP9相对表达量比较，差异均无统计学意义（P >0.05）。Spearman相关性分析结果显示，CA患者皮损组织中BIRC5与CASP9表达呈负相关（r_s =-0.344，P <0.05）。皮损组织中BIRC5、CASP9表达水平诊断CA的曲线下面积分别为0.872（95% CI：0.813，0.932）、0.935（95% CI：0.893，0.977），敏感性分别为85.9%（95% CI：0.762，0.927）、92.3%（95% CI：0.840，0.971），特异性分别为72.0%（95% CI：0.575，0.838）、84.0%（95% CI：0.709，0.928）。BIRC5、CASP9表达水平联合诊断CA的曲线下面积为0.974（95% CI：0.950，0.997），敏感性、特异性分别为91.0%（95% CI：0.824，0.963）、94.0%（95% CI：0.835，0.987）。结论 BIRC5、CASP9联合使用诊断CA效果显著，BIRC5和CASP9可以作为诊断CA的有效生物标志物，有助于提升诊断的准确性和效率。

Abstract:

Objective To investigate the diagnostic value of baculoviral inhibitor of apoptosis repeat-containing 5 (BIRC5) and cysteine-aspartic acid protease 9 (CASP9) expression levels in patients with condyloma acuminatum (CA).Methods A total of 78 CA patients treated in our hospital from September 2021 to October 2023 were selected as the CA group, and 50 individuals with healthy skin in the hospital during the same period were chosen as the control group. The relative expression levels of BIRC5 and CASP9 in skin lesions were compared between the groups, and their associations with clinicopathological parameters of CA patients were analyzed. The Spearman method was used to analyze the correlation between the expression levels of BIRC5 and CASP9 in the skin lesions of CA patients. The diagnostic value of BIRC5 and CASP9 expression levels in skin lesions for CA was assessed using the receiver operating characteristic (ROC) curves.Results The expression level of BIRC5 in the lesion tissues of the CA group was higher than that of the control group (P < 0.05), while the expression level of CASP9 in the lesion tissues of the CA group was lower than that of the control group (P < 0.05). The relative expression level of BIRC5 in lesion tissues was higher in patients with mixed HPV infections compared to those with single-type HPV infections (P < 0.05), while the relative expression level of CASP9 was lower in patients with mixed HPV infections than in those with single-type HPV infections (P < 0.05). The relative expression level of BIRC5 in lesion tissues was higher in patients with wart diameters ≥ 10 mm compared to those with wart diameters < 10 mm (P < 0.05), while the relative expression level of CASP9 was lower in patients with wart diameters ≥ 10 mm than in those with wart diameters <10 mm (P < 0.05). The relative expression level of BIRC5 in lesion tissues was higher in patients with a disease duration ≥ 3 months compared to those with a disease duration < 3 months (P < 0.05), while the relative expression level of CASP9 was lower in patients with a disease duration ≥ 3 months than in those with a disease duration < 3 months (P < 0.05). There were no statistically significant differences in the relative expression levels of BIRC5 and CASP9 between patients of different sex, age, BMI, lesion sites, or number of warts, as assessed by t-test (P > 0.05). Spearman correlation analysis revealed a negative correlation between the expression levels of BIRC5 and CASP9 in the lesion tissues of CA patients (r_s = 0.344, P < 0.05). The areas under the curves (AUCs) for the expression levels of BIRC5 and CASP9 in the diagnosis of CA were 0.872 (95% CI: 0.813, 0.932) and 0.935 (95% CI: 0.893, 0.977), with the sensitivities being 85.9% (95% CI: 0.762, 0.927) and 92.3% (95% CI: 0.840, 0.971), and the specificities being 72.0% (95% CI: 0.575, 0.838) and 84.0% (95% CI: 0.709, 0.928). The AUC for the combined expression levels of BIRC5 and CASP9 in the diagnosis of CA was 0.974 (95% CI: 0.950, 0.997), with a sensitivity of 91.0% (95% CI: 0.824, 0.963) and a specificity of 94.0% (95% CI: 0.835, 0.987).Conclusions The combined detection of BIRC5 and CASP9 significantly improves the diagnosis of CA. BIRC5 and CASP9 can serve as effective biomarkers for diagnosing CA, contributing to enhancing diagnostic accuracy and efficiency.