血清microRNA-377-3p、microRNA-424-5p联合阴道超声检测在子宫内膜癌诊断及预后中的临床价值

Diagnostic and prognostic value of serum microRNA-377-3p and microRNA-424-5p combined with transvaginal ultrasound in endometrial cancer

摘要:

目的 探讨血清microRNA-377-3p（miR-377-3p）、microRNA-424-5p（miR-424-5p）联合三维能量多普勒超声检测在子宫内膜癌（EC）诊断及预后中的价值。方法 选取2021年7月—2023年7月河北北方学院附属第一医院收治的169例EC患者为EC组，另取同期该院170例子宫内膜良性病变患者作为对照组。随访1年，根据预后情况将EC患者分为预后良好组（73例）和预后不良组（96例）。经阴道超声获取超声检测参数：血管形成指数（VI）、血流指数（FI）、血管形成-血流指数（VFI）；采用实时荧光定量聚合酶链反应检测血清miR-377-3p、miR-424-5p的表达；采用单因素和多因素Cox回归模型分析EC患者预后影响因素；绘制受试者工作特征曲线分析血清miR-377-3p、miR-424-5p联合超声检测参数对EC的诊断和预后预测价值。结果 与对照组相比，EC组VI、FI、VFI升高（P 0.05），血清miR-377-3p和miR-424-5p相对表达量降低（P 0.05）；与预后良好组相比，预后不良组VI、FI、VFI升高（P 0.05），血清miR-377-3p和miR-424-5p相对表达量降低（P 0.05）；EC患者miR-377-3p和miR-424-5p相对表达量与淋巴结转移、国际妇产科联盟（FIGO）分期、组织学分级有关（P 0.05）；FIGO分期、淋巴结转移、miR-377-3p和miR-424-5p是EC患者预后的影响因素（P 0.05）；VI+FI+VFI联合血清miR-377-3p和miR-424-5p诊断EC及预测不良预后的曲线下面积分别为0.964、0.972，敏感性分别为89.7%（95% CI：0.843，0.935）、82.9%（95% CI：0.742，0.893），特异性分别为92.5%（95% CI：0.875，0.956）、97.30%（95% CI：0.908，0.992），具有较高临床诊断、预测价值（P 0.05）。结论 miR-424-5p和miR-377-3p在EC中均表达下调，二者联合超声参数（VI、FI、VFI）在EC诊断和预后预测中展现出较高临床应用价值，有望成为EC早期诊断和预后评估的潜在生物标志物。

Abstract:

Objective To explore the diagnostic and prognostic value of serum microRNA-377-3p (miR-377-3p) and microRNA-424-5p (miR-424-5p) combined with three-dimensional power Doppler ultrasound in endometrial cancer (EC).Methods From July 2021 to July 2023, 169 EC patients admitted to the First Affiliated Hospital of Hebei North University were included as the EC group, and another 170 patients with benign endometrial lesions in the same hospital were included as the control group. After 1 year of follow-up, EC patients were classified into a favorable prognosis group (73 cases) and an unfavorable prognosis group (96 cases) based on their prognosis. Transvaginal ultrasound was performed to obtain ultrasound parameters including vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Real-time fluorescence quantitative PCR was used to detect serum miR-377-3p and miR-424-5p expressions. The univariable and multivariable Cox regression analyses were performed to identify prognostic factors in patients with EC. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic and prognostic value of serum miR-377-3p and miR-424-5p combined with ultrasound parameters for EC.Results Compared with the control group, the VI, FI, and VFI were higher in the EC group (P 0.05), and the serum miR-377-3p and miR-424-5p expressions were lower in the EC group (P 0.05). Compared with the favorable prognosis group, the VI, FI, and VFI of the unfavorable prognosis group were higher (P 0.05), and the serum miR-377-3p and miR-424-5p expressions of the unfavorable prognosis group were lower (P 0.05). The relative expressions of miR-377-3p and miR-424-5p in EC patients were correlated with lymph node metastasis, FIGO stages, and histological grades (P 0.05). FIGO stages, lymph node metastasis, and miR-377-3p and miR-424-5p expressions are prognostic factors for patients with EC (P 0.05). The areas under the curves of VI + FI + VFI combined with serum miR-377-3p and miR-424-5p in diagnosing EC and predicting unfavorable prognosis were 0.964 and 0.972, with the sensitivities being 89.7% (95% CI: 0.843, 0.935) and 82.9% (95% CI: 0.742, 0.893), and the specificities being 92.5% (95% CI: 0.875, 0.956) and 97.30% (95% CI: 0.908, 0.992), respectively, indicating high clinical diagnostic and predictive value (P 0.05).Conclusion MiR-424-5p and miR-377-3p are both downregulated in EC. The combination of these two indicators with ultrasound parameters (VI, FI, VFI) demonstrates high clinical utility in EC diagnosis and prognosis prediction, showing potential as biomarkers for early diagnosis and prognostic assessment of EC.