JAM3基因DNA甲基化在宫颈高级别上皮内瘤变及术后复发预测的临床研究

A Clinical Study of DNA Methylation of JAM3 Gene in Predicting Cervical High-Grade Intraepithelial Neoplasia and Postoperative Recurrence

摘要: 目的：探讨JAM3 (junctional adhesion molecules 3)基因DNA甲基化水平在高级别上皮内瘤变中的诊断效能，实现宫颈癌精准筛查，协助高级别上皮内瘤变(cervical intraepithelial neoplasia, CIN) II~III级分级管理，预测术后复发风险，规范宫颈上皮内瘤变治疗。研究方法：选择2020年1月至2023年1月就诊于临沂市中心医院需行宫颈活检术的200例病例，分别行HPV检查、液基细胞学检查、病理标本DNA甲基化检测。检测期间由一名固定医生取样。所有研究对象均通过阴道镜检查并进行宫颈组织病理学确诊后分组。根据病理学检查结果分为正常组、CIN I级组、CIN II级组、CIN III级组，各50例进行数据统计和临床分析。结果：正常组、CIN I级组、CIN II级组、CIN III级组JAM3基因甲基化者分别为4%、10%、38%、54%。随着宫颈病变程度的加重，JAM3基因的甲基化水平呈逐渐升高趋势。JAM3基因在正常组、CIN I组、CIN II组、CIN III组任意两组之间均存在显著差异(P < 0.01)。联合JAM3基因甲基化检测可弥补HPV低特异性及TCT低敏感性的缺陷，复发患者甲基化水平明显高于治愈者，差异具有统计学意义。结论:JAM3甲基化检测可显著提高宫颈高级别上皮内瘤变检出率，可为阴道镜检查不满意的LSIL患者分流管理提供参考；协助CIN II~III分级管理，提高病理诊断一致性；JAM3甲基化可作为高级别上皮内瘤变术后复发预测标志物。

Abstract: Objective: To explore the diagnostic efficacy of DNA methylation level of JAM3 (junctional adhesion molecules 3) gene in high-grade intraepithelial neoplasia, and to achieve accurate screening of cervical cancer. To assist grade II~III management of high-grade intraepithelial neoplasia (CIN), predict the risk of postoperative recurrence, and standardize the treatment of cervical intraepithelial neoplasia. Methods: A total of 200 cases requiring cervical biopsy were selected from Linyi Central Hospital from January 2020 to January 2023. HPV examination, liquid-based cytology examination and DNA methylation detection of pathological specimens were performed respectively. Samples are taken by a regular doctor during testing. All subjects were grouped by colposcopy and confirmed by cervical histopathology. According to the pathological examination results, the patients were divided into normal group, CIN Grade I group, CIN grade II group and CIN grade III group, with 50 cases in each group for statistical and clinical analysis. Results: The methylation rate of JAM3 gene in normal group, CIN I group, CIN II group and CIN III group was 4%, 10%, 38% and 54%, respectively. With the aggravation of cervical lesions, the methylation level of JAM3 gene increased gradually. There were significant differences in JAM3 gene between normal group, CIN I group, CIN II group and CIN III group (P < 0.01). The combination of JAM3 gene methylation detection can make up for the defects of low specificity of HPV and low sensitivity of TCT. The methylation level of relapsed patients is significantly higher than that of cured patients, and the difference is statistically significant. Conclusion: JAM3 methylation detection can significantly improve the detection rate of high-grade cervical intraepithelial neoplasia, and can provide reference for shunt management of LSIL patients with unsatisfactory colposcopy. Assist CIN-II~III grading management to improve the consistency of pathological diagnosis; JAM3 methylation can be used as a predictor of recurrence after high-grade intraepithelial neoplasia.