关键词: 宫颈肿瘤；超声检查, 多普勒, 彩色；阴道镜检查；微RNAs；诊断

Abstract: Background　Approaches for the screening and early diagnosis of cervical carcinoma（CC）include ultrasound，colposcopy，HPV-DNA testing，and thin-layer liquid-based cytology.How to choose an inexpensive，easy-to-use and mini-invasive examination with ideal diagnostic accuracy for CC，is a closely watched clinical issue.Objective　To explore the clinical values of transvaginal color Doppler sonography（TVCDS）combined with serum miRNA-18a and miRNA-92a in the diagnosis of CC.Methods　We enrolled 362 cases from Department of Obstetrics and Gynecology，Beijing Chaoyang Hospital，Capital Medical University，from March 2015 to July 2017，including 122 with a postoperative pathological diagnosis of CC（CC group），120 with a pathological diagnosis of cervical intraepithelial neoplasia（CIN）（CIN group），and 120 with benign uterine lesions（normal group）．Three groups' general data，TVCDS test results and serum miRNA-18a，miRNA-92a were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of CC.ROC curves of blood flow resistance index（RI），miRNA-18a，and miRNA-92a，either alone or in combination，for the diagnosis of CC were drawn and analyzed.And their diagnostic accuracy was evaluated by comparing the gold standard，postoperative pathological diagnosis results.Results　The incidence of HR-HPV infection in CIN group and CC group was higher than that in normal group（P<0.05），and it was higher in CC group than that in CIN group（P<0.05）．The incidence of menopause in CIN group was lower than that of other two groups（P<0.05）．Cervical manifestations of suspected carcinogenesis were observed in both CC and CIN groups.The margin of the cervix was not complete.The blood flow was richer in CC group than those of the CIN group.The blood flow RI in CIN group and CC group was lower than that in the normal group（P<0.05），and it was lower in CC group than that of the CIN group（P<0.05）．There were no pathological manifestations in the uterine body，ovary and para-uterine tissues among three groups.The serum miRNA-18a and miRNA-92a in CIN group and CC group were higher than those in the normal group（P<0.05）．The serum miRNA-18a and miRNA-92a in CC group were higher than those of the CIN group（P<0.05）．Multivariate Logistic regression analysis showed that age，HR-HPV infection，menopause，blood flow RI，serum miRNA-18a，and serum miRNA-92a were the influencing factors of CC（P<0.05）．The area under the ROC curve of blood flow RI，serum miRNA-18a，serum miRNA-92a，blood flow RI combined with serum miRNA-18a，blood flow RI combined with serum miRNA-92a and blood flow RI combined with serum miRNA-18a and miRNA-92a in diagnosing CC was 0.844，0.880，0.763，0.936，0.886，and 0.940，respectively.The sensitivities were 80.8%，78.7%，64.8%，87.7%，82.8%，and 94.3%，respectively.And the specificities were 68.0%，83.7%，81.8%，85.8%，78.3%，and 81.3%，respectively.Conclusion　The blood flow RI of TVCDS in CC patients decreased, and serum microRNA-18a and microRNA-92a increased.The blood flow RI of TVCDS combined with serum miRNA-18a and miRNA-92a has higher diagnostic accuracy for CC than the blood flow RI of TVCDS，serum miRNA-18a and miRNA-92a alone，and it is easy to perform，which can improve the early diagnosis rate of CC，and is worthy of clinical promotion.

Key words: Uterine cervical neoplasms；Ultrasonography, Doppler, color；Colposcopy；MicroRNAs；Diagnosis