p16和Ki-67在高危型HPV持续性感染的宫颈鳞状上皮内病变中的诊断价值分析
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摘要
目的探讨p16和Ki-67在高危型人乳头瘤病毒(human papillomavirus,HPV)持续性感染的宫颈鳞状上皮内病变中的诊断价值,并分析联合诊断的临床意义。方法选取2016年2月至2017年6月于四川省广元市中心医院妇产科诊治的宫颈鳞状上皮内病变高危型HPV持续性感染患者100例作为研究组,另选择同期就诊的未患妇科疾病的女性患者100例作为对照组,将两组患者的活检组织制作石蜡切片,分别进行p16和Ki-67免疫组化检测,分析p16、Ki-67的独立诊断价值,结合独立诊断结果进行串并联联合诊断实验,制作ROC曲线。结果 p16单独进行诊断的假阴性率(18.00%)较高;Ki-67单独进行诊断的假阳性率(16.00%)较高;p16与Ki-67进行并联诊断能够降低漏诊率,而进行串联诊断能够降低误诊率。结论 p16与Ki-67作为联合诊断指标在高危型HPV持续性感染的宫颈鳞状上皮内病变中价值较高,串并联联合诊断是一种较为理想的诊断方法。
Objective To investigate the diagnostic value of p16 and Ki-67 in squamous intraepithelial lesion of high-risk type HPVpersistent infection and to discuss the signi?cance of the application of combined diagnostic test. Method Paraf?n sections were made fromthe biopsies of patients in the CIN group and the control group, and immunohistochemistry of p16 and Ki-67. The indexes of independentdiagnosis of p16 and Ki-67 were respectively calculated, and the diagnostic results of serial and parallel combined with independentdiagnosis were used to make the working curve(ROC curve). Result The false-negative rate of p16 alone was higher; the false-positiverate of Ki-67 alone was higher; the rate of misdiagnosis of p16 and Ki-67 in parallel test could reduce the misdiagnosis rate. Conclusionp16 and Ki-67 have the higher value as joint diagnostic indicators in the high-risk HPV persistent cervical squamous intraepithelial lesion,combined with parallel-series diagnosis is a more ideal diagnostic method.
Objective To investigate the diagnostic value of p16 and Ki-67 in squamous intraepithelial lesion of high-risk type HPVpersistent infection and to discuss the signi?cance of the application of combined diagnostic test. Method Paraf?n sections were made fromthe biopsies of patients in the CIN group and the control group, and immunohistochemistry of p16 and Ki-67. The indexes of independentdiagnosis of p16 and Ki-67 were respectively calculated, and the diagnostic results of serial and parallel combined with independentdiagnosis were used to make the working curve(ROC curve). Result The false-negative rate of p16 alone was higher; the false-positiverate of Ki-67 alone was higher; the rate of misdiagnosis of p16 and Ki-67 in parallel test could reduce the misdiagnosis rate. Conclusionp16 and Ki-67 have the higher value as joint diagnostic indicators in the high-risk HPV persistent cervical squamous intraepithelial lesion,combined with parallel-series diagnosis is a more ideal diagnostic method.
引文
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[14]Gavressea T,Kalogeras KT,Koliou GA,et al.The prognostic value of the immunohistochemical expression of phosphorylated RB and p16 proteins in association with Cyclin D1 and the p53pathway in a large cohort of patients with breast cancer treated with taxane-based adjuvant chemotherapy[J].Anticancer Res,2017,37(6):2947-2957.
[15]周文俊.p16、Ki-67蛋白表达与宫颈鳞状上皮病变中HPV感染的相关性分析[J].临床合理用药杂志,2017,10(4):48-50.
[16]李萱,刘颖群,方兆武.P16、Ki67和cyclinD1在宫颈癌中的表达及TCT与HPV-DNA检查在宫颈癌早期诊断中的研究[J].中国妇幼保健,2016,31(4):829-831.
[17]张伟静,杨冬,刘陶.高危人乳头瘤病毒阳性患者做宫颈活检的临床价值探讨[J].中国医刊,2016,51(2):101-104.
[18]廖媛,简燚,罗克枢.增殖细胞核抗原67与胸腺激酶1在宫颈上皮内瘤变及宫颈癌中的表达[J].实用医院临床杂志,2017,14(1):55-58.
[19]肖峰,颜红柱,邹珏,等.子宫颈鳞状上皮内病变和鳞状细胞癌中CENP-F、Ki-67的表达及意义[J].临床与实验病理学杂志,2017,33(5):562-564.
[2]Lellis RF,Veasey JV,Gon?alves RDJ.Pigmented Bowen’s disease associated with high-risk HPV simulating melanoma of the hand[J].An Bras Dermatol,2017,92(5):686-688.
[3]孙蕾蕾,李绍条,林兴园.高危型HPV-DNA联合液基细胞学检测对宫颈癌筛查的价值[J].中国生化药物杂志,2017,37(1):283-285.
[4]师晓艳,雷侠.宫颈液基细胞学检查与高危型HPV检测用于宫颈癌前病变并发感染早期筛查的对比研究[J].中国性科学,2017,26(1):33-35.
[5]刘镜文,吴秋良.p16与Ki-67含量检测在子宫颈上皮内病变临床诊断中的意义[J].诊断学理论与实践,2017,16(2):195-198.
[6]杨小风,刘芳,武明莉,等.p16和Ki-67蛋白在宫颈组织中的表达及其对宫颈早期癌变的预警作用[J].广东医学,2017,38(17):2641-2644.
[7]Ebisch RM,van der Horst J,Hermsen M,et al.Evaluation of p16/Ki-67 dual-stained cytology as triage test for high-risk human papillomavirus-positive women[J].Mod Pathol,2017,30(7):1021-1031.
[8]张丽,张庆欣,芦莉,等.超声联合试验室检查对宫内胎儿TORCH感染的诊断价值研究[J].中华医院感染学杂志,2017,27(21):4986-4988.
[9]王晓平.p16和Ki-67在宫颈鳞癌癌前病变中的表达及其诊断价值分析构架[J].中国医药科学,2017,7(14):203-205.
[10]钟萍萍,顾依群,孙笑非,等.p16和Ki-67在低级别鳞状上皮内病变预测持续性高危型HPV感染中的应用价值[J].诊断病理学杂志,2017,24(1):45-48.
[11]李旭,鲍健,孙翠翠.p16、Ki-67在宫颈鳞状上皮病变分级诊断中的意义[J].现代肿瘤医学,2017,25(13):2119-2121.
[12]王维俊,吴强.p16、Ki-67和CK7在宫颈癌前病变中的表达及临床意义[J].国际检验医学杂志,2017,38(22):3091-3093.
[13]Purwaningsih NMS,Sailan AT,Sinon SHM,et al.Role of p16 and p53 in oral potentially malignant disorders and oral squamous cell carcinoma:a study in Malaysia[J].J Intern Dent Med Res,2017,10(2):42-47.
[14]Gavressea T,Kalogeras KT,Koliou GA,et al.The prognostic value of the immunohistochemical expression of phosphorylated RB and p16 proteins in association with Cyclin D1 and the p53pathway in a large cohort of patients with breast cancer treated with taxane-based adjuvant chemotherapy[J].Anticancer Res,2017,37(6):2947-2957.
[15]周文俊.p16、Ki-67蛋白表达与宫颈鳞状上皮病变中HPV感染的相关性分析[J].临床合理用药杂志,2017,10(4):48-50.
[16]李萱,刘颖群,方兆武.P16、Ki67和cyclinD1在宫颈癌中的表达及TCT与HPV-DNA检查在宫颈癌早期诊断中的研究[J].中国妇幼保健,2016,31(4):829-831.
[17]张伟静,杨冬,刘陶.高危人乳头瘤病毒阳性患者做宫颈活检的临床价值探讨[J].中国医刊,2016,51(2):101-104.
[18]廖媛,简燚,罗克枢.增殖细胞核抗原67与胸腺激酶1在宫颈上皮内瘤变及宫颈癌中的表达[J].实用医院临床杂志,2017,14(1):55-58.
[19]肖峰,颜红柱,邹珏,等.子宫颈鳞状上皮内病变和鳞状细胞癌中CENP-F、Ki-67的表达及意义[J].临床与实验病理学杂志,2017,33(5):562-564.