宫颈液基细胞P16、Ki-67诊断非典型鳞状细胞的价值

Diagnosis Value of Liquid-based Cervical Cell P16,Ki-67 in Atypical Squamous Cells

目的:探讨宫颈液基细胞P16及Ki-67诊断不能明确意义的非典型鳞状细胞(ASCUS)的价值。方法:用免疫细胞化学染色法检测156例液基细胞学诊断为ASCUS患者的液基细胞学剩余标本P16及Ki-67的表达情况,并行高危型人乳头瘤病毒(HPV)检测。以病理检查结果为"金标准"。结果:P16和Ki-67表达阳性率与病变程度均呈正相关(rs=0.685和rs=0.713,均P<0.05)。高危型HPV阳性率(59.62%)高于P16、Ki-67蛋白高表达率(32.05%和33.97%),差异有统计学意义(χ2分别为30.31和25.81,P<0.01)。P16、Ki-67的免疫细胞化学染色检出宫颈上皮内瘤样病变(CIN)Ⅱ及以上病变的敏感度和特异度分别为87.50%、93.75%和82.26%、81.45%,特异度均明显高于HPV检测的48.39%(P<0.01)。结论:应用免疫细胞化学染色检测P16和Ki-67,较高危型HPV检测能更好地提高高级别CIN的检出率,剔除ASCUS中的良性病变,对临床具有指导意义。

Objective：To investigate diagnosis value of testing P16 and Ki-67 protein expression in cervical atypical squamous cells undefined significance（ASCUS）.Methods：156 cases who suffered from ASCUS were collected.Then tested and compared the expression of P16 and Ki-67 in the cervical cell of all specimen by immunocytochemistry staining and high-risk human papillomavirus（HPV） by nucleic acid amplification with fluorescence.Results：The positive expression rate of P16 and Ki-67 was positive correlated with the severity of cervical disease（rs=0.685、rs=0.713,P〈0.05）.High-risk HPV-positive rate（59.62%）is higher than P16,Ki-67 high expression rate（32.5%、33.97%）,there are significant difference（χ^2=30.31 and 25.81,P〈0.01）.The sensitivity and specificity of P16,Ki-67 staining in immune cells detecting CIN Ⅱ and above CIN Ⅱlesions were 87.50%,93.75% and 82.26%,81.45%,respectively.The specificity of P16 and Ki-67 testing in all groups were significantly higher than HPV testing（48.39%,P〈0.01）.Conclusions：Detecting P16 and Ki-67 by immunocytotochemical staining had a higher detecting rate of high-evel CIN compared with a high-risk type HPV testing.It can exclude benign lesions in ASCUS and has a great clinical signification.