p16^(INK4a)在液基细胞学筛查宫颈病变中高危人群的临床价值

The clinic value of p16^(INK4a) expression by liquid-based cytology to detect high-risk patients with CIN.

目的:利用液基细胞学标本探讨p16INK4a在宫颈癌前病变及宫颈癌中的表达。方法:选取104例经活检证实的TCT阳性病例剩余标本,包括9例非典型鳞状细胞-意义不明(ASC-US)、54例低度鳞状上皮内病变(LSIL)、4例非典型鳞状细胞-不除外上皮内高度病变(ASC-H)、33例高度鳞状上皮内病变(HSIL)和4例鳞状上皮细胞癌(SCC),制作液基薄片进行p16INK4a免疫细胞化学检测,同时用基因杂交捕获法Ⅱ(HC-Ⅱ)检测高危人乳头瘤病毒(HR-HPV)DNA,探讨病毒负荷量与宫颈病变级别的关系。结果:p16INK4a在ASC-US、LSIL、ASC-H、HSIL和SCC中的表达率分别是22.2%、40.7%、50%、81.8%和100%。p16INK4a在ASC-US和HSIL之间、LSIL和HSIL之间表达有差异(P<0.003);结合组织学分析54例LSIL标本中p16INK4a阳性率,在炎症、CINⅠ、CINⅡ～Ⅲ中的阳性率分别是28.6%,25.0%和91.7%,CINⅡ～Ⅲ中p16INK4a的阳性率明显高于炎症组和CINⅠ组,3组之间的差异有显著统计学意义(P<0.001);HR-HPV DNA的荷载量与宫颈病变级别无相关性。结论:p16INK4a在液基细胞学HSIL中高表达,是细胞学诊断为LSIL病例中筛查癌前病变高危人群有意义的生物标记物。

Objective：To evaluate the expression of p16INK4a by liquid-based cytology in cervical squamous neoplasm.Methods： p16INK4a immunocytochemical detection was performed on 104 specimens remaining from liquid-based cytology with available biopsy,and compared with the results of high-risk human papillomavirus（HR-HPV）DNA tests.Results： p16INK4a expression rate in the ASC-US,LSIL,ASC-H,HSIL,SCC was 22.2%,40.7%,50%,81.8% and 100% respectively.Significant difference was detected between ASC-US and HSIL,LSIL and HSIL.p16INK4a positive rate of 54 cases of LSIL specimens in inflammation,CINⅠ,CINⅡ～Ⅲ was 28.6%,25.0% and 91.7% respectively,p16INK4a expression rate of CINⅡ~Ⅲ group was significantly higher than that of CINⅠ group and inflammation group（P0.001）.Whereas the viral load of HR-HPV DNA has no correlation with the grade of cervical lesions.Conclusion： p16INK4a immunocytochemical assay is useful to predict underlying HSIL,may be a marker to detect CINⅡ or worse in the triage of LSIL.