结合醋酸白试验、病理组织学与Ki67和p63表达诊断宫颈上皮内瘤变的研究

THE STUDY OF COMBINING VISUAL INSPECTION WITH ACETIC ACID,PATHOLOGICAL HISTOMORPHOLOGY AND THE EXPRESSION OF Ki67 AND p63 ON DIAGNOSING CERVICAL INTRAEPITHELIAL NEOPLASIA

目的:通过分析阴道镜宫颈黏膜醋酸白试验(VIA)与病理组织学诊断宫颈上皮内瘤变(CIN)患者的不符合情况,结合Ki67和p63蛋白表达,探索综合诊断CIN的评定方法。方法:分析VIA与病理诊断CIN的不符合率,从病理组织学层面探寻不符合的原因;采用免疫组化方法分别检测Ki67和p63,观察其在炎症和不同级别CIN表达情况并分析其相互关系。结果:VIA对CIN的诊断与病理组织学诊断在炎症组、CINⅠ级组、CINⅡ级组和CINⅢ级/原位癌组的不符合率分别为46.34%、32.00%、44.44%及50.00%。VIA对宫颈病变的评估较病理诊断结果程度过重。Ki67在炎症组低表达,在CIN各级别组高表达,并随CIN级别增高表达增加(P<0.05);p63在炎症组中伴有鳞状化生或增生增厚的上皮组织及CIN各级别组均呈高表达(均P<0.05),但随CIN级别增高表达增加。Ki67与p63在宫颈炎症及CIN组织中的表达呈正相关关系(rs=0.791,P<0.05)。结论:VIA+病理形态观察+Ki67细胞增殖指数计数相结合,是诊断CIN实用而准确的方法。

Objective： To explore the methods of combining visual inspection with acetic acid （VIA） and pathological morphology with expression of Ki67 and p63 to diagnose the cervical intraepithelial neoplasia （CIN）. Methods：Analyzed the non-coincidence rate of VIA and pathological diagnosis of CIN, and explored the reason of non-coincidence rate by pathological and histological observation. Ki67 and p63 were detected by immunohistochemical test to observe CIN expression in inflammation group and in groups at various grades. Then analyzed their relationship. Results：The non-coincidence rate was 46.34%, 32.00%, 44.44% and 50.00% respectively for the diagnosis of CIN based on VIA and pathomorphism in inflammation group and CIN Ⅰ group, CIN Ⅱ group, CIN Ⅲ （preinvasive carcinoma group）. In VIA, the assessment of cervical lesions was more severe than pathological diagnosis. Ki67 was lowly expressed in the inflammation group and highly expressed in the CIN groups. The expression increased when CIN grades went higher （ P 〈0.05）, p63 was highly expressed in both inflammation group with squamous metaplasia or proliferous thickening of epithelial tissue and CIN groups （ P 〈0.05）, and its expression was directly proportional to the increase of CIN grades. Ki67 and p63 expressed in the tissue of CIN and cervical inflammation were positively correlated （ rs =0. 791, P 〈0.05）. Conclusion：The combination of VIA, pathological morpholo- gy observation and Ki67 cell proliferation index count was practical and accurate for the differential diagnosis of CIN.