P16、Ki67联合细胞学检查在宫颈脱落细胞中的诊断意义

Significance of P16 and Ki67 detection combined with cytologic examination in diagnosis of cervical exfoliated cells

目的通过检测宫颈脱落细胞中的P16、Ki67的共表达情况,探讨P16、Ki67筛查宫颈病变的意义。方法采用免疫荧光双标法检测50例非典型鳞状上皮细胞(ASCUS)、50例上皮内低度病变(LSIL)、50例上皮内高度病变(HSIL)及20例细胞学检查正常宫颈脱落细胞中的P16、Ki67的表达情况,并行Cervista高危型人乳头瘤病毒(HR-HPV)检测,以病理活体组织检查(活检)为金标准。结果 HR-HPV A 9组在慢性宫颈炎、宫颈低级别病变(CINⅠ),宫颈高级别病变组(CINⅡ-Ⅲ,鳞癌)中的感染率差异有统计学意义(χ2=17.256,P<0.05);P16、Ki67共表达在慢性宫颈炎、CINⅠ、CINⅡ、CINⅢ、鳞癌组差异有统计学意义(χ2=75.566,P<0.05),依次为0.00%、33.33%、55.00%、86.96%、100.00%。在ASCUS中,P16、Ki67诊断宫颈高级别病变的灵敏度和阴性预测值高于Cervista HR-HPV检测。结论 A 9组感染是引起宫颈鳞癌发生、发展的主要原因之一;P16和Ki67共表达在宫颈高级别病变中高于低级别病变,在ASCUS中,P16和Ki67对宫颈高级别病变诊断的准确性高于Cervista HR-HPV检测,与细胞学检查联合,具有很大的筛查价值。

Objective To explore the significance of P16 and Ki67 in screening of cervical lesions by detecting coexpression of P16 and Ki67 in cervical exfoliated cells. Methods Immunofluorescence double-staining method was used to detect the expression levels of P16 and Ki67 in 50 cases of atypical squamous cells（ ASCUS）,50 cases of low-grade squamous intraepithelial lesion（ LSIL）,50 cases of highgrade squamous intraepithelial lesion（ HSIL）,and 20 cases of normal cervical cells. Cervista high-risk human papillomavirus（ HR-HPV）detection was conducted,pathological examination after biopsy was gold standard. Results There was statistically significant difference in infection rate of HR-HPV A9 group among chronic cervicitis group,cervical intraepithelial neoplasia（ CIN） Ⅰ group,CINⅡ-Ⅲ and cervical squamous cell carcinoma group（ χ2= 17. 256,P 0. 05）; the coexpression rates of P16 and Ki67 in chronic cervicitis group,CIN Ⅰgroup,CIN Ⅱ group,CIN Ⅲ group,and cervical squamous cell carcinoma group were 0. 00%,33. 33%,55. 00%,86. 96%,and100. 00%,respectively,there was statistically significant difference（ χ2= 75. 566,P〈0. 05）. In ASCUS,the sensitivity and negative predictive value of P16 and Ki67 detection in diagnosing cervical high- grade lesions were higher than those of Cervista HR- HPV detection.Conclusion HR-HPV A9 group infection is one of the reasons for occurrence and development of cervical squamous cell carcinoma; coexpression rates of P16 and Ki67 in cervical high-grade lesions are higher than those in cervical low-grade lesions,the accuracy of P16 and Ki67 detection in diagnosing cervical high-grade lesions is higher than that of Cervista HR-HPV detection in ASCUS,P16 and Ki67 detection combined with cytologic examination have high screening value.