Krt7和p16在宫颈病变进展中的临床意义

The clinical significance of Krt7 and p16 in the progression of cervical lesions

为探讨Krt7和p16在宫颈病变进展和临床诊治中的意义。收集慢性宫颈炎、宫颈低级别鳞状上皮内病变(Low-grade Squamous Intraepithelial Lesion,LSIL)、宫颈高级别鳞状上皮内病变(High-grade Squamous Intraepithelial Lesion,HSIL)和宫颈癌的石蜡标本及临床资料,免疫组织化学法检测石蜡组织中Krt7和p16的表达,统计分析Krt7和p16的表达与慢性宫颈炎、LSIL、HSIL和宫颈癌的相关性。结果显示,Krt7在慢性宫颈炎、LSIL、HSIL和宫颈癌中的阳性表达率呈逐渐递增的趋势,依次为24%(10/41)、13%(4/30)、71%(31/44)、88%(22/25),差异具有统计学意义(P<0.05);Krt7阳性表达率在LSIL与HSIL、LSIL与宫颈癌、HSIL与宫颈癌之间存在统计学差异(P<0.001),但在宫颈炎与LSIL之间没统计学差异(P=0.251);p16在慢性宫颈炎、LSIL、HSIL和宫颈癌中的阳性表达率呈现逐渐递增的趋势,依次为39%(16/41)、60%(18/30)、88.6%(39/44)、100%(25/25),差异具有统计学意义(P<0.05);p16阳性表达率在慢性宫颈炎与LSIL,LSIL与HSIL,LSIL与宫颈癌,HSIL与宫颈癌之间均存在统计学差异(P<0.001);Krt7和p16均阳性表达者在慢性宫颈炎、LSIL、HSIL、宫颈癌中的比例分别为2.44%(1/41)、3%(3/30)、68.18%(30/44)、88.00%(22/25),差异具有统计学意义(P<0.05)。Krt7、p16、联合检测Krt7和p16诊断宫颈病变的ROC曲线下面积分别为0.67、0.72、0.23(P<0.01)。结论:Krt7表达阴性的LSIL,进展为HSIL或宫颈癌的风险可能较低,无需临床过多干预治疗;Krt7表达阳性的LSIL进展成HSIL或宫颈癌的风险可能较高,应当引起临床重视;联合检测Krt7和p16,可能在临床中能更有效的筛选出进展为HSIL的高危人群。

To explore the clinical diagnosis and treatment significance of Krt7 and p16 in cervical lesions progression. Paraffin specimens and clinical data of chronic cervicitis tissues, cervical low grade squamous intraepithelial lesion（LSIL） tissues, cervical high grade squamous intraepithelial lesion（HSIL） tissues and cervical cancer tissues were collected, immunohistochemical staining（IHC） was used to detect the expression of Krt7 and p16 in these specimens. Statistical analysis was performed to evaluate the expression levels of Krt7 and p16, and their correlation with chronic cervicitis, LSIL, HSIL and cervical cancer.The positive expression rates of Krt7 in chronic cervicitis, LSIL, HSIL and cervical cancer were gradually increased by 24%（10/41）, 13%（4/30）, 71%（31/44）, 88%（22/25）, the differences were statistically significant（P0.05）; and the positive expression rate of Krt7 was statistically different between LSIL and HSIL, LSIL and cervical cancer, HSIL and cervical cancer（P0.001）,however, there was no significant difference between cervicitis and LSIL（P = 0.251）; The positive expression rates of p16 in chronic cervicitis, LSIL, HSIL and cervical cancer were gradually increased by 39%（16/41）, 60%（18/30）, 88.6%（39/44）, 100%（25/25）（P0.05）, and the difference was statistically significant（P0.05）; The positive rate of chronic cervicitis and LSIL, LSIL and HSIL, LSIL and cervical cancer, HSIL and cervical cancer were statistically different（P0.001）;The positive rates of both Krt7 and p16 were 2.44%（1/41）, 3%（3/30）, 68.18%（30/44） and 88.00%（22/25） in chronic cervicitis, LSIL, HSIL and cervical cancer, the difference was statistically significant（P 0.05）. The risk of Krt7-negativeprogressing to HISL or cervical cancer was low, while the risk of Krt7-positive developing to HISL or cervical cancer was high. Moreover, Krt7-positive should get clinical attention. Compared with Krt7 or P16 alone, the combined detection of Krt7 and p16 may helpful to patients for clinical screening in potential progressing to HSIL.