CK7、P16、SCC-Ag对宫颈鳞状上皮内病变的诊断评价

CK7,P16,SCC-Ag in the diagnosis and evaluation of cervical squamous intraepithelial lesions

目的探讨细胞角蛋白7(CK7)、抑癌基因P16和血清鳞状上皮细胞癌抗原(SCC-Ag)对宫颈鳞状上皮内病变(SIL)的诊断评价。方法选取2018年8月~2019年12月邯郸市中心医院妇一科收治的264例患者为研究对象,根据病理诊断标准分为对照组、低级别宫颈鳞状上皮内病变(LSIL)组和高级别宫颈鳞状上皮内病变(HSIL)组。其中宫颈活检炎症病例(对照组)77例、LSIL组92例、HSIL组95例。采用免疫组织化学SP法检测各组织中CK7、P16蛋白的表达,化学发光免疫分析法检测各组血清SCC-Ag的表达,用列联系数对CK7、SCC-Ag、P16三者在各组中表达情况进行相关性分析,观察单项检测、两两配对检测及联合检测对SIL患者的灵敏度、特异度、阳性预测值、阴性预测值准确度和约登指数,比较三者的诊断效力。结果CK7、P16、SCC-Ag的单项、两两配对及三者联合检测阳性表达率对照组、LSIL组和HSIL组中均逐渐升高,且HSIL组与其他组差异均有统计学意义(P<0.05);CK7与SCC-Ag呈正相关(r=0.204,P=0.001),CK7与P16表达呈正相关(r=0.437,P<0.001),SCC-Ag与P16表达呈正相关(r=0.350,P<0.001),三者具有明显的正向协同效应;三者联合检测的灵敏度和阴性预测值最高(98.95%;99.00%)。结论CK7、SCC-Ag和P16三指标联合检测比单独和两两配对检测对SIL具有更好的诊断效力,三者联合检测可作为SIL诊断的价值指标之一。

Objective The objective of this essay was to analyze the diagnostic value of cytokeratin 7(CK7),p16 and serum squamous cell carcinoma antigen(SCC Ag)in the diagnosis of squamous intraepithelial lesion(SIL).Methods 264 patients in Department of Gynecology,Handan Central Hospital from August 2018 to December 2019 were selected as the study subjects.According to the pathological diagnosis results,264 patients were divided into control group,low-level cervical squamous intraepithelial lesions(LSIL)group and high-level cervical squamous intraepithelial lesions(HSIL)group.77 cases of cervical biopsy inflammation were treated as control group,92 cases in LSIL group and 95 in HSIL group.The expression of CK7 and p16 in each group was detected by immunohistochemistry SP method.The expression of SCC Ag in serum of each group was detected by chemiluminescence immunoassay.The expression of CK7,SCC Ag and p16 in each group was analyzed by the association coefficient.The sensitivity,specificity,positive predictive value,negative of single test,two pair test and combined test were observed.The accuracy of the predicted value and the Jordan index were compared with the diagnostic effectiveness of the three.Results In control group,LSIL group and HSIL group,the positive expression rates of CK7,p16 and SCC Ag increase gradually,which are 10.39%,31.52%,67.37%,5.19%,48.91%,95.79%,6.49%,15.22%,26.32%,respectively.The differences between the HSIL group and other groups were statistically significant(2=53.241,P<0.05;2=108.933,P<0.05;2=9.948,P<0.05).CK7 was positively correlated with SCC Ag(r=0.204,P=0.001),CK7 was positively correlated with p16(r=0.437,P=0.000),and SCC Ag was positively correlated with p16(r=0.350,P=0.000).The sensitivity and negative predictive value of the three methods were the highest(98.95%,99.00%).The three had obvious positive synergy effect,and the sensitivity and negative predictive value of the three combined detection were the highest(98.95%,99.00%).Conclusion The combined detection of CK7,SCC-Ag and P16 protein has better diagnostic value than single or pairwise paired detection.The combined detection of CK7,SCC Ag and p16 may be one of the value indicators of SIL diagnosis.