p16/Ki67双染检测在分流宫颈LSIL/HSIL及预测LSIL转归中的临床应用价值

The clinical application value of p16/Ki67 double stain detection in shunting cervical LSIL/HSIL and predicting the outcome of LSIL

目的探讨并分析p16/Ki67双染检测对宫颈低度鳞状上皮内病变(LSIL)/高度鳞状上皮内病变(HSIL)的分流作用以及对LSIL转归的预测价值。方法选取2019年1月至2020年2月淄博市妇幼保健院妇科收治的300例宫颈疾病患者作为研究对象,所有患者均进行细胞学诊断、组织学诊断以及p16/Ki67双染检测,根据宫颈细胞学诊断结果将患者划分为未见上皮内瘤样病变及恶性细胞(NILM)、无明确诊断意义的鳞状上皮细胞病变(ASCUS)、LSIL以及非典型鳞状细胞不除外高级别上皮内病变(ASU-H+)四组;根据宫颈组织学诊断结果不同分为宫颈炎、LSIL、HSIL以及宫颈癌四组。比较不同细胞学诊断结果以及不同组织学诊断结果的患者接受p16/Ki67双染检测的阳性率,统计p16/Ki67双染检测对宫颈组织学诊断结果HSIL及宫颈癌的患者的诊断效能,并统计宫颈组织学诊断结果为LSIL的患者随访1年时间的转归情况。结果宫颈细胞学诊断结果显示,ASCUS组与LSIL组p16/Ki67双染检测阳性率比较,差异无统计学意义(P>0.05);NILM组p16/Ki67双染检测阳性率低于ASCUS组,差异有统计学意义(P<0.05);NILM组p16/Ki67双染检测阳性率低于LSIL组,差异有统计学意义(P<0.05);NULM组p16/Ki67双染检测阳性率低于ASU-H+组,差异有统计学意义(P<0.05);ASCUS组p16/Ki67双染检测阳性率低于ASU-H+组,差异有统计学意义(P<0.05);LSIL组p16/Ki67双染检测阳性率低于ASU-H+组,差异有统计学意义(P<0.05)。宫颈组织学诊断结果显示,HSIL组与宫颈癌组p16/Ki67双染检测阳性率比较,差异无统计学意义(P>0.05);宫颈炎组p16/Ki67双染检测阳性率低于LSIL组,差异有统计学意义(P<0.05);宫颈炎组p16/Ki67双染检测阳性率低于HSIL组,差异有统计学意义(P<0.05);宫颈炎组p16/Ki67双染检测阳性率低于宫颈癌组,差异有统计学意义(P<0.05)、LSIL组p16/Ki67双染检测阳性率低于HSIL组,差异有统计学意义(P<0.05)、LSIL组p16/Ki67双染检测阳性率低于宫颈癌组,差异有统计学意义(P<0.05)。对300例患者进行p16/Ki67双染检测,诊断结果显示HSIL与宫颈癌阳性患者共145例,灵敏度为91.20%,特异度为82.23%,阳性预测值为78.62%;对宫颈组织学诊断结果为LSIL的74例患者进行1年随访,p16/Ki67双染检测为阴性的患者出现病变进展的概率低于p16/Ki67双染检测为阳性的患者,差异有统计学意义(P<0.05)。结论p16/Ki67双染检测能够对宫颈疾病严重程度进行有效的诊断,能够分流LSIL/HSIL,并对LSIL的转归具有较高的预测价值,值得临床推广应用。

Objective Explore and analyze the shunt effect of p16/Ki67 double staining detection on cervical low-grade squamous intraepithelial lesion(LSIL)/high-grade squamous intraepithelial lesion(HSIL)and its predictive value for LSIL outcome.Methods A total of 300 patients with cervical diseases who were admitted to Zibo Maternal and Child Health Hospital of Shandong Province from January 2019 to February 2020 were selected to carry out cytological diagnosis,all patients underwent cytological diagnosis,histological diagnosis,and p16/Ki67 double staining test.According to the diagnosis of cervical cytology,patients are divided into four groups:no intraepithelial neoplasia and malignant cells(NILM),atypical squamous cells of undetermined significance(ASCUS),LSIL,and atypical squamous cells with squamous intraepithelial lesions several times higher cannot be excluded(ASU-H+),according to different cervical histological diagnosis results,they are divided into four groups:cervicitis,LSIL,HSIL and cervical cancer.The positive rate of p16/Ki67 double-stain test for patients with different cytological diagnosis results and different histological diagnosis results,calculate the diagnostic efficiency of p16/Ki67 double-stain test for cervical histological diagnosis results,HSIL and cervical cancer,and count the cervical tissues The outcome of patients with LSIL after a 1-year follow-up were compared.Results Cervical cytology results showed that the positive rate of p16/Ki67 double staining in the ASCUS group and the LSIL group was not statistically significant(P>0.05);the positive rate of p16/Ki67 double staining in the NILM group was lower than that of ASCUS Group,the difference was statistically significant(P<0.05).The positive rate of p16/Ki67 double staining in the NILM group was lower than that of the LSIL group,and the difference was statistically significant(P<0.05).The NULM group was p16 The positive rate of/Ki67 double staining was lower than that of the ASU-H+group,and the difference was statistically significant(P<0.05).The positive rate of p16/Ki67 double staining in the ASCUS group was lower than that of the ASU-H+group,and the difference was statistically significant Significance(P>0.05).The positive rate of p16/Ki67 double staining in the LSIL group was lower than that of the ASU-H+group,and the difference was statistically significant(P<0.05).Cervical histological diagnosis showed that the positive rate of p16/Ki67 double staining in the HSIL group and the cervical cancer group was not statistically significant(P<0.05).The positive rate of p16/Ki67 double staining in the cervicitis group was low In the LSIL group,the difference was statistically significant(P<0.05).The positive rate of p16/Ki67 double staining in the cervicitis group was lower than that in the HSIL group,and the difference was statistically significant(P>0.05).The positive rate of p16/Ki67 double staining in the cervicitis group was lower than that of the cervical cancer group,and the difference was statistically significant(P<0.05).The positive rate of p16/Ki67 double staining in the LSIL group was lower than that of the HSIL group,and the difference was statistically significant(P<0.05).The positive rate of p16/Ki67 double staining in the LSIL group was lower than that of the cervical cancer group,the difference was statistically significant(P<0.05).The results of p16/Ki67 double staining in 300 patients showed that there were 145 patients with positive HSIL and cervical cancer,the sensitivity was 91.20%,the specificity was 82.23%,and the positive predictive value was 78.62%.One year follow-up of 74 patients with LSIL diagnosed by cervical histology showed that patients with negative p16/Ki67 double staining had significantly lower probability of lesion progression than patients with positive p16/Ki67 double staining,the difference was statistically significant(P<0.05).Conclusion p16/Ki67 double staining detection can effectively diagnose the severity of cervical disease,shunt LSIL/HSIL,and has high predictive value for the prognosis of LSIL,which is worthy of clinical application.