| 尹璐,郑磊贞,赵学军.P16INK4A、Ki?67共表达检测对宫颈上皮内瘤样病变的诊断价值[J].安徽医药,2020,24(3):459-462. |
| P16INK4A、Ki?67共表达检测对宫颈上皮内瘤样病变的诊断价值 |
| The diagnostic value of P16INK4A and Ki?67 co?expression detection in cervical intraepithelial neoplasia |
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| DOI：10.3969/j.issn.1009?6469.2020.03.010 |
| 中文关键词: 宫颈上皮内瘤样病变 Ki?67抗原 基因， p16 镜检查 乳头状瘤病毒感染 诊断，鉴别阴道、 |
| 英文关键词: Cervical intraepithelial neoplasia Ki?67 antigen Genes,p16 Colposcopy Papillomavirus infections Diagnosis, differential |
| 基金项目:上海市长宁区科学技术委员会项目( CNKW2016Y12) |
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| 中文摘要: |
| 目的研究 p16基因(P16INK4A)、Ki?67共表达检测在宫颈上皮内瘤样病变(CIN)鉴别诊断中的临床和经济价值。方法选取上海市长宁区妇幼保健院 2016年 12月至 2018年 8月收诊的液基细胞学(LCT)诊断为 ≥意义不明的不典型鳞状细胞( ASCUS)女性病人 431例，其中因细胞量不足、细胞学不满意无法行 P16/Ki?67双染剔除 21例，最终有效标本数量为 410例，均经采取 P16INK4A、Ki?67单染及 P16/Ki?67双染检测，以阴道镜活检作为金标准，分析 P16INK4A、Ki?67对 CIN的诊断价值(诊断准确性、敏感性、特异性)及其与人乳头状瘤病毒( HPV)感染的关联性。结果(1)P16INK4A、Ki?67与 HPV感染关联性:经 Spearman相关性分析， P16INK4A、Ki?67与 HPV感染呈正相关( r1＝0.572，P1＝0.005；r2＝0.554，P2＝0.011)；(2)阴道镜活检结果:经阴道镜活检， 410例 LCT诊断为 ≥ASCUS女性病人中， 132例为阳性病人，占 32.20%，阴性病人 278例，占 67.80%；(3)P16INK4A、Ki?67诊断结果: P16INK4A单染检查，阳性 144例，阴性 266例； Ki?67单染检查，阳性 143例，阴性 267例； P16/Ki?67双染检查，阳性 168例，阴性 242例；(4)诊断价值: P16/Ki?67双染诊断准确性 90.27%、敏感性 98.48%高于 P16INK4A、Ki?67单染( 85.37%、84.15%)、(81.82%、 79.55%)(P＜0.05)； P16/Ki?67双染诊断特异性 86.33%与 P16INK4A单染 87.05%、Ki?67单染 86.33%相比，差异无统计学意义( P＞ 0.05)。结论 P16INK4A、Ki?67应用于 CIN鉴别诊断中，与HPV感染具有正相关关系，可显著提高诊断准确性、敏感性，为临床判断 CIN病情程度、制定治疗方案等提供有力参考依据。但 P16INK4AKi?67及P16/Ki?67双染检测经济费用较高，致使临床应用受限。 |
| 英文摘要: |
| Objective To study the clinical and economic value of P16INK4A and Ki?67 co?expression detection in the differential di? agnosis of cervical intraepithelial neoplasia(CIN).Methods From December 2016 to August 2018，431 female patients with ≥ atypical squamous cell(ASCUS)of unknown significance diagnosed by liquid?based cytology(LCT)were selected in our hospital. Among them，21 cases of P16/Ki?67 double staining were eliminated due to insufficient cell volume and cytological dissatisfaction.The number of valid specimens was 410 cases.By using P16INK4A，Ki?67 single staining and P16/Ki?67 double staining，colposcopicbiopsy as gold standard，the diagnostic value of P16INK4Aand Ki?67 for CIN(diagnostic accuracy，sensitivity，specificity)and its asso? ciation with human papillomavirus(HPV)infection were analyzed.Results(1)Association of P16INK4A，Ki?67 with HPV infection: Spearman correlation analysis showed that P16INK4Aand Ki?67 were positively correlated with HPV infection(r1＝0.572，P1＝0.005； r2＝0.554，P2＝0.011)(.2)Colposcopic biopsy results:Among 410 women diagnosed with ≥ASCUS by LCT，132 cases were positive， accounting for 32.20%，278 cases of negative patients，accounting for 67.80%；(3)P16INK4A and Ki?67 diagnostic results:P16INK4A sin? gle stain test was positive in 144 cases and negative in 266 cases；Ki?67 single stain test showed positive in 143 cases and negative in 267 cases；P16/Ki?67 double staining showed positive in 168 cases and negative in 242 cases.(4)Diagnostic value:The diagnos? tic accuracy and sensitivity of P16/Ki?67 double staining were 90.27% and 98.48% respectively，which were higher than those of P16INK4A and Ki?67 single staining(85.37% and 84.15%)，(81.82% and 79.55%)( P＜0.05).The specificity of P16/Ki?67 double stain?ing diagnosis was 86.33% compared with P16INK4A single staining 87.05% and Ki?67 single staining 86.33%，the difference was not statistically significant(P＞0.05).Conclusions P16INK4A and Ki?67 are used in the differential diagnosis of CIN and have positivecorrelation with HPV infection.It can significantly improve the diagnostic accuracy and sensitivity，and provide a strong reference for clinical judgment of CIN and formulation of treatment programs.However，the high cost of P16INK4A，Ki?67 and P16/Ki?67 double staining tests result in limited clinical application. |
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