P16蛋白表达在分流宫颈上皮内瘤变Ⅱ中临床意义.docVIP

P16蛋白表达在分流宫颈上皮内瘤变Ⅱ中临床意义 　　[摘要] 目的 ?^察不同宫颈病变患者组织中p16蛋白的表达，探讨p16蛋白作为CINⅡ分流参考指标的可行性。 方法 选取2013年1月～2015年8月于南方医科大学附属中山博爱医院行阴道镜下活检病理证实为子宫颈炎、CINⅠ、CINⅡ、CINⅢ及宫颈癌四组标本各170例，进行p16免疫组化染色，观察各组不同宫颈病变中p16表达情况，统计p16蛋白检测在诊断宫颈上皮内瘤样病变2级及以上（简称CINⅡ+，包括CINⅡ、CINⅢ及宫颈癌）中的效能。并对确诊的170例CINⅡ患者进行每6个月1次的随访直至确诊后2年，随访异常患者则行阴道镜下活检，分析p16蛋白表达情况与患者CINⅡ级病变转归结局的关系。 结果 ①宫颈炎组、CINⅠ组、CINⅡ组、CINⅢ及宫颈癌组p16蛋白阳性率分别为3.53%、41.18%、81.18%、100%，总体差异有统计学意义（P 0.05）；CINⅡ组p16蛋白阳性率显著高于宫颈炎组、CINⅠ，差异有统计学意义（P 0.01），CINⅢ与宫颈癌组p16蛋白阳性率显著高于CINⅡ、CINⅠ、宫颈炎组，差异有统计学意义（P 0.01）。②p16蛋白检测CINⅡ+的灵敏度、特异度、符合率、阳性预测值和阴性预测值分别是90.59%、77.65%、84.12%、80.21%、89.19%。③138例p16蛋白表达阳性的CINⅡ随访异常患者中62例（44.93%）病变进展，32例p16蛋白表达阴性的CINⅡ随访异常患者中3例（9.38%）病变进展，两者比较，差异有统计学意义（P 0.05）。 结论 随着宫颈病变程度的加重，p16蛋白阳性率不断增加。p16蛋白检测在发现CINⅡ+的病变中具有较好的灵敏度、特异度、符合率、阳性预测值和阴性预测值。p16蛋白表达情况可预测CINⅡ疾病进展情况，临床上可应用于CINⅡ的分流。 　　[关键词] 宫颈上皮内瘤样病变；细胞周期蛋白依赖激酶抑制剂p16蛋白；子宫颈癌；高度鳞状上皮内病；低度上皮内病变 　　[中图分类号] R737.33 [文献标识码] A [文章编号] 1673-7210（2018）01（b）-0083-05 　　[Abstract] Objective To observe the expression of p16 protein in the tissues of patients with different cervical lesions， and to investigate the feasibility of p16 protein as a reference index of CIN Ⅱ. Methods From January 2013 to August 2015， 170 cases underwent colposcopy and biopsy in Zhongshan BOAI Hospital Affiliated to Southern Medical University proved cervicitis， CIN Ⅰ and CIN Ⅱ， CIN Ⅲ and four cervical carcinoma group were selected， the expression of p16 were observed in different cervical lesions by p16 immunohistochemical staining， efficiency of the test of p16 protein in the diagnosis of CIN Ⅱ and above statistic （CINⅡ+， including CIN Ⅱ， CIN Ⅲ and cervical cancer） performance. And 170 cases of CIN Ⅱ patients were followed up every six months until 2 years after diagnosis with abnormal colposcopic biopsy， the relationship between the expression of p16 and outcome measures of CIN Ⅱ patients lesions was analyzed. Results ①The p16 positive rates of the cervicitis group and CIN Ⅰ group and CIN Ⅱ group， CIN Ⅲ and cervical cancer groups were