多因素在预测高级别宫颈上皮内瘤变术后转归中的应用

发布时间：2018-01-13 22:01

本文关键词：多因素在预测高级别宫颈上皮内瘤变术后转归中的应用　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

更多相关文章： P16 Ki67 高级别上皮内瘤变 预后

【摘要】：目的:1.通过分析高级别宫颈上皮内瘤变(HSIL)患者术后组织病理切片中P16、Ki67的表达与术后TCT和HPV-DNA检测结果的相关性,探讨P16、Ki67作为患者术后病情转归预测指标的应用价值。2.了解HSIL患者宫颈锥切术后4年中TCT和HPV检测结果转阴情况及其变化趋势,指导临床对于HSIL患者锥切术后随访,对此类患者随访方式及随访时间等进行分流,最大程度避免术后随访漏诊及过度治疗,为病人带来福音。方法:1.收集350例因阴道镜下宫颈活检病理为“HSIL”行子宫颈锥形切除术的住院患者,对所有患者行宫颈锥切的手术标本组织进行免疫组织化学染色,检测P16、Ki67在宫颈病变组织中的表达。2.根据P16在宫颈鳞状上皮垂直面分布比例高低将所有HSIL患者(350例)手术标本分为A1和A2两组;A1组为P16在宫颈鳞状上皮垂直面分布比例大于等于病变细胞在宫颈鳞状上皮垂直面分布比例,A2组为P16在宫颈鳞状上皮垂直面分布比例小于病变细胞在宫颈鳞状上皮垂直面分布比例。同样,根据Ki67在宫颈鳞状上皮垂直面分布比例高低将所有HSIL患者(350例)手术标本分为B1和B2两组,B1组为Ki67在宫颈鳞状上皮垂直面分布比例大于等于病变细胞在宫颈鳞状上皮垂直面分布比例,B2组为Ki67在宫颈鳞状上皮垂直面分布比例小于病变细胞在宫颈鳞状上皮垂直面分布比例。3.随访HSIL患者术后4年间TCT及HPV-DNA负荷量检查结果,统计学分析比较A1与A2两组之间、B1与B2两组之间的4年时段TCT及HPV转阴率的差异。4.计算HSIL患者术后多个时间节点(分别为6、12、18、24、30、36、42及48个月)TCT和HPV相关统计学指标(TCT评分、TCT和HPV阴性率),并绘制曲线分析其随术后时间变化趋势。结果:1.A1组HSIL患者术后4年间TCT和HPV转阴率均显著低于A2组患者(差异均有统计学意义P㩳0.05)。A1、A2两组的TCT转阴率分别为93.45%和100%;HPV转阴率分别为:92.36%和100%。2.B1组HSIL患者术后4年间TCT和HPV转阴率均显著低于于B2组患者(差异均有统计学意义P㩳0.05)。B1、B2两组的TCT转阴率分别为93.21%和100%;HPV转阴率分别为:92.45%和98.82%。3.所有纳入HSIL患者术后6个月TCT检查阴性率为100%,随着随访时间的延长TCT阴性率逐渐降低。4.HSIL患者术后36个月内HPV-DNA负荷量较术前明显下降,而在术后42个月时HPV感染阳性率较前明显增高,高达50%。结论:P16、Ki67对HSIL患者宫颈锥切术后转归有一定的预测价值,HSIL患者病变宫颈组织中P16、Ki67表达程度越高,术后TCT和HPV检测阳性率越高。HSIL患者术后TCT和HPV可由阳性转为阴性,HPV-DNA负荷量较术前明显下降,虽然HPV负荷量和转阴方面没有呈现明显的变化规律,但术后42个月可能是HPV复发或再次感染的高峰时间。
[Abstract]:Objective 1. To analyze the correlation between the expression of P16 / Ki67 and the results of TCT and HPV-DNA in postoperative histopathological sections of patients with high grade cervical intraepithelial neoplasia (HSIL). To explore P16. Application value of Ki67 as a predictor of postoperative prognosis. 2. To understand the negative changes of TCT and HPV in patients with HSIL during the 4 years after cervix conization. 2. To guide the clinical follow-up of HSIL patients after conization, to such patients follow-up mode and follow-up time for shunt, to avoid postoperative missed diagnosis and over-treatment. To bring good news to patients. Methods: 1. Collect 350 inpatients who underwent cervical conical excision due to cervical biopsy under colposcopy and pathology as "HSIL". The specimens of all patients underwent cervical conization were stained with immunohistochemical staining and P16 was detected. Expression of Ki67 in cervical lesions. According to the distribution of P16 in cervical squamous epithelium, 350 cases of HSIL were divided into A1 and A2 groups. In A1 group, the distribution ratio of P16 on the vertical plane of cervical squamous epithelium was greater than that of pathological cells in the vertical plane of cervical squamous epithelium. In A2 group, the distribution of P16 on the vertical plane of cervical squamous epithelium was smaller than that of pathological cells on the vertical plane of cervical squamous epithelium. According to the vertical distribution of Ki67 in cervical squamous epithelium, 350 patients with HSIL were divided into B1 and B2 groups. Group B1 showed that the distribution of Ki67 on the vertical plane of cervical squamous epithelium was greater than that of lesion cells in the vertical plane of cervical squamous epithelium. The distribution of Ki67 on the vertical plane of cervical squamous epithelium in B2 group was smaller than that of pathological cells on the vertical plane of cervical squamous epithelium. 3. TCT and HPV-DNA were negative in 4 years after HSIL follow-up. Load test results. Statistical analysis and comparison between A1 and A2 groups between B _ 1 and B _ 2 groups between the 4-year period of TCT and HPV negative rate difference. 4. Calculate the HSIL patients after multiple time points (6 respectively). TCT and HPV were correlated with the negative rate of TCT and HPV. Results the negative rates of TCT and HPV in HSIL group were significantly lower than those in A2 group during the 4 years after operation (P < 0.05). The negative rate of TCT in group A 1 A 2 was 93.45% and 100, respectively. The negative rate of HPV was 92.36% in group B and 100% in group B 1. The negative rates of TCT and HPV in group B 1 were significantly lower than those in group B 2 during the 4 years after operation (P < 0.05). All the differences were statistically significant (P? The negative rate of TCT was 93.21% in group B _ (1) B _ (2) and 93.21% in group B _ (1) B _ (2); The negative rate of HPV was 92.45% and 98.82% respectively. The negative rate of TCT was 100% in all HSIL patients 6 months after operation. With the prolongation of follow-up time, the negative rate of TCT decreased gradually. 4. The HPV-DNA load decreased significantly in patients with HSIL within 36 months after operation. The positive rate of HPV infection in 42 months after operation was significantly higher than that of the former, as high as 50. Conclusion: P16Ki67 has a certain value in predicting the outcome of cervical conization in patients with HSIL. The higher the expression of P16 ~ + Ki67 in cervical tissues of patients with HSIL was, the higher the positive rate of TCT and HPV was. TCT and HPV could change from positive to negative after operation in patients with HSIL. The load volume of HPV-DNA was significantly lower than that of pre-operation. Although there was no obvious change in HPV load and negative change, 42 months after operation might be the peak time of recurrence or re-infection of HPV.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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