P16、Ki67及ΔNp63在提高高级别宫颈鳞状上皮内病变诊断中的价值

发布时间：2018-06-07 15:07

本文选题：P16 + Ki67　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:1.通过测定不同级别宫颈上皮组织中P16、Ki67及ΔNp63蛋白的表达情况,初步了解P16、Ki67及ΔNp63的表达水平与不同级别宫颈病变之间的关系;2.进一步探讨单独或联合检测上述生物学标记物对高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)的辅助诊断价值。方法:选择2015年1月-2015年12月就诊于山西医科大学第二医院患者,依据常规HE染色病理诊断结果,分为宫颈正常组(60例)、低级别鳞状上皮内病变组织(LSIL组,即CIN I级组60例)、高级别鳞状上皮内病变组织(HSIL组120例,其中CIN II及CIN III各60例)及宫颈早期浸润癌组(30例),共270例。采用免疫组织化学检查S-P法分别检测P16、Ki67及ΔNp63蛋白在四组中的表达情况。研究数据采用SPSS 20.0软件进行统计学分析。结果:1.P16、Ki67及ΔNp63的表达与宫颈病变级别均存在相关性;2.P16、Ki67及ΔNp63在正常组、LSIL组、HSIL组及宫颈癌组的阳性表达情况:P16阳性率分别为18.33%、73.33%、95.83%、100%,Ki67阳性率分别为10.00%、63.33%、87.50%、100%,ΔNp63阳性率分别为6.67%、81.67%、96.67%、100%,三个指标的阳性表达率随宫颈病变级别的升高而呈上升趋势,且四组阳性率之间存在差异;3.P16、Ki67及ΔNp63在HSIL组的阳性表达与正常组、LSIL组均有统计学差异,与宫颈癌组差异无统计学意义;4.单独检测ΔNp63蛋白阳性诊断HSIL的灵敏度和特异度分别为95.0%和96.7%,均高于单独使用Ki67(87.5%和90.0%);其特异度与P16相当,但灵敏度相对较高;5.ROC曲线结果分析:单独应用ΔNp63免疫组化检测HSIL的曲线下面积为0.958(95%CI为0.924-0.993),高于P16和Ki67检测曲线下面积,与Ki67曲线下面积比较差异有统计学意义,而与P16曲线下面积比较差异无统计学意义;在包含ΔNp63的多种联合检测方式中,以ΔNp63与P16并联方式的曲线下面积最大(0.950),与单独检测ΔNp63的曲线下面积(0.958)相比较,差异无统计学意义。结论:1.P16、Ki67、ΔNp63在一定程度上可以客观的反映CIN病变的程度;2.ΔNp63是一种高潜力的宫颈癌相关性的标记物;3.三种生物学指标,对有效筛选及提升HSIL病理诊断准确率,均有一定临床的指导意义。
[Abstract]:Purpose 1. By measuring the expression of P16 Ki67 and 螖 Np63 in different grades of cervical epithelium, the relationship between the expression level of P16 Ki67 and 螖 Np63 and the cervical lesions of different grades was preliminarily understood. To further explore the diagnostic value of detecting the above biological markers alone or in combination for high-grade squamous intraepithelial lesioning in high-grade squamous intraepithelial lesions. Methods: patients in the second Hospital of Shanxi Medical University from January 2015 to December 2015 were selected. According to the pathological diagnosis results of routine HE staining, they were divided into two groups: normal cervical group (n = 60) and low grade squamous intraepithelial lesion (LSIL) group. There were 60 cases of CIN grade I, 120 cases of high grade squamous intraepithelial lesions, including 60 cases of CIN II and 60 cases of CIN III, and 30 cases of early invasive carcinoma of cervix (270 cases). The expression of P16 Ki67 and 螖 Np63 protein in the four groups were detected by S-P immunohistochemical method. The data were analyzed by SPSS 20.0 software. Results 2. P16 Ki67 and 螖 Np63 were correlated with cervical lesion grade. The positive rate of P16 Ki67 and 螖 Np63 in normal group and cervical cancer group were 18.33, 73.33 and 95.83, respectively. The positive rates of Ki67 and 螖 Np63 were 10.00 and 87.50, respectively, and the positive rates of 螖 Np63 were 6.676.6796. 6767 and 96. 6767, respectively. The positive expression rate increased with the increase of cervical lesion grade. There was a significant difference in the positive rates between the four groups. The positive expression of p16 Ki67 and 螖 Np63 in the HSIL group was significantly different from that in the normal group and that in the normal group. There was no significant difference between the four groups and the cervical cancer group. The sensitivity and specificity of detecting 螖 Np63 protein positive in HSIL alone were 95.0% and 96.70.The sensitivity and specificity were higher than those of Ki677777.5% and 90.0%, respectively, and the specificity was similar to that of P16. But the relative sensitivity of ROC curve analysis: the area under the curve of 螖 Np63 immunohistochemical detection of HSIL was 0.924-0.993g, which was higher than that under P16 and Ki67, and the difference was statistically significant compared with the area under Ki67 curve. However, there was no significant difference between the area under the P16 curve and the area under the curve with 螖 Np63 and P16 parallel connection, but there was no significant difference in the area under the curve between 螖 Np63 and P16, as compared with the area under the curve detected only by 螖 Np63 (0.958). Conclusion: 1. P16 + Ki67, 螖 Np63 can objectively reflect the degree of CIN lesion to some extent. 螖 Np63 is a high potential marker for cervical cancer. The three biological indexes are of clinical significance for screening and improving the accuracy of pathological diagnosis of HSIL.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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