P16、Ki67在宫颈尖锐湿疣与上皮内瘤变的相关性研究

发布时间：2018-07-02 14:02

本文选题：P16 + Ki67　；参考：《泰山医学院》2014年硕士论文

【摘要】：目的：通过研究P16、Ki67在宫颈尖锐湿疣及上皮内瘤变中表达,分析其临床意义,以及探讨宫颈尖锐湿疣与上皮内瘤变的鉴别诊断。研究方法：选择从2013年1月1日至2013年12月31日,在聊城市人民医院病理科经宫颈活检或锥切术,病理诊断为CIN组的患者558例,入选最大年龄78岁,最小年龄22岁；宫颈尖锐湿疣组患者129例,入选患者最大年龄69岁,最小年龄21岁；选取因子宫肌瘤、子宫脱垂或肌腺病行全子宫切除术的正常宫颈或宫颈炎组织96例作为对照组,两组年龄无明显差异。其中有592例患者在妇科门诊行阴道镜及镜下活检或宫颈锥切术。全部标本都经过10%的福尔马林固定,并且常规石蜡包埋,3umm连续切片。应用SPSS13.0统计软件包进行统计学分析处理,对于多样本率比较整体检验有差别的组间两两比较采用四格表x2检验,相关性分析采用r检验相关分析。结果：1、P16在宫颈尖锐湿疣中的表达情况：正常皮肤宫颈尖锐湿疣(9.09%)’、宫颈尖锐湿疣合并低级别CIN(82.35%)2、宫颈尖锐湿疣合并高级别C1N(98.41%)’、宫颈尖锐湿疣合并宫颈癌(100%)‘,分别比较时,P16表达有差别(①②P0.01,②③P0.01,②④P0.01),有统计学意义；P16在正常宫颈组织或宫颈炎中阳性率为0%；P16在宫颈上皮内瘤变中的表达情况：P16在低级别CIN和高级别CIN的阳性率分别为：57.69%,85.80%,弱阳性率分别为：39.74%、7.10%,中度阳性率分别为：12.82%、17.59%,强阳性率分别为：5.13%、61.11%。P16在单纯低级别和挖空样低级别组,P0.01,有统计学意义；P16在单纯高级别CIN和高级别C1N累腺时,单纯高级别CIN和挖空样高级别CIN累腺时,P0.05,有统计学意义。2、Ki67在宫颈尖锐湿疣中的表达情况：正常皮肤宫颈尖锐湿疣(36.36%)1、宫颈尖锐湿疣合并低级别CIN(76.47%)2、宫颈尖锐湿疣合并高级别CIN(98.41%)3、宫颈尖锐湿疣合并宫颈癌(100%)‘,分别比较时,Ki67表达有差别(①②P0.05,②③P0.01,①③P0.01,②④P0.05),均有统计学意义；Ki67在宫颈上皮内瘤变中的表达情况：Ki67在低级别CIN和高级别CIN的阳性率分别为：79.49%、87.04%,弱阳性率分别为：16.23%、5.86%,中度阳性率分别为：58.12%、21.3%,强阳性率分别为：5.14%、59.88%。Ki67在单纯低级别CIN和挖空样低级别CIN组,P0.05,有统计学意义；Ki67在单纯高级别C1N和挖空样高级别CIN累腺时,P0.05,有统计学意义。3、P16在对照组、宫颈尖锐湿疣组及宫颈上皮内瘤变中的阳性率分别为：0.00%、84.50%、74.04%,每两组通过四格表法检验,P16表达均有差别(P0.01,P0.01,P0.05),差别均有统计学意义；Ki67在对照组、宫颈尖锐湿疣组及宫颈上皮内瘤变中的阳性率分别为8.33%、84.5%、83.87%；Ki67在对照组和宫颈尖锐湿疣组(P0.01)、对照组和宫颈上皮内瘤变组(P0.01),差别有统计学意义；P16、Ki67在宫颈尖锐湿疣和上皮内瘤变中的表达呈显著正相关(r=0.704,r=0.685)。4、阴道镜在宫颈炎、宫颈尖锐湿疣合并低级别CIN、宫颈尖锐湿疣合并高级别CIN、宫颈尖锐湿疣合并宫颈癌、低级别CIN、高级别CIN的符合率分别为：71.19%、73.68%、77.28%、100%、70.74%、80.40%,早期尖锐湿疣易和鳞状上皮疣状增生假性湿疣混淆,需通过组织学检查联合免疫组化P16、Ki67相鉴别。5、P16在单纯低级别CIN、挖空样低级别C1N、尖锐湿疣合并低级别CIN的阳性率分别为：34.95%,75.57%,82.35%；Ki67在它们中阳性率分别为72.82%,84.73%,76.47%。P16在单纯高级别CIN、挖空样高级别CCA合并高级别CIN中的阳性率分别为：85.77%、85.92%、98.41%；Ki67在它们中阳性率分别为：85.37%、90.14%、98.41%。结论：1、P16在宫颈尖锐湿疣组织中低表达,如表达增高,则提示宫颈尖锐湿疣有癌变倾向；P16在正常宫颈组织或宫颈炎中不表达,在低级别上皮内瘤变中弱阳性表达为主,在高级别上皮内瘤变中强阳性表达为主,在挖空样高级别累腺时全部表达；P16可以早期发现宫颈病变及辅助诊断宫颈上皮内瘤变的分级,我们应重视有挖空样细胞的高级别累腺病理。2、Ki67在宫颈尖锐湿疣组织表达增强,提示宫颈尖锐湿疣有癌变倾向,Ki67在宫颈上皮内瘤变的表达：随着级别升高,表达的强度也逐渐升高,高级别累腺强阳性率更高,Ki67可以预测宫颈病变的严重程度。3、P16、Ki67可以作为正常宫颈组织、宫颈尖锐湿疣及上皮内瘤变鉴别的生物标志物,并且P16、Ki67在其诊断上具有一致性,呈显著正相关。4、阴道镜下可以区分大部分的正常宫颈组织、宫颈尖锐湿疣及上皮内瘤变,对早期宫颈病变的诊断及分级具有重要价值,阴道镜下可疑病变区活检联合免疫组化P16、Ki67的检测,提高了临床的确诊率,值得广泛推广。5、当宫颈上皮内瘤变合并尖锐湿疣或合并挖空样细胞时,P16、Ki67表达明显增强,P16、Ki67可用于作为检测HPV感染的指标；宫颈尖锐湿疣和上皮内瘤变有密切联系。
[Abstract]:Objective: To study the expression of P16 and Ki67 in cervical condyloma acuminata and intraepithelial neoplasia, analyze its clinical significance, and explore the differential diagnosis of cervical condyloma acuminata and intraepithelial neoplasia. Methods of study: from January 1, 2013 to December 31, 2013, cervical biopsy or conization in the Department of pathology of Liaocheng People's Hospital, and pathological diagnosis 558 patients in group CIN were selected for the maximum age of 78 years and the minimum age of 22 years, and 129 cases of condyloma acuminata in the cervical condyloma group, with the maximum age of 69 years and the minimum age of 21 years. 96 cases of normal cervix or cervitis were selected as the control group for Hysteromyoma, uterine prolapse or adenomyosis, and 96 cases of cervical inflammation were found in two groups. 592 patients were treated with colposcopy and endoscopic biopsy or cervical conization in gynecologic outpatients. All the specimens were fixed by 10% formalin, and the routine paraffin embedding, 3umm continuous slice. The SPSS13.0 statistical package was used for statistical analysis, and 22 comparison of the groups with different sample rates compared to the overall test were compared. Four lattice x2 test, correlation analysis using R test correlation analysis. Results: 1, P16 in cervical condyloma: normal skin cervical condyloma acuminatum (9.09%), cervical condyloma with low grade CIN (82.35%) 2, cervical condyloma with advanced C1N (98.41%) ", cervical condyloma with cervical cancer (100%)", The expression of P16 was different ((2) P0.01, (2) P0.01, (2) P0.01), and the positive rate of P16 in normal cervical tissue or cervicitis was 0%; the expression of P16 in cervical intraepithelial neoplasia: the positive rates of P16 in low grade CIN and high grade CIN were 57.69%, 85.80%, and 39.74%, respectively, respectively. 7.10%, the moderate positive rate was 12.82%, 17.59%, and the strong positive rate was 5.13%, 61.11%.P16 was statistically significant in the simple low grade and hollowed low grade group, P0.01. When P16 was pure high grade CIN and high grade C1N tired gland, P0.05, with statistical significance.2, Ki67 in the cervix when pure high grade CIN and hollowed high grade CIN tired gland The expression of condyloma acuminatum: normal skin cervical condyloma (36.36%) 1, cervical condyloma acuminatum with low grade CIN (76.47%) 2, cervical condyloma acuminata with high grade CIN (98.41%) 3, cervical condyloma acuminata with cervical cancer (100%) ', Ki67 expression was different ((1) P0.05, (((((((((((1), P0.01, and P0.05), respectively. Statistical significance; the expression of Ki67 in cervical intraepithelial neoplasia: the positive rates of Ki67 in low grade CIN and high grade CIN were 79.49%, 87.04%, respectively: 16.23%, 5.86%, and moderate positive rates were 58.12%, 21.3%, respectively: 5.14%, 59.88%.Ki67 at low level CIN and low level of hollowing samples. CIN group, P0.05, statistical significance; Ki67 in high grade C1N and hollowed high grade CIN tired gland, P0.05, statistically significant.3, P16 in the control group, cervical condyloma acuminate group and cervical intraepithelial neoplasia positive rates are: 0%, 84.50%, 74.04%, each two groups by four table test, P16 expression is different (P0.01, P0.01, P0.) 05) the difference was statistically significant; Ki67 in the control group, the positive rate of cervical condyloma acuminata group and cervical intraepithelial neoplasia were 8.33%, 84.5%, 83.87%, respectively, in the control group and the cervical condyloma acuminatum group (P0.01), the control group and the cervical intraepithelial neoplasia group (P0.01), the difference was statistically significant; P16, Ki67 in cervix condyloma acuminata and epithelium. The expression of intraepithelial neoplasia was significant positive correlation (r=0.704, r=0.685).4, colposcopy in cervicitis, condyloma acuminata with low grade CIN, cervical condyloma with high grade CIN, cervical condyloma with cervical cancer, low grade CIN and high grade CIN, respectively: 71.19%, 73.68%, 77.28%, 100%, 70.74%, 80.40%, and early condyloma acuminata To be confused with squamous verrucous hyperplasia of Pseudocondyloma, it is necessary to use histology to combine immunohistochemical P16, Ki67 to identify.5, P16 in simple low grade CIN, low grade C1N for hollowing. The positive rate of condyloma acuminata with low grade CIN are 34.95%, 75.57%, 82.35%, and Ki67 in them is 72.82%, 84.73%, 76.47%.P16 in simple The positive rates of high grade CIN, high grade CCA combined with high grade CIN were 85.77%, 85.92%, 98.41%, and the positive rate of Ki67 in them were 85.37%, 90.14%, 98.41%. conclusion: 1, low expression in cervical condyloma acuminata, if the expression increased, suggested that the cervical condyloma acuminata had canceration tendency; P16 in normal cervical tissue. Or not expressed in cervicitis, mainly in low grade intraepithelial neoplasia, strong positive expression in high grade intraepithelial neoplasia, all expressed in a hollowed high level gland; P16 can be found early in cervical lesions and auxiliary diagnosis of cervical intraepithelial neoplasia. We should pay attention to the high grade of empty cells. The expression of.2 and Ki67 in cervical condyloma is enhanced, suggesting that the cervical condyloma acuminata has a tendency of canceration, and the expression of Ki67 in the cervical intraepithelial neoplasia: as the level rises, the intensity of the expression increases gradually and the high positive rate of the advanced gland is higher. Ki67 can predict the severity of the cervical lesions,.3, P16, Ki67 can be used as the normal palace. Cervical tissue, cervical condyloma and intraepithelial neoplasia identification biomarkers, and P16, Ki67 in their diagnostic consistency, a significant positive correlation of.4, colposcopy can distinguish most of the normal cervical tissue, cervical condyloma acuminata and intraepithelial neoplasia, the diagnosis and classification of early cervical lesions is of great value, under colposcopy The suspicious lesion area biopsy combined with immunohistochemical P16, Ki67, improved the clinical diagnosis rate, and it was worth popularizing the.5. When the cervical intraepithelial neoplasia merged with condyloma acuminata or amalgamated hollowed cells, the expression of P16, Ki67 was obviously enhanced, and P16, Ki67 could be used as a marker for detecting HPV infection; cervical condyloma acuminata and intraepithelial neoplasia were closely related. Contact.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【参考文献】