DNA倍体分析在宫颈病变中的应用价值

发布时间：2018-11-13 13:31

【摘要】：目的：本研究主要通过检测宫颈癌及癌前病变组织中的DNA倍体状态来探讨DNA异倍体细胞在宫颈病变发生发展过程中的生物学特性，进而预测宫颈病变的发展趋势，为临床诊断及处理提供依据。方法：收集2013年3月-2014年2月河北医科大学第二医院妇科门诊及住院患者的385例液基细胞学剩余标本进行DNA倍体分析，以组织病理学结果作为诊断的金标准。临床表现为白带增多（无临床症状因体检时发现宫颈病变）、性交后出血、绝经后出血、不规则阴道流血、流液（米泔样，伴恶臭味）、腹疼等症状者和宫颈糜烂者。结果：共于我院妇科实验室收集液基细胞学剩余标本385例进行DNA倍体分析。其中包括：液基薄层细胞诊断为ASCUS的剩余标本310例，LSIL标本73例，住院病人最终病理结果为腺癌的2例液基细胞学保存标本。383例液基细胞学诊断为ASCUS及LSIL的标本均搜集到了组织病理学结果，CIN以上病变141例（36.81%）。其中CIN I71例（50.35%），CIN II20例（14.18%）,CIN III36例（25.53%），宫颈癌14例（9.93%）。DNA倍体分析可见DNA异倍体细胞233例（DNA异倍体细胞阳性）阳性率60.84%，未见DNA异倍体细胞150例（DNA异倍体细胞阴性）。宫颈脱落细胞的DNA异倍体细胞数1-2个83例，病理结果证实为高级别宫颈病变7例，阳性检出率为8.43%。异倍体细胞3-9个80例,高级别宫颈病变17例，阳性检出率为21.25%。异倍体细胞≥10个有70例,高级别宫颈病变44例，阳性检出率为62.86%。两两比较差异均有统计学意义。若以DNA指数2.5的3个或超过3个异倍体细胞定位为筛查后需作活检的标准，CINII以上病变的敏感性、特异性、阴性预测值分别为89.71%、46.06%、91.57%。若以DNA指数2.5的1个或超过1个异倍体细胞（异倍体细胞阳性）定位为筛查后需作活检的标准，CINII以上病变的敏感性、特异性、阴性预测值分别为97.14%、47.28%、98.67%。且DNA异倍体细胞阴性及阳性者发生宫颈病变的例数比较差异有统计学意义（χ2=118.823，P0.01）。在310例ASCUS患者中随访到211例HPV检测结果，其中高危型HPV阳性152例，高危型HPV阴性患者59例。在高危型HPV阳性组中：DNA异倍体细胞阴性者67例，病理结果检测出CINIII1例。DNA异倍体细胞阳性者85例，，病理结果提示CINII13例，CINIII15例，宫颈癌9例。在高危型HPV检测阴性组中：DNA异倍体细胞阴性者26例，病理结果提示CINIII1例。DNA异倍体细胞阳性者33例，病理结果提示CINII5例，CINIII4例。在高危型HPV阳性组中，DNA异倍体细胞阴性、阳性者中高级别宫颈病变的病理结果比较差异有统计学意义（χ2=35.311P0.01）。在高危型HPV阴性组中，DNA异倍体细胞阴性、阳性者中高级别宫颈病变的病理结果比较差异有统计学意义（χ2=4.128P0.05）。结论：宫颈脱落细胞的DNA定量分析作为一种行之有效的方法已应用于肿瘤病理分析及临床诊断研究中。能使临床病理医师较为客观的对每个细胞核的DNA含量进行检测，受细胞自身蜕变的影响较小，在临床检测中具有较高的敏感性及阴性预测值。标准化的DNA倍体分析仪以更高的质量评估肿瘤的良恶性，进而为临床诊断提供客观准确的分析结果。
[Abstract]:Objective: To study the biological characteristics of DNA heteroploid cells in the development of cervical lesions, and to predict the development trend of cervical lesions, and to provide the basis for clinical diagnosis and treatment. Methods: 385 cases of liquid-based cytology in the second hospital of Hebei Medical University from March, 2013 to February, 2014 were collected for DNA ploidy analysis, and the pathological results were used as gold for diagnosis. Standard. The clinical manifestation is the increase of leucorrhea (no clinical symptoms found in the cervical lesion due to physical examination), post-sexual hemorrhage, post-menopausal bleeding, irregular vaginal bleeding, fluid (misty, with bad smell), abdominal pain, and the like Results: The total of 385 cases of the remaining specimens of the liquid-based cytology in the gynecology laboratory of our hospital were DN. A-fold analysis was performed, including: the diagnosis of liquid-based thin-layer cells as the remaining specimens of ASUS, 73 cases of LSIL, and 2 liquid-based cytology samples of the in-patient final pathological results. 383 cases of liquid-based cytology were collected in the specimens of ASUS and LSIL. Pathological findings, 141 cases of above CIN (36. 81%). Of these, CIN I71 (50. 35%), CIN II20 (14. 18%), CIN III36 (25. 53%), and cervical cancer 14 (9.93%). Cell negative). The number of DNA heteroploid cells of cervical exfoliated cells was 1-2, and the pathological results were confirmed to be 7 cases of high-grade cervical lesions. The positive rate of positive rate was as follows: 8. 43%. 3-9, 80 and 17 high-level cervical lesions. The positive rate of positive rate was 2. 1. 25%. There were 70 cases of heteroploid somatic cell and 44 cases of high-grade cervical lesions. The positive rate of positive rate was 6. 2.86% and 2.86% respectively. Statistical significance. The sensitivity, specificity and negative predictive value of CINII lesions were 89. 71%, 46. 06%, 9, respectively, in the case of 3 or more than 3 heteroploid somatic cells with a DNA index of 2.2. 5 as the standard for biopsy. 1. 57%. The sensitivity, specificity and negative predictive value of CINII lesions were 97. 14%, 47. 28%, 9, respectively, if 1 or more of the heteroploid cells (heteroploid cell positive) were located in the DNA index of 2.5. 5 as the standard for biopsy, and the sensitivity, specificity and negative predictive value of the CINII lesions were 97,14%, 47. 28%, 9, respectively. There was a significant difference in the number of cervical lesions in the negative and positive cases of DNA heteroploid cell negative and positive (Sup2 = 118. 823, P 0. 01). Follow-up to 211 cases of HPV testing in 310 ASUS patients, including 152 high-risk HPV positive, high-risk HPV negative 59 of the patients. In the high-risk HPV-positive group, 67 cases of DNA heteroploid cell-negative were detected and CIN was detected by the pathological results. In III1 cases, 85 cases of DNA heteroploid cell were positive, and the pathological results suggested that CINII13 and CINIII15 cases were positive. 9 cases of cervical cancer. In the negative group of high-risk HPV, 26 cases were negative, and the pathological results suggested that CIN III1 cases. 33 cases of DNA heteroploid cell were positive, and the pathological findings suggested that CINII 5 cases, CIN III4. In the high-risk HPV-positive group, there was a statistically significant difference in the pathological findings of the high-grade non-cervical lesions in the positive and positive cases (Sup2 = 35. 311P 0. 01). In the high-risk HPV-negative group, the DNA heteroploid cell was negative, and the pathological results of the high-grade cervical lesions in the positive-positive case were statistically significant (Sup2 = 4.128P Conclusion: The DNA quantitative analysis of cervical exfoliated cells has been applied to the pathological analysis of the tumor. and has high sensitivity in clinical detection. The standardized DNA ploidy analyzer is used for evaluating the good and malignant of the tumor with higher quality, and further provides a passenger for clinical diagnosis
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.74

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