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目的探讨P16INK4a、Ki-67、高危型人乳头瘤病毒(hr-HPV)对宫颈病变的诊断价值。方法采用免疫组织化学染色法检测P16INK4a、Ki-67在120例宫颈上皮病变组织中的表达情况;采用第二代杂交捕获法检测病例的13种hr-HPV DNA负荷量。分析P16INK4a、Ki-67、hr-HPV的临床诊断价值。结果 P16INK4a表达水平与宫颈病变级别呈正相关(r=0.759,P<0.01)。P16INK4a检测人CINⅡ级及以上病变(CIN2+)的敏感性为94.4%,特异性为75.0%。Ki-67检测人CIN2+的敏感性为100%,特异性为20.8%。hr-HPV对人CIN2+诊断的敏感性为91.7%,特异性为37.5%。一致性检验证实,P16INK4a阳性表达与hr-HPV感染有一致性(Kappa=0.400,P<0.001)。但相关性分析证实,宫颈病变程度、P16INK4a表达水平与hr-HPV DNA负荷量均无相关性(r分别为0.02、0.126、0.028,P>0.05)。结论 P16INK4a比Ki-67、hr-HPV能够更准确地反映宫颈病变程度。DNA负荷量高低并不能代表宫颈上皮病变的严重程度。P16INK4a阳性表达程度能反映hr-HPV导致宫颈上皮恶性转化的程度。
Objective To investigate the diagnostic value of P16INK4a, Ki-67 and human papillomavirus (HPV) in the diagnosis of cervical lesions. Methods Immunohistochemical staining was used to detect the expression of P16INK4a and Ki-67 in 120 cases of cervical epithelial lesions. The second generation hybridization capture method was used to detect 13 kinds of hr-HPV DNA loads. The clinical diagnostic value of P16INK4a, Ki-67, hr-HPV was analyzed. Results The expression of P16INK4a was positively correlated with the grade of cervical lesions (r = 0.759, P <0.01). The sensitivity and specificity of P16INK4a in detecting CIN level Ⅱ and above (CIN2 +) were 94.4% and 75.0% respectively. The sensitivity and specificity of Ki-67 for detecting human CIN2 + were 100% and 20.8% respectively. hr-HPV had a sensitivity of 91.7% and a specificity of 37.5% for human CIN2 + diagnosis. Consistency testing confirmed that P16INK4a positive expression was consistent with hr-HPV infection (Kappa = 0.400, P <0.001). However, correlation analysis confirmed that there was no correlation between the degree of cervical lesions and the expression of P16INK4a and hr-HPV DNA load (r = 0.02,0.126,0.028, P> 0.05). Conclusion P16INK4a can reflect cervical lesions more accurately than Ki-67 and hr-HPV. The level of DNA load does not represent the severity of cervical epithelial lesions. The positive expression of P16INK4a can reflect the degree of HPV-induced cervical epithelial malignant transformation.