p16、p125的表达及HPV分型检测在宫颈鳞状上皮内病变中的临床应用  

Clinical value of p16 and p125 expression and HPV genotyping in squamous intraepithelial lesion of cervix

作　　者：阮细玲 丁莉利[1] 黄幼生[1] 杨丞[1] 罗志飞[1] 牛海艳[1] RUAN Xi-ling;DING Li-li;HUANG You-sheng;YANG Cheng;LUO Zhi-fei;NIU Hai-yan(Department of Pathology,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院病理科,海口570102

出　　处：《诊断病理学杂志》2020年第11期789-793,799,共6页Chinese Journal of Diagnostic Pathology

基　　金：海南医学院科研培育基金项目(HY2016-18);海南省自然科学基金项目(814303)。

摘　　要：目的研究不同级别宫颈病变中p16、p125蛋白的表达情况,并分析不同宫颈病变中HPV的分型结果,以探讨p16、p125联合HPV分型检测在宫颈病变诊断中的应用价值。方法选取我院2017-01—2018-12间不同宫颈病变231例,共分为4组,其中慢性宫颈炎28例、低级别鳞状上皮内病变60例、高级别鳞状上皮内病变88例、宫颈鳞状细胞癌55例,用免疫组织化学的方法检测p16、p125蛋白的表达情况,用PCR-反向点杂交方法进行HPV分型检测。结果 p16在慢性宫颈炎、低级别鳞状上皮内病变、高级别鳞状上皮内病变及宫颈癌4组宫颈病变中阳性率分别为3.6%、21.7%、80.7%、96.4%,p125在四组病变中的阳性率分别为10.7%、26.7%、85.2%、96.4%,差异均具有统计学意义(P=0.000)。两两比较结果显示,高级别鳞状上皮内病变与宫颈鳞状细胞癌两组中p16、p125的表达阳性率明显高于慢性宫颈炎或低级别鳞状上皮内病变组。四种不同宫颈病变中p16、p125的表达阳性率呈正相关。HPV分型结果显示慢性宫颈炎、低级别鳞状上皮内病变、高级别鳞状上皮内病变及宫颈癌四组中高危型HPV感染率分别为:61%、77%、76%、78%,差异无统计学意义(P=0.323),而四组感染HPV16/18的比率分别为:18%、17%、47%、64%,差异具有统计学意义(P=0.000)。两两比较结果:高级别鳞状上皮内病变或宫颈鳞状细胞癌两组中HPV16/18的表达阳性率明显高于慢性宫颈炎或低级别鳞状上皮内病变组。结论 p16、p125的表达检测对鉴别高级别鳞状上皮内病变与低级别鳞状上皮内病变或慢性宫颈炎具有非常重要的辅助诊断价值,且p125固定表达于细胞核,免疫组织化学染色结果更易判断,更易于临床应用;联合检测p16、p125及进行HPV分型更有助于判断宫颈鳞状上皮内病变的级别及宫颈病变进展的风险度评估。Objective To investigate the expression of P16 and p125 proteins in different grades of cervical lesions,and to analyze the genotyping of HPV in different cervical lesions to explore the value of P16,p125 combined with HPV genotyping in the diagnosis of cervical lesions. Methods A total of 231 patients with different cervical lesions from January 2017 to December 2018 in our hospital were divided into 4 groups,including 28 cases of chronic cervicitis,60 cases of low-grade squamous intraepithelial lesions,88 cases of high-grade squamous intraepithelial lesions and 55 cases of cervical squamous cell carcinoma. The expression of P16 and p125 protein was detected by immunohistochemistry;HPV genotyping was detected by PCR-reverse dot hybridization. Results The positive rates of P16 in chronic cervicitis,lowgrade squamous intraepithelial lesions,high-grade squamous intraepithelial lesions and cervical squamous cell carcinoma were 3. 6%,21. 7%,80. 7%,and 96. 4%,respectively. The positive rates of p125 in these four groups were 10. 7%,26. 7%,85. 2%,and 96. 4%,respectively,and the differences were statistically significant( P = 0. 000). The results of pairwise comparison showed that the positive expression rates of P16 and p125 in high-grade squamous intraepithelial lesions and cervical squamous cell carcinoma were significantly higher than those in chronic cervicitis or low-grade squamous intraepithelial lesions. The positive expression rates of P16 and p125 were positively correlated in four different cervical lesions. HPV genotyping showed that the high-risk HPV infection rates in chronic cervicitis,low-grade squamous intraepithelial lesions,high-grade squamous intraepithelial lesions,and cervical squamous cell carcinoma were 61%,77%,76%,and 78%,respectively. The difference was no statistically significant( P = 0. 323),while the infection rates of HPV16/18 in the four groups was 18%,17%,47%,and 64%,respectively,and the difference was statistically significant( P= 0. 000). Results of pairwise comparison showed that infe

关 键 词：宫颈低度鳞状上皮内病变 宫颈高度鳞状上皮内病变 P16 p125 HPV分型 

分 类 号：R737.3[医药卫生—肿瘤]