p16/Ki67细胞双染和配对盒家族基因1甲基化检测对细胞学未明确意义的不典型鳞状上皮细胞患者分流的作用  

The role of p16/Ki67 dual staining and PAX1 methylation detection for triage in patients with cervical atypical squamous cell of undetermined significance

作　　者：秦漓洪 苏玥辉[1] 张梦真[1] QIN Li-Hong;SU Yue-Hui;ZHANG Meng-Zhen(Department of Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州大学第一附属医院河南省宫颈疾病中心,河南郑州450000

出　　处：《中国妇幼保健》2022年第13期2472-2476,共5页Maternal and Child Health Care of China

基　　金：河南省医学科技攻关计划省部共建项目(SB201901043)。

摘　　要：目的 探讨p16/Ki67细胞双染和配对盒家族基因1(PAX1)甲基化检测在细胞学未明确意义的不典型鳞状上皮细胞(ASC-US)患者中的分流作用。方法 选取2019年7月—2020年9月于郑州大学第一附属医院行宫颈癌筛查的患者25 532例,其中TCT结果为ASC-US,并接受p16/Ki67细胞双染、PAX1甲基化检测及阴道镜下活检且结果有效的患者共431例,以组织病理诊断为金标准,采用灵敏度、特异度、准确率、约登指数比较p16/Ki67细胞双染、PAX1甲基化及p16/Ki67细胞双染+PAX1甲基化联合检测(以下简称联合检测)诊断CIN2+、CIN3+的效能,并计算不同方法的阴道镜转诊率。结果 p16/Ki67细胞双染、PAX1甲基化和联合检测的阳性率均随着宫颈病变严重程度升高而升高。PAX1甲基化诊断CIN2+和CIN3+的灵敏度、特异度、准确率及约登指数分别为60.28%、92.07%、81.67%、0.524和78.48%、86.93%、85.38%、0.654,特异度和准确率均高于p16/Ki67细胞双染及联合检测(P<0.05),且约登指数最大。使用PAX1甲基化进行分流时,阴道镜转诊率降低73.13%。联合检测诊断CIN2+和CIN3+的灵敏度高于p16/Ki67细胞双染、PAX1甲基化单独检测,差异有统计学意义(P<0.05)。使用联合检测分流时,阴道镜转诊率降低44.78%,且诊断宫颈癌的准确率为100%。结论 对于分流细胞学ASC-US的患者,PAX1甲基化检测具有较高的特异度,可在一定程度上降低阴道镜转诊率。联合检测可提高灵敏度,对宫颈癌的诊断具有重要作用。Objective To investigate the application value of p16/Ki67 dual staining and methylation detection of paired-box gene 1(PAX1) for triage in patients with cervical cytological ASC-US.Methods A total of 25 532 patients who underwent cervical cancer screening in the First affiliated Hospital of Zhengzhou University from July 2019 to September 2020 were selected, of which 431 patients with a TCT result of ASC-US and the results were valid for p16/Ki67 dual staining, PAX1 methylation detection and colposcopy biopsy.According to the gold standard of histopathological diagnosis, sensitivity, specificity, accuracy and Youden index were used to compare the efficacy of p16/Ki67 dual staining, PAX1 methylation and p16/Ki67 dual staining + PAX1 methylation(hereinafter referred to as combined detection) in the diagnosis of CIN2+ and CIN3+ patients, and the colposcopy referral rates of different methods were calculated.Results The positive rates of p16/Ki67 dual staining, PAX1 methylation and combined detection increased with the severity of cervical lesions.The sensitivity, specificity, accuracy and Youden index of PAX1 methylation in the diagnosis of CIN2+ and CIN3+ were 60.28%,92.07%,81.67%,0.524 and 78.48%,86.93%,85.38%,0.654,respectively.The specificity and accuracy of PAX1 methylation was higher than that of p16/Ki67 dual staining and combined detection(P<0.05),and the Youden index is the highest.When PAX1 methylation was used for cytological triage, the colposcopy referral rate can be reduced by 73.13%.The sensitivity of combined detection was higher than p16/Ki67 dual staining and PAX1 methylation detection alone, the difference was statistically significant(P<0.05).When combined detection was used for cytological triage, the colposcopy referral rate can be reduced by 44.78% and the accuracy of diagnosis of cervical cancer was 100%.Conclusion The PAX1 methylation detection has a high specificity in triage for cytological ASC-US,which can reduce the colposcopy referral rate to a certain extent.Combined detection can imp

关 键 词：未明确意义的不典型鳞状上皮细胞 p16/Ki67细胞双染 配对盒家族基因1 宫颈癌 联合检测 

分 类 号：R737.33[医药卫生—肿瘤]