p16/Ki-67双重染色检查对高危型人乳头瘤病毒感染的诊断价值  

Value of p16/Ki-67 double staining in the diagnosis of high-risk human papillomavirus infection

作　　者：张玲[1] 傅珂 李少丛[1] 张艳玉[1] 焦盈盈[1] ZHANG Ling;FU Ke;LI Shao-cong;ZHANG Yan-yu;JIAO Ying-ying(Brain Hospital,Liaocheng People's Hospital,Liaocheng,Shandong 252000,China)

机构地区：[1]山东省聊城市人民医院脑科医院妇产科,山东聊城252000

出　　处：《中华医院感染学杂志》2022年第4期569-573,共5页Chinese Journal of Nosocomiology

基　　金：山东省科技厅基金资助项目(Z-2014-1-3-46-1)。

摘　　要：目的 分析p16/Ki-67双重染色检查对高危型人乳头瘤病毒(HR-HPV)感染妇女的筛查诊断价值,为HR-HPV感染患者的分流和诊断提供依据。方法 选取2017年8月-2020年10月于山东省聊城市人民医院脑科医院妇产科门诊就诊或住院治疗的102例HR-HPV感染患者作为研究对象,对患者宫颈细胞HR-HPV检查结果进行调查分析;对患者行宫颈细胞薄层液基细胞学检查(TCT)和p16/Ki-67双重染色检查,TCT检查阳性者转行阴道镜检查,阴道镜异常者行宫颈组织活检;采用受试者工作特征(ROC)曲线比较TCT和p16/Ki-67双染检查在宫颈上皮内瘤变(CIN)2级以上宫颈病变和宫颈癌诊断中的价值。结果 检出14种HR-HPV(共143株),25例为多重感染,HPV-16的感染率最高(24.51%),其次为HPV-52和HPV-58。66例TCT检查呈阳性,阳性率为64.71%。正常宫颈细胞p16/Ki-67双染阳性率低于CIN 2级、CIN 3级和宫颈癌,CIN 1级低于CIN 3级,CIN 3级低于宫颈癌。存在宫颈病变的患者的宫颈细胞p16/Ki-67双染阳性率高于非宫颈病变患者,宫颈癌患者高于非宫颈癌患者(P<0.05)。TCT、p16/K-i67诊断宫颈病变的ROC曲线下面积(AUC)分别为0.816和0.786(P均<0.05)。p16/K-i67诊断宫颈癌的AUC为0.779(P<0.05),而TCT诊断宫颈癌的AUC无统计学意义。结论 在HR-HPV感染患者宫颈病变的筛查和诊断中,p16/Ki-67双染检查可获得高于TCT检查的特异度,特别是在宫颈癌诊断中的价值高于TCT,可作为针对HR-HPV感染患者转诊分流的手段。OBJECTIVE To analyze the value of p16/Ki-67 double staining in the screening and diagnosis of women with high-risk human papillomavirus infection(HR-HPV), so as to provide a basis for the diversion and diagnosis of patients with HR-HPV infection. METHODS A total of 102 patients with HR-HPV infection who were treated or hospitalized in Obstetrics and Gynecology Department of Brain Hospital of Liaocheng people′s Hospital of Shandong Province from Aug 2017 to Oct 2020 were selected as the research subjects, and the results of HR-HPV examination of cervical cells were investigated and analyzed;Thin-prep cytologic test(TCT) examination and p16/Ki-67 double staining of cervical cells was performed. The patients with positive TCT were transferred to colposcopy, and those with abnormal colposcopy was subjected to cervical biopsy. The receiver operating characteristic(ROC) curve was employed to compare the values of TCT and p16/Ki-67 double staining in the diagnosis of the lesions more than 2 grade of cervical intraepithelial neoplasia(CIN) and cervical cancer. RESULTS A total of 14 types of HR-HPV(143 strains) were detected, 25 cases were multiple infection, among which, the infection rate of HPV-16 was the highest(24.51%), followed by HPV-52 and HPV-58. TCT was positive in 66 patients(64.71%). The positive rate of p16/Ki-67 double staining of normal cervical cells was lower than that of CIN 2, CIN 3 or cervical cancer, the rate of CIN 1 cervical cells was lower than that of CIN 3, and the rate in CIN 3 grade cervical cells was lower than that in cervical cancer. The positive rate of p16/Ki-67 double staining of cervical cells in patients with positive cervical lesions was significantly higher than that in patients with negative cervical lesions, and patients with cervical cancer was significantly higher than that those with non-cervical cancer(P<0.05). The area under ROC curve(AUC) of TCT and p16/k-i67 in the diagnosis of cervical lesions were 0.816 and 0.786 respectively(P<0.05). AUC of p16/k-i67 in the diagnosis of

关 键 词：p16/Ki-67双重染色 高危型人乳头瘤病毒 筛查诊断 

分 类 号：R446[医药卫生—诊断学]