P16蛋白检测联合HR-HPV、TCT在宫颈癌前病变及宫颈癌诊断中的价值  

Value of P16 protein detection combined with HR-HPV and TCT in the diagnosis of cervical precancerous lesions and cervical cancer

作　　者：王立娟 曹丽娟[1] 吴琼[1] WANG Lijuan;CAO Lijuan;WU Qiong(Department of Gynecology,Chengde Central Hospital,Chengde Hebei 067000,China)

机构地区：[1]承德市中心医院妇科,河北承德067000

出　　处：《临床与病理杂志》2023年第4期660-669,共10页Journal of Clinical and Pathological Research

基　　金：河北省医学科学研究课题计划项目(20200349);承德市科技计划项目(202102A011)。

摘　　要：目的:探讨P16蛋白检测联合高危型人乳头瘤病毒(high-risk human papilloma virus,HR-HPV)、液基薄层细胞学检测(thinprep cytologic test,TCT)在宫颈癌前病变及宫颈癌诊断中的临床价值。方法:选取2019年9月至2021年8月在承德市中心医院妇科门诊行宫颈癌筛查的390例患者为研究对象。所有患者均行P16蛋白、HRHPV及TCT检测。任一结果阳性者或高度怀疑宫颈恶性病变者行阴道镜下宫颈活检组织病理检查。探讨P16蛋白、HR-HPV、TCT检测及两两联合检测在宫颈癌中的诊断,并绘制诊断的受试者工作特征(receiver operating characteristic,ROC)曲线。结果:390例患者中,HR-HPV阳性者101例,阳性率25.90%(101/390);TCT阳性者64例,阳性率16.41%(64/390);P16阳性者57例,阳性率14.62%(57/390)。任一阳性者133例,共召回100例行阴道镜活检,组织病理学结果为:正常或炎症62例,宫颈低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)19例,高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)14例,宫颈癌5例;组织病理学检测阳性19例,阴性81例。在组织病理学检测阳性中,HR-HPV阳性18例,TCT检测阳性14例,P16阳性者17例。HR-HPV、TCT及P16诊断HSIL及宫颈癌的敏感度分别为94.74%、73.68%、89.47%,差异无统计学意义(P>0.05);P16诊断HSIL及宫颈癌的特异度高于TCT与HR-HPV检测,差异有统计学意义(P<0.05)。在两两联合检测中,HR-HPV+P16诊断HSIL及宫颈癌的敏感度最高,但3种联合检测方式的敏感度比较无统计学意义(P>0.05);TCT+P16诊断HSIL及宫颈癌的特异度为86.39%,高于HR-HPV+TCT、HR-HPV+P16(P<0.05)检测。HR-HPV、TCT、P16、HR-HPV+TCT、TCT+P16及HR-HPV+P16诊断宫颈癌前病变及宫颈癌的AUC分别为0.880、0.814、0.915、0.858、0.879、0.902。结论:P16的表达与宫颈病变进展具有正相关性,其可提高HSIL及宫颈癌的诊断效能,降低误诊率。P16+TCT检测相较于HR-HPV+TCT在不损失敏感度的前Objective:To investigate the value of P16 protein detection combined with high-risk human papilloma virus(HR-HPV)and thinprep cytologic test(TCT)in the diagnosis of cervical precancerous lesions and cervical cancer.Methods:A total of 390 patients who underwent cervical cancer screening in the gynecological clinic of Chengde Central Hospital from September 2019 to August 2021 were selected as the study subjects.All patients underwent P16 protein,HR-HPV,and TCT detection.Any positive results or highly suspected cervical malignant lesions underwent cervical biopsy under colposcopy.The diagnosis of P16 protein,HR-HPV,TCT and pin-two combined detection in cervical cancer was studied,and the receiver operating characteristic(ROC)curve was drawn.Results:Among the 390 patients,101 were positive for HR-HPV,with a positive rate of 25.90%(101/390);64 was positive for TCT,with a positive rate of 16.41%(64/390);57 were P16 positive,with a positive rate of 14.62%(57/390).A total of 133 patients were positive of the above for any results test,and 100 patients were recalled for colposcopy biopsy.The histopathological results were as follows:62 patients with normal or inflammation,19 low-grade squamous intraepithelial lesion(LSIL),14 high-grade squamous intraepithelial lesion(HSIL),and 5 cervical cancer;19 patients were positive and 81 were negative.Among the positive results of histopathological examination,18 patients were HR-HPV positive,14 were TCT positive,and 17 were P16 positive.The sensitivity of HR-HPV,TCT,and P16 in the diagnosis of HSIL and cervical cancer was 94.74%,73.68%,and 89.47%,respectively,but the difference was not statistically significant(P>0.05).The specificity of P16 in the diagnosis of HSIL was higher than that of TCT and HR-HPV(P<0.05).The sensitivity of HR-HPV+P16 in the diagnosis of HSIL and cervical cancer was the highest,but the sensitivity of the 3 combined detection methods was not statistically significant(P>0.05).The highest specificity for the diagnosis of HSIL was TCT+P16(86.39%),which was high

关 键 词：宫颈癌 癌前病变 P16蛋白 高危型人乳头瘤病毒 液基薄层细胞学 诊断价值 

分 类 号：R737.33[医药卫生—肿瘤]