P16^(INK4a)、HPV DNA和DNA倍体分析对宫颈非典型鳞状上皮的诊断价值  

The diagnostic value of P16^(INK4a),HPV DNA detection and DNA ploidy analysis in the detection of cervical atypical squamous epithelium

作　　者：张康 张雯静 李向利 梁健伟 蒋国庆 ZHANG Kang;ZHANG Wenjing;LI Xiangli;LIANG Jianwei;JIANG Guoqing(Department of Gynecology,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院妇科,北京100016

出　　处：《中国研究型医院》2023年第4期35-39,共5页Chinese Research Hospitals

摘　　要：目的探讨细胞P16INK4a、人乳头瘤病毒(HPV)DNA基因分型和DNA倍体分析单独和联合检测对宫颈非典型鳞状上皮细胞(ASC-US)的诊断价值。方法搜集2021年5月—2022年9月86例液基薄层细胞(TCT)检测诊断为ASC-US,并同时行P16INK4a、HPV DNA分型和DNA倍体分析患者的病例资料,进行回顾性分析。以阴道镜组织病理诊断结果为金标准,根据宫颈活检病理结果分为高级别鳞状上皮内病变(HSIL/CINⅡ)及以上组、低级别鳞状上皮内病变(LSIL/CINⅠ)及以下组,利用ROC曲线评价P16INK4a、HPV DNA基因分型和DNA倍体分析单独和联合检测在ASC-US分流中的诊断效能;组间计数资料比较采用χ^(2)检验,P<0.05为差异有统计学意义。结果宫颈细胞P16INK4a在LSIL/CINⅠ及以下组阳性率37.9%、在HSIL/CINⅡ及以上组阳性率62.1%,两者差异具有统计学意义(χ^(2)=23.108、P<0.05)。P16INK4a、HPV DNA基因分型、DNA倍体分析检测ASC-US病变的敏感度分别为72.0%、96.0%、60.0%,特异度分别为82.0%、68.9%、77.0%,ROC曲线下面积(AUC)分别为0.770、0.824、0.685;两两联合检测,P16INK4a和HPV DNA基因分型联合检测的诊断效能最佳,其敏感度、特异度和AUC分别为98.0%、75.4%、0.837。三者联合检测AUC最高,为0.967。结论P16INK4a、HPV DNA基因分型和DNA倍体分析单独和联合检测均有助于ASC-US分流;两两联合中,P16INK4a和HPV DNA联合检测具有较好的诊断效能,可有效进行ASC-US分流。Objective To explore the diagnostic value of individual and combined detection of cytological P16INK4a,human papillomavirus(HPV)DNA genotyping,and DNA ploidy analysis in atypical squamous cell of undetermined significance(ASC-US).Methods A retrospective analysis was conducted on the medical records of 86 cases diagnosed with ASC-US through liquid-based thin-layer cytology test(TCT)from May 2021 to September 2022.The cases underwent concurrent P16INK4a,HPV DNA genotyping,and DNA ploidy analysis.The vaginal colposcopy histopathological diagnosis was used as the gold standard,and based on the cervical biopsy pathology results,the cases were divided into high-grade squamous intraepithelial lesion(HSIL/CINⅡ)and above groups,and low-grade squamous intraepithelial lesion(LSIL/CINⅠ)and below groups.The diagnostic performance of P16INK4a,HPV DNA genotyping,and DNA ploidy analysis,alone and in combination,for ASC-US triage was evaluated using ROC curves.Theχ^(2) test was used for comparison of count data between groups,with P<0.05 indicating statistical significance.Results The positive rates of cervical cell P16INK4a were 37.9%in the LSIL/CINⅠand below group and 62.1%in the HSIL/CINⅡand above group,with a statistically significant difference between the two groups(χ^(2)=23.108,P<0.05).The sensitivity of P16INK4a,HPV DNA genotyping,and DNA ploidy analysis in detecting ASC-US lesions was 72.0%,96.0%,and 60.0%,respectively,and the specificity was 82.0%,68.9%,and 77.0%,respectively.The areas under the ROC curve(AUC)were 0.770,0.824,and 0.685,respectively.The best diagnostic performance was achieved by the combined detection of P16INK4a and HPV DNA genotyping,with a sensitivity,specificity,and AUC of 98.0%,75.4%,0.837,respectively.The highest AUC(0.967)was obtained when all three were combined.Conclusion Individual and combined detection of P16INK4a,HPV DNA genotyping,and DNA ploidy analysis are helpful in ASC-US triage.Among the combined detection methods,the combination of P16INK4a and HPV DNA genotyping showed goo

关 键 词：宫颈肿瘤 宫颈非典型增生 早期诊断 分子诊断技术 细胞诊断学 

分 类 号：R737.33[医药卫生—肿瘤]