HPV基因分型及p16/ki-67双染色对宫颈转化区3型女性CINⅡ+的评估价值  

Evaluation value of HPV genotyping and p16/ki-67 double staining for grade II or higher intraepithelial neoplasia in women with cervical transformation zone type 3

作　　者：高月月 顾丽霞 杨梦霞 朱慧 冯海娇 陈书玲[1] Gao Yueyue;Gu Lixia;Yang Mengxia;Zhu Hui;Feng Hajiao;Chen Shuling(Department of Obstetrics and Gynecology,The First Affiliated Hospital of Hebei North University,Zhangjiakou Hebei 075000,P.R.China)

机构地区：[1]河北北方学院附属第一医院妇产科,河北张家口075000

出　　处：《中国计划生育和妇产科》2024年第8期85-89,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：河北张家口市重点研发计划项目(项目编号:2221179D)。

摘　　要：目的分析人乳头瘤病毒(hunan papillomavirus,HPV)检测和p16/ki-67双染对宫颈转化区(TZ)3型女性宫颈上皮内瘤变(CIN)Ⅱ及以上病变的诊断价值。方法前瞻性收集2020年1月至2022年12月在河北北方学院附属第一医院接受阴道镜检查和宫颈移行区大环切除术(LLETZ)治疗的TZ 3型女性临床资料。分析并比较LLETZ前宫颈液基细胞学检查(TCT)、HPV检测、宫颈管搔刮术(ECC)检查及p16/ki-67双染对CINⅡ+的诊断价值。分别计算不同诊断方式预测组织学诊断CINⅡ+的敏感性、特异性、阳性预测值和阴性预测值。并使用McNemar检验比较不同诊断方法。结果纳入接受LLETZ治疗的患者共101例,其中CINⅡ+51例(50.5%)。37例HSIL患者中28例CINⅡ+(75.7%);64例LSIL患者中23例CINⅡ+(35.9%)。感染HPV 16型女性中82.1%组织病理学为CINⅡ+,但CINⅡ+患者中感染HPV 16型女性仅为45.1%。高危型HPV预测诊断CINⅡ+的阳性预测值仅为60.7%,阴性预测值为100%。p16/ki-67双染检查的阴性预测值为100%,阳性预测值为79.7%。LSIL女性中p16/ki-67双染预测CINⅡ+的阳性预测值较高危型HPV更高(76.1%vs.35.9%),而在HSIL女性中ECC双染可改善高危型HPV阳性预测值(96.5%vs.75.7%)。结论p16/ki-67双染可提高TZ 3型女性常规筛查对CIN II+预测效能,有助于更好监测TZ 3型女性宫颈情况。Objective To analyze the diagnostic value of human papillomavirus(HPV)detection and p16/ki-67 double staining for cervical intraepithelial neoplasia(CIN)Ⅱor above in women with cervical transformation zone(TZ)type 3.Methods Prospective collection of clinical data on TZ type 3 women who underwent colposcopy examination and large loop exclusion of the transformation zone(LLETZ)treatment in the First Affiliated Hospital of Hebei North University from January 2020 to December 2022.Analyzed and compared the diagnostic value of thin prep cytology test(TCT),HPV detection,endocervical canal curettage(ECC),and p16/ki-67 double staining in CINⅡ+before LLETZ.The sensitivity,specificity,positive predictive value,and negative predictive value of different diagnostic methods for predicting histological diagnosis of CINⅡ+were calculated.And McNemar test were used to compare different diagnostic methods.Results A total of 101 patients who received LLETZ treatment,of which 51(50.5%)had CINⅡ+.Among 37 HSIL patients,28(75.7%)had CINⅡ+;among 64 LSIL patients,23(35.9%)had CINⅡ+.82.1%of women infected with HPV 16 had CINⅡ+,but only 45.1%of women of CINⅡ+infected with HPV 16.The positive predictive value of CINⅡ+in high-risk HPV predictive diagnosis was only 60.7%,and the negative predictive value was 100%.The negative predictive value of p16/ki-67 double staining examination was 100%,and the positive predictive value was 79.7%.In LSIL women,p16/ki-67 cytological double staining predicted a higher positive predictive value for CINⅡ+compared to high-risk HPV(76.1%vs.35.9%),while in HSIL women,ECC double staining improved the positive predictive value for high-risk HPV(96.5%vs.75.7%).Conclusion The p16/ki-67 double staining can improve the predictive efficacy of routine screening for CINⅡ+in TZ 3 type women,which is helpful for better monitoring of cervical conditions in TZ 3 type women.

关 键 词：宫颈癌 人乳头瘤病毒 P16 KI-67 病理学 

分 类 号：R711.74[医药卫生—妇产科学]