宮頸癌前病變應用P16/Ki—67免疫細胞化學雙染檢查的診斷價值

方佳 陳鳳燕

[摘要]目的 探析P16/Ki-67免疫細胞化學雙染檢測在宮頸癌前病變診斷的準確性。方法 選擇2016年5月～2017年3月我院收治的宮頸癌前病變患者900例，所有患者均接受P16/Ki-67免疫化學雙染法檢測、液基細胞學檢查（TCT）、人乳頭瘤病毒DNA（HPVDNA）檢測，應用P16/Ki-67免疫化學雙染法檢測宮頸癌前病變的陽性率，以病理活檢結果為金標準，評估P16/Ki-67免疫化學雙染法、TCT法檢測宮頸癌前病變的準確性。結果 900例患者，以病理活檢為金標準（陽性54例），發現宮頸癌前病變p16/Ki-67免疫細胞化學雙染法的特異性為82.3%（696/846），敏感性為92.6%（50/54），TCT檢查法的特異性為68.6%（580/846），敏感性為62.9%（34/54），兩種檢查方式比較，p16/Ki-67免疫細胞化學雙染法的特異性、敏感性顯著高于TCT法，差異有統計學意義（P<0.05）。結論 P16/Ki-67免疫細胞化學雙染檢測可提高宮頸癌前病變診斷的準確性，效果確切，值得臨床推廣。

[關鍵詞]癌前病變；宮頸癌；化學雙染法；P16/Ki-67；細胞免疫學

[中圖分類號] R737.33 [文獻標識碼] A [文章編號] 1674-4721（2018）4（c）-0125-03

Diagnostic value of P16/Ki-67 immunocytochemistry double staining for cervical precancerous lesions

FANG Jia CHEN Feng-yan

Department of Pathology，People′s Hospital of Puning City，Guangdong Province，Puning 515300，China

[Abstract]Objective To explore the application of P16/Ki-67 immunocytochemistry double staining in the diagnosis of cervical precancerous lesions for its accuracy.Methods A total of 900 patients with cervical precancerous lesions who were treated in our hospital from May 2016 to March 2017 were selected.Each patient was provided with P16/Ki-67 immunochemistry double staining assay and thinprep cytologic test （TCT） for human papilloma virus DNA.The positive rate of cervical precancerous lesions was detected using P16/Ki-67 immunochemistry double staining method.The pathological biopsy results were set as the gold standard，the accuracy of P16/Ki-67 immunochemistry double staining and TCT detecting cervical precancerous lesions was assessed.Results Among 900 participants，54 subjects were examined as positivity by pathological biopsy.The specificity and sensitivity of P16/Ki-67 immunocytochemistry double staining for cervical precancerous lesions were 82.3% （696/846） and 92.6% （50/54）.By TCT，they were 68.6% （580/846） and 62.9% （34/54） respectively.Compared with the two examination methods，the specificity and sensitivity of P16/Ki-67 immunocytochemistry double staining were superior to those by TCT with significant differences（P<0.05）.Conclusion The detection of P16/Ki-67 immunocytochemistry double staining can improve the diagnostic accuracy of cervical precancerous lesions in a definite effect，which is worthy of clinical promotion.

[Key words]Precancerous lesions；Cervical cancer；Chemical double staining；P16/Ki-67；Cellular immunology

宮頸原位癌的高發群體為30～35歲女性，浸潤癌的高發群體為45～55歲女性[1]。宮頸癌的發病與吸煙、感染滴蟲、單純皰疹病毒Ⅱ型、沙眼衣原體、多產、多孕、初產年齡小、性伴侶過多、感染人乳頭瘤病毒（HPV）等因素密切相關。宮頸癌早期無特異性臨床表現，病情進展可出現排液、陰道流血等特征。研究表明，HPV是導致宮頸癌的因素之一，但只有持續長期感染HPV高危型病毒會引發高級別宮頸癌上皮內瘤變，進展為宮頸癌，同時通過新技術、新檢測方式有助于提高宮頸癌篩查的準確性及有效性[2]。宮頸癌的細胞學篩查方式在實際臨床操作中存在重復性差、靈敏度較低，檢查結果存在一定的假陽性率及假陰性率，P16/Ki-67雙染檢測輔助細胞學技術診斷有助于降低陰道鏡的轉診率。……