P16/Ki⁃67对宫颈细胞学正常的高危型HPV阳性患者预后的价值
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江苏妇幼健康重点课题(F201718)


Predictive value of p16/Ki⁃67 in high⁃risk HPV⁃positive patients with negative cytology
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    摘要:

    目的:探讨p16/Ki-67双染检测对宫颈细胞学正常的高危型HPV阳性患者病情转归的预测意义。方法:收集2017年5—7月在南京医科大学第一附属医院妇产科就诊的168例宫颈薄层液基细胞学检查(thinprep cytologic test,TCT)正常的高危型人乳头瘤病毒(human papillomavirus,HPV)阳性并排除宫颈病变的患者,进行为期2年的随访,根据转归结果评估p16/Ki-67双染检测与病情进展的关系。结果:①转归结局:88例(52.4%)消退,54例(32.1%)持续,26例(15.5%)进展;②单因素分析:患者年龄、初次HC2 HPV检测值、初次cobas HPV的分型结果与TCT正常的高危型HPV患者病情进展无明显相关关系(P>0.05),而p16/Ki-67双染检测阳性与病情进展明显相关(P<0.001);多因素分析:p16/Ki-67双染检测阳性是TCT正常的高危型HPV阳性患者病情进展的危险因素;③ 55例p16/Ki-67双染检测阳性患者中19例(34.5%)病情进展,113例p16/Ki-67双染检测阴性患者中7例(6.2%)病情进展,二者差异有统计学意义(P<0.05)。p16/Ki-67双染检测阳性预测病情进展的灵敏度为73.1%,特异度为74.7%,阳性预测值为34.5%,阴性预测值为93.8%;④高危型HPV的自然变化:152例患者完成2年随访,HPV转阴率随时间增加,P16/Ki-67双染检测阴性组患者高危型HPV转阴率均高于阳性组患者(P<0.05)。结论:P16/Ki-67双染检测阳性是宫颈细胞学正常的高危型HPV阳性患者病情进展和HPV转阴的危险因素,对病情进展有一定的预测价值,可用于该类患者的分流。

    Abstract:

    Objective:This study aims to explore the predictive value of p16/Ki-67 in the progression of high-risk HPV-positive patients with negative cytology. Methods:One hundred and sixty-eight high-risk HPV-positive women with negative cytology were enrolled from May 2017 to June 2017 in the Department of Gynecology,the First Affiliated Hospital of Nanjing Medical University. Follow up were conducted for a period of 2 years to analyze the relationship between the progression and p16/Ki-67 dual staining. Results:①Outcome:88 cases(52.4%)had regressed,54 cases(32.1%)persisted,26 cases(15.5%)progressed;②Univariate analysis showed that age of patient,HC2 HPV value and high-risk HPV genotyping were not risk factors of the progression(P>0.05),positive p16/Ki-67 dual staining showed higher rates of progression(P<0.001). Multivariable logistic analysis showed that positive p16/Ki-67 dual staining was related to the progression;③55 cases had positive p16/Ki-67 dual staining,19 cases(34.5%)of them progressed;113 cases had negative p16/Ki - 67 dual staining,7 cases(6.2%)of them progressed. There were significant difference in progression between patients with positive p16/Ki-67 dual staining and patients with negative p16/Ki-67 dual staining(P<0.05). The sensitivity of p16/Ki-67 in prognosis was 73.1%,the specificity was 74.7%,the positive predictive value was 34.5%,the negative predictive value was 93.8%;④High-risk HPV natural changes:152 patients finished the 2-year follow up. The negative conversion ratio at 6,12,18,24 months for women with negative results of p16/Ki-67 dual staining were higher than those with positive results(P<0.05). Conclusion:Positive p16/Ki-67 dual staining result was a risk factor for progression and negative high-risk HPV conversion. P16/Ki-67 dual staining had predictive value for progression and showed good risk stratification for TCT-negative and high-risk HPV-positive women.

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方 钦,Soul Hassanati,房园园,邢 燕. P16/Ki⁃67对宫颈细胞学正常的高危型HPV阳性患者预后的价值[J].南京医科大学学报(自然科学版),2020,(12):1768-1773

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  • 收稿日期:2020-03-19
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  • 在线发布日期: 2021-01-04
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