文章摘要
方 钦,Soule Hassanati,房园园,戎 荣,邢 燕.p16/Ki⁃67在ASCUS合并HPV阳性患者中对宫颈高级别鳞状上皮内病变的检测意义[J].南京医科大学学报,2019,(10):1459~1463
p16/Ki⁃67在ASCUS合并HPV阳性患者中对宫颈高级别鳞状上皮内病变的检测意义
p16/Ki⁃67 dual stain cytology for detection of high⁃grade squamous intraepithelial lesion in ASCUS/HPV positive women
投稿时间:2019-05-29  
DOI:10.7655/NYDXBNS20191010
中文关键词: p16/Ki⁃67  不能明确意义的非典型鳞状上皮细胞  人乳头瘤病毒分型  宫颈高级别鳞状上皮内病变
英文关键词: p16/Ki⁃67  atypical squamous cell of undetermined significance  viral genotype of human papillomavirus  high⁃grade squamous intraepithelial lesion
基金项目:江苏省妇幼健康科研项目重点课题(F201718)
作者单位
方 钦 南京医科大学第一附属医院妇产科江苏 南京 210029 
Soule Hassanati 南京医科大学第一附属医院妇产科江苏 南京 210029 
房园园 南京医科大学第一附属医院妇产科江苏 南京 210029 
戎 荣 南京医科大学第一附属医院妇产科2病理科江苏 南京 210029 
邢 燕 南京医科大学第一附属医院妇产科江苏 南京 210029 
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中文摘要:
      目的:探讨p16/Ki?67双染检测在不能明确意义的非典型鳞状上皮细胞(atypical squamous cell of undetermined significance/high risk human papillomavirus,ASCUS)合并高危型人乳头瘤病毒(human papillomavirus,HPV)阳性者中对宫颈高级别鳞状上皮内病变(high?grade squamous intraepithelial lesion,HSIL)的诊断价值。方法:回顾性分析2017年9月—2018年12月在南京医科大学第一附属医院妇科就诊的283例ASCUS合并高危型HPV阳性者阴道镜下的宫颈活检组织病理结果,探讨HSIL的危险因素,比较p16/Ki?67双染检测和HPV分型检测的诊断效能。结果:283例患者中88例被诊断为HSIL。单因素分析显示,不同HPV型别、p16/Ki?67双染检测结果间HSIL发生率差异有统计学意义(P<0.01),不同年龄患者HSIL发生率的差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,HPV16/18阳性、p16/Ki?67双染检测阳性是HSIL的高危因素(P<0.001)。p16/Ki?67双染检测较HPV分型检测有更高的灵敏度(62.03% vs. 51.14%)、阴性预测值(81.6% vs. 78.9%)及受试者工作特征(ROC)曲线下面积(0.794 vs. 0.669,P<0.05)。结论:p16/Ki?67双染检测阳性是ASCUS合并HPV阳性者中发现HSIL的预警因素,其筛查效能优于HPV分型检测,为宫颈病变初筛提供了一种新选择。
英文摘要:
      Objectives:To explore the diagnostic value of p16/Ki?67 dual stain cytology for high?grade squamous intraepithelial lesion(HSIL)in patients with positive atypical squamous cell of undetermined significance/high risk human papillomavirus(ASCUS/HPV). Methods:A total of 283 cases diagnosed as HSIL with positive ASCUS/HPV were selected between September,2017 and December,2018 from the Department of Gynecology,the First Affiliated Hospital of Nanjing Medical University. Colposcopy and biopsy were performed on all patients to analyze the risk factors of HSIL. And the diagnostic value of p16/Ki?67 dual stain cytology was compared with that of HPV genotype. Results:In total,88 of the 283 ASCUS/HPV positive cases were diagnosed with HSIL. Univariate logistic analysis indicated that different results of p16/Ki?67 dual stain cytology and HPV genotype test showed different HSIL rates,which were statistically significant(P<0.01). Ages of the patients did not contribute to the variation of HSIL incidences(P>0.05). Multivariable logistic analysis showed that both HPV genotype and p16/Ki?67 positives were risk factors for HSIL(P<0.001). The sensitivity,negative predictive value and area under ROC of p16/Ki?67 dual stain cytology were higher than those of HPV genotype test(P<0.05). Conclusion:p16/Ki?67 dual stain cytology positive is a warning sign of HSIL for patients with positive ASCUS/HPV,the screening efficacy of which is better than that of HPV genotype test. It provides a new option for cervical lesion screening.
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