文章摘要
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,2020,(12):1768~1773
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
Predictive value of p16/Ki⁃67 in high⁃risk HPV⁃positive patients with negative cytology
投稿时间:2020-03-19  
DOI:10.7655/NYDXBNS20201205
中文关键词: p16/Ki⁃67  细胞学正常  人乳头瘤病毒  随访
英文关键词: P16/Ki⁃67  normal cytology  human papillomavirus  follow⁃up
基金项目:江苏妇幼健康重点课题(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 
Soul 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 
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。
英文摘要:
      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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