本文關鍵詞：多因素在預測高級別宮頸上皮內(nèi)瘤變術后轉(zhuǎn)歸中的應用　出處：《青島大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： P16 Ki67 高級別上皮內(nèi)瘤變 預后

【摘要】：目的:1.通過分析高級別宮頸上皮內(nèi)瘤變(HSIL)患者術后組織病理切片中P16、Ki67的表達與術后TCT和HPV-DNA檢測結果的相關性,探討P16、Ki67作為患者術后病情轉(zhuǎn)歸預測指標的應用價值。2.了解HSIL患者宮頸錐切術后4年中TCT和HPV檢測結果轉(zhuǎn)陰情況及其變化趨勢,指導臨床對于HSIL患者錐切術后隨訪,對此類患者隨訪方式及隨訪時間等進行分流,最大程度避免術后隨訪漏診及過度治療,為病人帶來福音。方法:1.收集350例因陰道鏡下宮頸活檢病理為“HSIL”行子宮頸錐形切除術的住院患者,對所有患者行宮頸錐切的手術標本組織進行免疫組織化學染色,檢測P16、Ki67在宮頸病變組織中的表達。2.根據(jù)P16在宮頸鱗狀上皮垂直面分布比例高低將所有HSIL患者(350例)手術標本分為A1和A2兩組;A1組為P16在宮頸鱗狀上皮垂直面分布比例大于等于病變細胞在宮頸鱗狀上皮垂直面分布比例,A2組為P16在宮頸鱗狀上皮垂直面分布比例小于病變細胞在宮頸鱗狀上皮垂直面分布比例。同樣,根據(jù)Ki67在宮頸鱗狀上皮垂直面分布比例高低將所有HSIL患者(350例)手術標本分為B1和B2兩組,B1組為Ki67在宮頸鱗狀上皮垂直面分布比例大于等于病變細胞在宮頸鱗狀上皮垂直面分布比例,B2組為Ki67在宮頸鱗狀上皮垂直面分布比例小于病變細胞在宮頸鱗狀上皮垂直面分布比例。3.隨訪HSIL患者術后4年間TCT及HPV-DNA負荷量檢查結果,統(tǒng)計學分析比較A1與A2兩組之間、B1與B2兩組之間的4年時段TCT及HPV轉(zhuǎn)陰率的差異。4.計算HSIL患者術后多個時間節(jié)點(分別為6、12、18、24、30、36、42及48個月)TCT和HPV相關統(tǒng)計學指標(TCT評分、TCT和HPV陰性率),并繪制曲線分析其隨術后時間變化趨勢。結果:1.A1組HSIL患者術后4年間TCT和HPV轉(zhuǎn)陰率均顯著低于A2組患者(差異均有統(tǒng)計學意義P㩳0.05)。A1、A2兩組的TCT轉(zhuǎn)陰率分別為93.45%和100%;HPV轉(zhuǎn)陰率分別為:92.36%和100%。2.B1組HSIL患者術后4年間TCT和HPV轉(zhuǎn)陰率均顯著低于于B2組患者(差異均有統(tǒng)計學意義P㩳0.05)。B1、B2兩組的TCT轉(zhuǎn)陰率分別為93.21%和100%;HPV轉(zhuǎn)陰率分別為:92.45%和98.82%。3.所有納入HSIL患者術后6個月TCT檢查陰性率為100%,隨著隨訪時間的延長TCT陰性率逐漸降低。4.HSIL患者術后36個月內(nèi)HPV-DNA負荷量較術前明顯下降,而在術后42個月時HPV感染陽性率較前明顯增高,高達50%。結論:P16、Ki67對HSIL患者宮頸錐切術后轉(zhuǎn)歸有一定的預測價值,HSIL患者病變宮頸組織中P16、Ki67表達程度越高,術后TCT和HPV檢測陽性率越高。HSIL患者術后TCT和HPV可由陽性轉(zhuǎn)為陰性,HPV-DNA負荷量較術前明顯下降,雖然HPV負荷量和轉(zhuǎn)陰方面沒有呈現(xiàn)明顯的變化規(guī)律,但術后42個月可能是HPV復發(fā)或再次感染的高峰時間。
[Abstract]:Objective 1. To analyze the correlation between the expression of P16 / Ki67 and the results of TCT and HPV-DNA in postoperative histopathological sections of patients with high grade cervical intraepithelial neoplasia (HSIL). To explore P16. Application value of Ki67 as a predictor of postoperative prognosis. 2. To understand the negative changes of TCT and HPV in patients with HSIL during the 4 years after cervix conization. 2. To guide the clinical follow-up of HSIL patients after conization, to such patients follow-up mode and follow-up time for shunt, to avoid postoperative missed diagnosis and over-treatment. To bring good news to patients. Methods: 1. Collect 350 inpatients who underwent cervical conical excision due to cervical biopsy under colposcopy and pathology as "HSIL". The specimens of all patients underwent cervical conization were stained with immunohistochemical staining and P16 was detected. Expression of Ki67 in cervical lesions. According to the distribution of P16 in cervical squamous epithelium, 350 cases of HSIL were divided into A1 and A2 groups. In A1 group, the distribution ratio of P16 on the vertical plane of cervical squamous epithelium was greater than that of pathological cells in the vertical plane of cervical squamous epithelium. In A2 group, the distribution of P16 on the vertical plane of cervical squamous epithelium was smaller than that of pathological cells on the vertical plane of cervical squamous epithelium. According to the vertical distribution of Ki67 in cervical squamous epithelium, 350 patients with HSIL were divided into B1 and B2 groups. Group B1 showed that the distribution of Ki67 on the vertical plane of cervical squamous epithelium was greater than that of lesion cells in the vertical plane of cervical squamous epithelium. The distribution of Ki67 on the vertical plane of cervical squamous epithelium in B2 group was smaller than that of pathological cells on the vertical plane of cervical squamous epithelium. 3. TCT and HPV-DNA were negative in 4 years after HSIL follow-up. Load test results. Statistical analysis and comparison between A1 and A2 groups between B _ 1 and B _ 2 groups between the 4-year period of TCT and HPV negative rate difference. 4. Calculate the HSIL patients after multiple time points (6 respectively). TCT and HPV were correlated with the negative rate of TCT and HPV. Results the negative rates of TCT and HPV in HSIL group were significantly lower than those in A2 group during the 4 years after operation (P < 0.05). The negative rate of TCT in group A 1 A 2 was 93.45% and 100, respectively. The negative rate of HPV was 92.36% in group B and 100% in group B 1. The negative rates of TCT and HPV in group B 1 were significantly lower than those in group B 2 during the 4 years after operation (P < 0.05). All the differences were statistically significant (P? The negative rate of TCT was 93.21% in group B _ (1) B _ (2) and 93.21% in group B _ (1) B _ (2); The negative rate of HPV was 92.45% and 98.82% respectively. The negative rate of TCT was 100% in all HSIL patients 6 months after operation. With the prolongation of follow-up time, the negative rate of TCT decreased gradually. 4. The HPV-DNA load decreased significantly in patients with HSIL within 36 months after operation. The positive rate of HPV infection in 42 months after operation was significantly higher than that of the former, as high as 50. Conclusion: P16Ki67 has a certain value in predicting the outcome of cervical conization in patients with HSIL. The higher the expression of P16 ~ + Ki67 in cervical tissues of patients with HSIL was, the higher the positive rate of TCT and HPV was. TCT and HPV could change from positive to negative after operation in patients with HSIL. The load volume of HPV-DNA was significantly lower than that of pre-operation. Although there was no obvious change in HPV load and negative change, 42 months after operation might be the peak time of recurrence or re-infection of HPV.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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