本文關(guān)鍵詞：多因素在預(yù)測高級別宮頸上皮內(nèi)瘤變術(shù)后轉(zhuǎn)歸中的應(yīng)用　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： P16 Ki67 高級別上皮內(nèi)瘤變 預(yù)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(shù)后組織病理切片中P16、Ki67的表達(dá)與術(shù)后TCT和HPV-DNA檢測結(jié)果的相關(guān)性,探討P16、Ki67作為患者術(shù)后病情轉(zhuǎn)歸預(yù)測指標(biāo)的應(yīng)用價(jià)值。2.了解HSIL患者宮頸錐切術(shù)后4年中TCT和HPV檢測結(jié)果轉(zhuǎn)陰情況及其變化趨勢,指導(dǎo)臨床對于HSIL患者錐切術(shù)后隨訪,對此類患者隨訪方式及隨訪時(shí)間等進(jìn)行分流,最大程度避免術(shù)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(shù)的住院患者,對所有患者行宮頸錐切的手術(shù)標(biāo)本組織進(jìn)行免疫組織化學(xué)染色,檢測P16、Ki67在宮頸病變組織中的表達(dá)。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(shù)標(biāo)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(xì)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(xì)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(shù)標(biāo)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(xì)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(xì)胞在宮頸鱗狀上皮垂直面分布比例。3.隨訪HSIL患者術(shù)后4年間TCT及HPV-DNA負(fù)荷量檢查結(jié)果,統(tǒng)計(jì)學(xué)分析比較A1與A2兩組之間、B1與B2兩組之間的4年時(shí)段TCT及HPV轉(zhuǎn)陰率的差異。4.計(jì)算HSIL患者術(shù)后多個(gè)時(shí)間節(jié)點(diǎn)(分別為6、12、18、24、30、36、42及48個(gè)月)TCT和HPV相關(guān)統(tǒng)計(jì)學(xué)指標(biāo)(TCT評分、TCT和HPV陰性率),并繪制曲線分析其隨術(shù)后時(shí)間變化趨勢。結(jié)果:1.A1組HSIL患者術(shù)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(jì)學(xué)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(shù)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(jì)學(xué)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(shù)后6個(gè)月TCT檢查陰性率為100%,隨著隨訪時(shí)間的延長TCT陰性率逐漸降低。4.HSIL患者術(shù)后36個(gè)月內(nèi)HPV-DNA負(fù)荷量較術(shù)前明顯下降,而在術(shù)后42個(gè)月時(shí)HPV感染陽性率較前明顯增高,高達(dá)50%。結(jié)論:P16、Ki67對HSIL患者宮頸錐切術(shù)后轉(zhuǎn)歸有一定的預(yù)測價(jià)值,HSIL患者病變宮頸組織中P16、Ki67表達(dá)程度越高,術(shù)后TCT和HPV檢測陽性率越高。HSIL患者術(shù)后TCT和HPV可由陽性轉(zhuǎn)為陰性,HPV-DNA負(fù)荷量較術(shù)前明顯下降,雖然HPV負(fù)荷量和轉(zhuǎn)陰方面沒有呈現(xiàn)明顯的變化規(guī)律,但術(shù)后42個(gè)月可能是HPV復(fù)發(fā)或再次感染的高峰時(shí)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(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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