本文關(guān)鍵詞：CK17在HR-HPV感染的宮頸病變組織的表達(dá)及意義　出處：《皖南醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： HR-HPV CK17 宮頸病變 免疫組織化學(xué)

【摘要】：目的：1.了解宮頸組織中HPV的感染情況，探討HPV分型檢測(cè)在宮頸病變中的臨床意義,并結(jié)合TCT檢查結(jié)果評(píng)估宮頸癌的篩查方案；2.觀察CK17在正常宮頸組織及宮頸病變組織中的表達(dá)，結(jié)合宮頸HPV感染情況，分析其在HR-HPV感染的宮頸組織中的表達(dá)情況及規(guī)律，初步探討CK17的表達(dá)與高危型HPV（HR-HPV）感染的關(guān)系,以及其異常表達(dá)在預(yù)測(cè)宮頸病變發(fā)展中的臨床意義。方法：1.運(yùn)用導(dǎo)流雜交基因芯片技術(shù)（flow-through hybridization and gene chip）進(jìn)行HPV分型檢測(cè)，結(jié)合病理診斷結(jié)果，分析比較新柏氏液基細(xì)胞學(xué)檢查（Thin-prepliquid-based Cytology Test，TCT）、HR-HPV檢測(cè)對(duì)高級(jí)別宮頸病變的診斷效率。2.用免疫組織化學(xué)法檢測(cè)各種宮頸組織中CK17蛋白的表達(dá)情況，以及感染HR-HPV亞型患者宮頸組織中CK17蛋白的表達(dá)情況。3.運(yùn)用相關(guān)性分析探討CK17表達(dá)與HR-HPV感染的相關(guān)性。結(jié)果：1.在所研究的142例患者中，HR-HPV總的感染率79.58%（113/142），CK17的陽(yáng)性表達(dá)率為62.67%（65/142），其中HR-HPV陽(yáng)性組中CK17的陽(yáng)性表達(dá)率為53.1%(60/113), HR-HPV陰性組中CK17的陽(yáng)性表達(dá)率為17.2%（5/29），表達(dá)差異具有統(tǒng)計(jì)學(xué)意義（X2=11.95,P＜0.05）；根據(jù)病理結(jié)果將本實(shí)驗(yàn)142例患者分為A、B、C、D四組，A組為經(jīng)病理診斷均為慢性宮頸炎的患者組，有48例；B組為經(jīng)病理診斷為宮頸上皮內(nèi)瘤變Ⅰ級(jí)（CINⅠ）的患者組，共17例；C組為經(jīng)病理診斷為宮頸上皮內(nèi)瘤變Ⅱ-Ⅲ級(jí)（CIN Ⅱ/Ⅲ）的患者組，共63例；D組為經(jīng)病理診斷為宮頸浸潤(rùn)癌（SCC）的患者組，共14例。在A、B、C、D四組中，CK17的陽(yáng)性表達(dá)率逐漸增高，分別為2.08%（1/48）、23.53%（4/17）、76.19%（48/63)、85.71%（12/14)，統(tǒng)計(jì)結(jié)果表明，CK17在四組宮頸組織中的表達(dá)差異具有統(tǒng)計(jì)學(xué)意義（X2=72.78,P＜0.05）。2. A、B、C、D四組中HR-HPV的感染率分別為64.6%(31/48)、76.5%(13/17)、88.9%(56/63)、92.9%(13/14)，C、D組HR-HPV感染率高于A組和B組，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；根據(jù)相關(guān)性分析，CK17蛋白的陽(yáng)性表達(dá)率與HR-HPV的感染率呈正相關(guān)關(guān)系（ｒ=0.98,P＜0.05）。 3.單獨(dú)以HR-HPV檢測(cè)作為預(yù)測(cè)高級(jí)別宮頸上皮內(nèi)瘤變的敏感性為89.6%,特異性為32.3%，陽(yáng)性預(yù)測(cè)值為61.1%，陰性預(yù)測(cè)值為72.4%；單獨(dú)以TCT≥ASCUS預(yù)測(cè)高級(jí)別宮頸病變的敏感性為87.0%，特異性為53.8%，陽(yáng)性預(yù)測(cè)值為69.1%，，陰性預(yù)測(cè)值為77.8%；HR-HPV聯(lián)合TCT對(duì)診斷高級(jí)別宮頸病變的敏感性為98.6%，特異性為17.4%，陽(yáng)性預(yù)測(cè)值為58.5%，陰性預(yù)測(cè)值為91.7%。 結(jié)論：1.隨著宮頸上皮內(nèi)瘤變級(jí)別的升高，CK17的陽(yáng)性表達(dá)呈上升趨勢(shì)，CK17可能在宮頸病變的發(fā)生發(fā)展中發(fā)揮一定的作用；2.CK17的陽(yáng)性表達(dá)率與HR-HPV的感染率呈正相關(guān)關(guān)系，CK17可能在HR-HPV感染誘發(fā)的宮頸病變的機(jī)制中發(fā)揮了作用；3.HPV分型檢測(cè)可以了解與宮頸癌發(fā)生密切相關(guān)的高危型病毒，聯(lián)合HR-HPV檢測(cè)及宮頸TCT檢查仍是目前較好的宮頸癌及宮頸癌前病變的篩查方案。
[Abstract]:Objective 1. To understand the infection of HPV in cervix tissues, to explore the clinical significance of HPV typing in cervical lesions, and to evaluate the screening scheme of cervical cancer with the results of TCT. 2. To observe the expression of CK17 in normal cervical tissues and cervical lesions, and to analyze the expression and regularity of CK17 in cervical tissues infected with HR-HPV combined with the situation of cervical HPV infection. To explore the relationship between the expression of CK17 and high risk HPV-HR-HPV-infection. The clinical significance of its abnormal expression in predicting the development of cervical lesions. Methods: 1.Using diversion hybridization gene chip technique (. Flow-through hybridization and gene chip-based HPV typing was performed. Combined with pathological diagnosis, the Thin-Prepliquid-based Cytology TestTCTs were analyzed and compared. The efficiency of HR-HPV in the diagnosis of high grade cervical lesions. 2. Immunohistochemical method was used to detect the expression of CK17 protein in various cervical tissues. And the expression of CK17 protein in cervical tissues of patients infected with HR-HPV subtype. 3. The correlation between CK17 expression and HR-HPV infection was studied by correlation analysis. Results:. 1. Of 142 patients studied. The total infection rate of HR-HPV was 79.58% and the positive rate of CK17 was 62.67% (65 / 142). The positive expression rate of CK17 in HR-HPV positive group was 53.1% / 113%. The positive expression rate of CK17 in HR-HPV negative group was 17. 2 / 29, and the difference was statistically significant (P < 0. 05). According to the pathological results, 142 patients were divided into four groups: group A (n = 48) and group A (n = 48) with chronic cervicitis diagnosed pathologically. Group B (17 cases) was diagnosed as cervical intraepithelial neoplasia grade 鈪

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