本文選題：P16 + Ki67�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.通過測定不同級別宮頸上皮組織中P16、Ki67及ΔNp63蛋白的表達(dá)情況,初步了解P16、Ki67及ΔNp63的表達(dá)水平與不同級別宮頸病變之間的關(guān)系;2.進(jìn)一步探討單獨(dú)或聯(lián)合檢測上述生物學(xué)標(biāo)記物對高級別鱗狀上皮內(nèi)病變(high-grade squamous intraepithelial lesion,HSIL)的輔助診斷價(jià)值。方法:選擇2015年1月-2015年12月就診于山西醫(yī)科大學(xué)第二醫(yī)院患者,依據(jù)常規(guī)HE染色病理診斷結(jié)果,分為宮頸正常組(60例)、低級別鱗狀上皮內(nèi)病變組織(LSIL組,即CIN I級組60例)、高級別鱗狀上皮內(nèi)病變組織(HSIL組120例,其中CIN II及CIN III各60例)及宮頸早期浸潤癌組(30例),共270例。采用免疫組織化學(xué)檢查S-P法分別檢測P16、Ki67及ΔNp63蛋白在四組中的表達(dá)情況。研究數(shù)據(jù)采用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.P16、Ki67及ΔNp63的表達(dá)與宮頸病變級別均存在相關(guān)性;2.P16、Ki67及ΔNp63在正常組、LSIL組、HSIL組及宮頸癌組的陽性表達(dá)情況:P16陽性率分別為18.33%、73.33%、95.83%、100%,Ki67陽性率分別為10.00%、63.33%、87.50%、100%,ΔNp63陽性率分別為6.67%、81.67%、96.67%、100%,三個(gè)指標(biāo)的陽性表達(dá)率隨宮頸病變級別的升高而呈上升趨勢,且四組陽性率之間存在差異;3.P16、Ki67及ΔNp63在HSIL組的陽性表達(dá)與正常組、LSIL組均有統(tǒng)計(jì)學(xué)差異,與宮頸癌組差異無統(tǒng)計(jì)學(xué)意義;4.單獨(dú)檢測ΔNp63蛋白陽性診斷HSIL的靈敏度和特異度分別為95.0%和96.7%,均高于單獨(dú)使用Ki67(87.5%和90.0%);其特異度與P16相當(dāng),但靈敏度相對較高;5.ROC曲線結(jié)果分析:單獨(dú)應(yīng)用ΔNp63免疫組化檢測HSIL的曲線下面積為0.958(95%CI為0.924-0.993),高于P16和Ki67檢測曲線下面積,與Ki67曲線下面積比較差異有統(tǒng)計(jì)學(xué)意義,而與P16曲線下面積比較差異無統(tǒng)計(jì)學(xué)意義;在包含ΔNp63的多種聯(lián)合檢測方式中,以ΔNp63與P16并聯(lián)方式的曲線下面積最大(0.950),與單獨(dú)檢測ΔNp63的曲線下面積(0.958)相比較,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:1.P16、Ki67、ΔNp63在一定程度上可以客觀的反映CIN病變的程度;2.ΔNp63是一種高潛力的宮頸癌相關(guān)性的標(biāo)記物;3.三種生物學(xué)指標(biāo),對有效篩選及提升HSIL病理診斷準(zhǔn)確率,均有一定臨床的指導(dǎo)意義。
[Abstract]:Purpose 1. By measuring the expression of P16 Ki67 and 螖 Np63 in different grades of cervical epithelium, the relationship between the expression level of P16 Ki67 and 螖 Np63 and the cervical lesions of different grades was preliminarily understood. To further explore the diagnostic value of detecting the above biological markers alone or in combination for high-grade squamous intraepithelial lesioning in high-grade squamous intraepithelial lesions. Methods: patients in the second Hospital of Shanxi Medical University from January 2015 to December 2015 were selected. According to the pathological diagnosis results of routine HE staining, they were divided into two groups: normal cervical group (n = 60) and low grade squamous intraepithelial lesion (LSIL) group. There were 60 cases of CIN grade I, 120 cases of high grade squamous intraepithelial lesions, including 60 cases of CIN II and 60 cases of CIN III, and 30 cases of early invasive carcinoma of cervix (270 cases). The expression of P16 Ki67 and 螖 Np63 protein in the four groups were detected by S-P immunohistochemical method. The data were analyzed by SPSS 20.0 software. Results 2. P16 Ki67 and 螖 Np63 were correlated with cervical lesion grade. The positive rate of P16 Ki67 and 螖 Np63 in normal group and cervical cancer group were 18.33, 73.33 and 95.83, respectively. The positive rates of Ki67 and 螖 Np63 were 10.00 and 87.50, respectively, and the positive rates of 螖 Np63 were 6.676.6796. 6767 and 96. 6767, respectively. The positive expression rate increased with the increase of cervical lesion grade. There was a significant difference in the positive rates between the four groups. The positive expression of p16 Ki67 and 螖 Np63 in the HSIL group was significantly different from that in the normal group and that in the normal group. There was no significant difference between the four groups and the cervical cancer group. The sensitivity and specificity of detecting 螖 Np63 protein positive in HSIL alone were 95.0% and 96.70.The sensitivity and specificity were higher than those of Ki677777.5% and 90.0%, respectively, and the specificity was similar to that of P16. But the relative sensitivity of ROC curve analysis: the area under the curve of 螖 Np63 immunohistochemical detection of HSIL was 0.924-0.993g, which was higher than that under P16 and Ki67, and the difference was statistically significant compared with the area under Ki67 curve. However, there was no significant difference between the area under the P16 curve and the area under the curve with 螖 Np63 and P16 parallel connection, but there was no significant difference in the area under the curve between 螖 Np63 and P16, as compared with the area under the curve detected only by 螖 Np63 (0.958). Conclusion: 1. P16 + Ki67, 螖 Np63 can objectively reflect the degree of CIN lesion to some extent. 螖 Np63 is a high potential marker for cervical cancer. The three biological indexes are of clinical significance for screening and improving the accuracy of pathological diagnosis of HSIL.
【學(xué)位授予單位】：山西醫(yī)科大學(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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