本文選題：P16 + Ki67��； 參考：《泰山醫(yī)學院》2014年碩士論文

【摘要】：目的：通過研究P16、Ki67在宮頸尖銳濕疣及上皮內瘤變中表達,分析其臨床意義,以及探討宮頸尖銳濕疣與上皮內瘤變的鑒別診斷。研究方法：選擇從2013年1月1日至2013年12月31日,在聊城市人民醫(yī)院病理科經宮頸活檢或錐切術,病理診斷為CIN組的患者558例,入選最大年齡78歲,最小年齡22歲；宮頸尖銳濕疣組患者129例,入選患者最大年齡69歲,最小年齡21歲；選取因子宮肌瘤、子宮脫垂或肌腺病行全子宮切除術的正常宮頸或宮頸炎組織96例作為對照組,兩組年齡無明顯差異。其中有592例患者在婦科門診行陰道鏡及鏡下活檢或宮頸錐切術。全部標本都經過10%的福爾馬林固定,并且常規(guī)石蠟包埋,3umm連續(xù)切片。應用SPSS13.0統(tǒng)計軟件包進行統(tǒng)計學分析處理,對于多樣本率比較整體檢驗有差別的組間兩兩比較采用四格表x2檢驗,相關性分析采用r檢驗相關分析。結果：1、P16在宮頸尖銳濕疣中的表達情況：正常皮膚宮頸尖銳濕疣(9.09%)’、宮頸尖銳濕疣合并低級別CIN(82.35%)2、宮頸尖銳濕疣合并高級別C1N(98.41%)’、宮頸尖銳濕疣合并宮頸癌(100%)‘,分別比較時,P16表達有差別(①②P0.01,②③P0.01,②④P0.01),有統(tǒng)計學意義；P16在正常宮頸組織或宮頸炎中陽性率為0%；P16在宮頸上皮內瘤變中的表達情況：P16在低級別CIN和高級別CIN的陽性率分別為：57.69%,85.80%,弱陽性率分別為：39.74%、7.10%,中度陽性率分別為：12.82%、17.59%,強陽性率分別為：5.13%、61.11%。P16在單純低級別和挖空樣低級別組,P0.01,有統(tǒng)計學意義；P16在單純高級別CIN和高級別C1N累腺時,單純高級別CIN和挖空樣高級別CIN累腺時,P0.05,有統(tǒng)計學意義。2、Ki67在宮頸尖銳濕疣中的表達情況：正常皮膚宮頸尖銳濕疣(36.36%)1、宮頸尖銳濕疣合并低級別CIN(76.47%)2、宮頸尖銳濕疣合并高級別CIN(98.41%)3、宮頸尖銳濕疣合并宮頸癌(100%)‘,分別比較時,Ki67表達有差別(①②P0.05,②③P0.01,①③P0.01,②④P0.05),均有統(tǒng)計學意義；Ki67在宮頸上皮內瘤變中的表達情況：Ki67在低級別CIN和高級別CIN的陽性率分別為：79.49%、87.04%,弱陽性率分別為：16.23%、5.86%,中度陽性率分別為：58.12%、21.3%,強陽性率分別為：5.14%、59.88%。Ki67在單純低級別CIN和挖空樣低級別CIN組,P0.05,有統(tǒng)計學意義；Ki67在單純高級別C1N和挖空樣高級別CIN累腺時,P0.05,有統(tǒng)計學意義。3、P16在對照組、宮頸尖銳濕疣組及宮頸上皮內瘤變中的陽性率分別為：0.00%、84.50%、74.04%,每兩組通過四格表法檢驗,P16表達均有差別(P0.01,P0.01,P0.05),差別均有統(tǒng)計學意義；Ki67在對照組、宮頸尖銳濕疣組及宮頸上皮內瘤變中的陽性率分別為8.33%、84.5%、83.87%；Ki67在對照組和宮頸尖銳濕疣組(P0.01)、對照組和宮頸上皮內瘤變組(P0.01),差別有統(tǒng)計學意義；P16、Ki67在宮頸尖銳濕疣和上皮內瘤變中的表達呈顯著正相關(r=0.704,r=0.685)。4、陰道鏡在宮頸炎、宮頸尖銳濕疣合并低級別CIN、宮頸尖銳濕疣合并高級別CIN、宮頸尖銳濕疣合并宮頸癌、低級別CIN、高級別CIN的符合率分別為：71.19%、73.68%、77.28%、100%、70.74%、80.40%,早期尖銳濕疣易和鱗狀上皮疣狀增生假性濕疣混淆,需通過組織學檢查聯(lián)合免疫組化P16、Ki67相鑒別。5、P16在單純低級別CIN、挖空樣低級別C1N、尖銳濕疣合并低級別CIN的陽性率分別為：34.95%,75.57%,82.35%；Ki67在它們中陽性率分別為72.82%,84.73%,76.47%。P16在單純高級別CIN、挖空樣高級別CCA合并高級別CIN中的陽性率分別為：85.77%、85.92%、98.41%；Ki67在它們中陽性率分別為：85.37%、90.14%、98.41%。結論：1、P16在宮頸尖銳濕疣組織中低表達,如表達增高,則提示宮頸尖銳濕疣有癌變傾向；P16在正常宮頸組織或宮頸炎中不表達,在低級別上皮內瘤變中弱陽性表達為主,在高級別上皮內瘤變中強陽性表達為主,在挖空樣高級別累腺時全部表達；P16可以早期發(fā)現(xiàn)宮頸病變及輔助診斷宮頸上皮內瘤變的分級,我們應重視有挖空樣細胞的高級別累腺病理。2、Ki67在宮頸尖銳濕疣組織表達增強,提示宮頸尖銳濕疣有癌變傾向,Ki67在宮頸上皮內瘤變的表達：隨著級別升高,表達的強度也逐漸升高,高級別累腺強陽性率更高,Ki67可以預測宮頸病變的嚴重程度。3、P16、Ki67可以作為正常宮頸組織、宮頸尖銳濕疣及上皮內瘤變鑒別的生物標志物,并且P16、Ki67在其診斷上具有一致性,呈顯著正相關。4、陰道鏡下可以區(qū)分大部分的正常宮頸組織、宮頸尖銳濕疣及上皮內瘤變,對早期宮頸病變的診斷及分級具有重要價值,陰道鏡下可疑病變區(qū)活檢聯(lián)合免疫組化P16、Ki67的檢測,提高了臨床的確診率,值得廣泛推廣。5、當宮頸上皮內瘤變合并尖銳濕疣或合并挖空樣細胞時,P16、Ki67表達明顯增強,P16、Ki67可用于作為檢測HPV感染的指標；宮頸尖銳濕疣和上皮內瘤變有密切聯(lián)系。
[Abstract]:Objective: To study the expression of P16 and Ki67 in cervical condyloma acuminata and intraepithelial neoplasia, analyze its clinical significance, and explore the differential diagnosis of cervical condyloma acuminata and intraepithelial neoplasia. Methods of study: from January 1, 2013 to December 31, 2013, cervical biopsy or conization in the Department of pathology of Liaocheng People's Hospital, and pathological diagnosis 558 patients in group CIN were selected for the maximum age of 78 years and the minimum age of 22 years, and 129 cases of condyloma acuminata in the cervical condyloma group, with the maximum age of 69 years and the minimum age of 21 years. 96 cases of normal cervix or cervitis were selected as the control group for Hysteromyoma, uterine prolapse or adenomyosis, and 96 cases of cervical inflammation were found in two groups. 592 patients were treated with colposcopy and endoscopic biopsy or cervical conization in gynecologic outpatients. All the specimens were fixed by 10% formalin, and the routine paraffin embedding, 3umm continuous slice. The SPSS13.0 statistical package was used for statistical analysis, and 22 comparison of the groups with different sample rates compared to the overall test were compared. Four lattice x2 test, correlation analysis using R test correlation analysis. Results: 1, P16 in cervical condyloma: normal skin cervical condyloma acuminatum (9.09%), cervical condyloma with low grade CIN (82.35%) 2, cervical condyloma with advanced C1N (98.41%) ", cervical condyloma with cervical cancer (100%)", The expression of P16 was different ((2) P0.01, (2) P0.01, (2) P0.01), and the positive rate of P16 in normal cervical tissue or cervicitis was 0%; the expression of P16 in cervical intraepithelial neoplasia: the positive rates of P16 in low grade CIN and high grade CIN were 57.69%, 85.80%, and 39.74%, respectively, respectively. 7.10%, the moderate positive rate was 12.82%, 17.59%, and the strong positive rate was 5.13%, 61.11%.P16 was statistically significant in the simple low grade and hollowed low grade group, P0.01. When P16 was pure high grade CIN and high grade C1N tired gland, P0.05, with statistical significance.2, Ki67 in the cervix when pure high grade CIN and hollowed high grade CIN tired gland The expression of condyloma acuminatum: normal skin cervical condyloma (36.36%) 1, cervical condyloma acuminatum with low grade CIN (76.47%) 2, cervical condyloma acuminata with high grade CIN (98.41%) 3, cervical condyloma acuminata with cervical cancer (100%) ', Ki67 expression was different ((1) P0.05, (((((((((((1), P0.01, and P0.05), respectively. Statistical significance; the expression of Ki67 in cervical intraepithelial neoplasia: the positive rates of Ki67 in low grade CIN and high grade CIN were 79.49%, 87.04%, respectively: 16.23%, 5.86%, and moderate positive rates were 58.12%, 21.3%, respectively: 5.14%, 59.88%.Ki67 at low level CIN and low level of hollowing samples. CIN group, P0.05, statistical significance; Ki67 in high grade C1N and hollowed high grade CIN tired gland, P0.05, statistically significant.3, P16 in the control group, cervical condyloma acuminate group and cervical intraepithelial neoplasia positive rates are: 0%, 84.50%, 74.04%, each two groups by four table test, P16 expression is different (P0.01, P0.01, P0.) 05) the difference was statistically significant; Ki67 in the control group, the positive rate of cervical condyloma acuminata group and cervical intraepithelial neoplasia were 8.33%, 84.5%, 83.87%, respectively, in the control group and the cervical condyloma acuminatum group (P0.01), the control group and the cervical intraepithelial neoplasia group (P0.01), the difference was statistically significant; P16, Ki67 in cervix condyloma acuminata and epithelium. The expression of intraepithelial neoplasia was significant positive correlation (r=0.704, r=0.685).4, colposcopy in cervicitis, condyloma acuminata with low grade CIN, cervical condyloma with high grade CIN, cervical condyloma with cervical cancer, low grade CIN and high grade CIN, respectively: 71.19%, 73.68%, 77.28%, 100%, 70.74%, 80.40%, and early condyloma acuminata To be confused with squamous verrucous hyperplasia of Pseudocondyloma, it is necessary to use histology to combine immunohistochemical P16, Ki67 to identify.5, P16 in simple low grade CIN, low grade C1N for hollowing. The positive rate of condyloma acuminata with low grade CIN are 34.95%, 75.57%, 82.35%, and Ki67 in them is 72.82%, 84.73%, 76.47%.P16 in simple The positive rates of high grade CIN, high grade CCA combined with high grade CIN were 85.77%, 85.92%, 98.41%, and the positive rate of Ki67 in them were 85.37%, 90.14%, 98.41%. conclusion: 1, low expression in cervical condyloma acuminata, if the expression increased, suggested that the cervical condyloma acuminata had canceration tendency; P16 in normal cervical tissue. Or not expressed in cervicitis, mainly in low grade intraepithelial neoplasia, strong positive expression in high grade intraepithelial neoplasia, all expressed in a hollowed high level gland; P16 can be found early in cervical lesions and auxiliary diagnosis of cervical intraepithelial neoplasia. We should pay attention to the high grade of empty cells. The expression of.2 and Ki67 in cervical condyloma is enhanced, suggesting that the cervical condyloma acuminata has a tendency of canceration, and the expression of Ki67 in the cervical intraepithelial neoplasia: as the level rises, the intensity of the expression increases gradually and the high positive rate of the advanced gland is higher. Ki67 can predict the severity of the cervical lesions,.3, P16, Ki67 can be used as the normal palace. Cervical tissue, cervical condyloma and intraepithelial neoplasia identification biomarkers, and P16, Ki67 in their diagnostic consistency, a significant positive correlation of.4, colposcopy can distinguish most of the normal cervical tissue, cervical condyloma acuminata and intraepithelial neoplasia, the diagnosis and classification of early cervical lesions is of great value, under colposcopy The suspicious lesion area biopsy combined with immunohistochemical P16, Ki67, improved the clinical diagnosis rate, and it was worth popularizing the.5. When the cervical intraepithelial neoplasia merged with condyloma acuminata or amalgamated hollowed cells, the expression of P16, Ki67 was obviously enhanced, and P16, Ki67 could be used as a marker for detecting HPV infection; cervical condyloma acuminata and intraepithelial neoplasia were closely related. Contact.
【學位授予單位】：泰山醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

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相關期刊論文 前2條

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本文編號：2090348