p16、Ki-67蛋白表达及HPV检测在宫颈上皮内瘤变中的诊断意义

目的 探讨p16、Ki-67联合应用在宫颈上皮内瘤变(CIN)诊断及分级中的意义及人乳头状瘤病毒(HPV)感染与CIN的关系.方法 分别对160例宫颈各类病变采用免疫组化方法检测p16、Ki-67蛋白表达情况,并行人乳头状瘤病毒分型检测.结果 ①宫颈上皮内低度瘤变(CINⅠ)中,p16阳性率为85.7%,Ki-67阳性率为67.8%,较宫颈良性病变的阳性率明显增加(P<0.01);宫颈上皮内高度瘤变(CINⅡ-Ⅲ)中,p16阳性率为100%,Ki-67阳性率为98.3%,两者相比差异极显著(P<0.01).在CINⅡ-Ⅲ中,p16、 Ki-67表达呈正相关.②高危型HPV在宫颈良性病变、CINⅠ和CINⅡ-Ⅲ病变组感染者分别为30.6%、75.7%和93.3%,宫颈CINI和CINⅡ-Ⅲ明显高于良性病变组,差异极显著(P<0.01).随着宫颈上皮内瘤变程度加重,HPV感染与p16表达呈正相关.结论 p16、Ki-67联合应用可作为宫颈良性病变与CINⅠ以及CINⅠ与CINⅡ-Ⅲ鉴别的重要标记物;高危型HPV感染与宫颈上皮内瘤变密切相关,在高危人员筛查与判断预后上有重要意义.

Expression of p16 and Ki-67 and detection of high -risk HPV in the diagnosis of cervix intraepithelial neoplasia

Objective To investigate the expression of p16 and Ki-67 and detection of high-risk HPV in the diagnosis and grading of cervical intraepithelial neoplasia (CIN). Method Immunohistochemical staining was used for detection of pl6 and Ki-67 protein expression in 160 cases of various cervical lesions. Quick nuclear hybridization method was used for detection of high- risk HPV. The data were analysed by SPSS software. Result (1) In CIN Ⅰ , p16 and Ki-67 expression rates were 85.7% and 67.8% respectively, which were significantly higher than that of benign cervical lesions (P< 0.001). In CIN Ⅱ-Ⅲ, p16 and Ki-67 expression rates were 100% and 98.3% respectively, which were significantly higher than that of CIN Ⅰ (P < 0.001). In addition, pl6 expression was strongly associated with Ki-67 expression in CIN Ⅱ-Ⅲ. (2) High-risk HPV infected rate was 75.7% and 93.3% in CIN Ⅰ and CIN Ⅱ-Ⅲ , respectively, which is significantly higher than that of benign cervical lesions (30.6% P < 0.01). In addition, high risk HPV infected rate was strongly associated with expression of pl6 protein. Conclusions p16 and Ki-67 can be used as important markers to distinguish CIN Ⅰ from benign cervix lesions as well as CIN Ⅰ from CIN Ⅱ-Ⅲ. High-risk HPV infection is closely related with CIN, and thus detection of high-risk HPV is of great importance in screening high risk group and evaluating the prognosis of cervical diseases.