p16和Ki-67免疫组化检测与宫颈上皮内瘤变(CIN)程度的相关性分析

目的:分析免疫组化检测p16和Ki-67与宫颈上皮内瘤变（CIN）严重程度的关系，以及 p16联合Ki-67在高级别CIN鉴别中的效能。方法:采用回顾性研究，纳入2016年1月至2018年3月期间粤北人民医院经HE染色病理确诊的宫颈病变患者160例，其中慢性宫颈炎者共38例归为对照组，CINⅠ级、Ⅱ级、Ⅲ级分别为41例、46例、35例；再将CIN患者分为低级别鳞状上皮内病变（LSIL）和高级别鳞状上皮内病变（HSIL）组。对比对照组与CINⅠ级、Ⅱ级、Ⅲ级组、ISIL组、HSIL组p16及Ki-67阳性表达情况；采用Spearman相关性分析观察p16阳性表达、Ki-67阳性表达与CIN严重程度的关系。联合使用p16、Ki-67半定量评分，评估联合p16、Ki-67半定量评分诊断结果与病理结果一致性，评估效能。结果:CINⅠ-Ⅲ级组p16阳性率较对照组高，CINⅡ、Ⅲ级p16阳性率较CINⅠ级高；HSIL组阳性率较LSIL组高,差异均有统计学意义，P＜0.05。Ki-67在对照组中阳性率为0.00%，在LSIL组、HSIL组中分别为68.29%、100.00%。p16与宫颈病变程度呈正相关，r=0.692，P=0.021 0；Ki-67与宫颈病变程度呈正相关，r=0.612，P=0.001 8。p16联合Ki-67诊断炎症结果与病理完全一致，CINⅠ级共36例（87.80%）符合，CINⅡ级共43例（93.48%）符合，CINⅢ级共34例（97.14%）符合；LSIL符合率为87.80%（36/41），HSIL符合率为95.06%（77/81）。p16联合Ki-67诊断LSIL敏感性、特异性为94.74%和97.58%，诊断HSIL敏感性、特异性分别为96.25%、98.81%，诊断CIN敏感性、特异性分别为92.62%、96.48%，其中LSIL敏感性高于单用，CIN诊断特异性较单用p16高，P＜0.05。结论:p16和Ki-67表达与宫颈上皮内瘤样病变严重程度密切相关，可以通过观察二者表达情况辅助CIN病情严重程度判断，联合p16和Ki-67免疫组化检测能提高诊断高级别鳞状上皮内病变诊断特异性、敏感性。

Correlation analysis between p16 and Ki-67 immunohistochemical detection and degree of cervical intraepithelial neoplasia (CIN)

Objective:To analyze the relationship between p16 and Ki-67 and the severity of cervical intraepithelial neoplasia (CIN) by immunohistochemistry,and the efficacy of p16 combined with Ki-67 in high-grade CIN.Methods:A retrospective study was conducted to enroll 160 patients with cervical lesions diagnosed by HE staining in Yuebei people＇ hospital from January 2016 to March 2018.Among them,38 patients with chronic cervicitis were classified as control group,including CIN I,II and III with 41,46,and 35.The patients with CIN were divided into low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL).The control group and CIN I grade,II grade,III grade group,ISIL group,HSIL group p16 and Ki-67 positive expression were compared.Spearman correlation analysis to observe the relationship between p16 positive expression,Ki-67 positive expression and CIN severity.Combined with p16 and Ki-67 semi-quantitative scores,the results of combined semi-quantitative scores of p16 and Ki-67 were compared with pathological results to evaluate the efficacy.Results:The positive rate of p16 in CIN I-III group was higher than that in control group,the positive rate of p16 in CIN II and III group was higher than that in CIN I group,and the positive rate of HSIL group was higher than that in LSIL group.The difference was statistically significant，P＜0.05.The positive rate of Ki-67 in the control group was 0.00%,and it was 68.29% and 100.00% in the LSIL group and the HSIL group,respectively.p16 was positively correlated with cervical lesions,r=0.692,P=0.021 0.Ki-67 was positively correlated with cervical lesions,r=0.612,P=0.001 8.The diagnosis of p16 combined with Ki-67 was consistent with pathology.36 cases of CIN I were consistent (87.80%),43 cases of CIN II (93.48%) were consistent,and 34 cases of CIN III (97.14%) were consistent.LSIL coincidence rate was 87.80% (36/41).HSIL compliance rate was 95.06% (77/81).The sensitivity and specificity of p16 combined with Ki-67 diagnosis of LSIL was 94.74% and 97.58%.The sensitivity and specificity of diagnosis of HSIL were 96.25% and 98.81%,respectively.The sensitivity and specificity of diagnosis of CIN were 92.62% and 96.48%,respectively.Above the single use,the diagnostic specificity of CIN was higher than that of p16 alone,P＜0.05.Conclusion:The expression of p16 and Ki-67 is closely related to the severity of cervical intraepithelial neoplasia.The expression of p16 and Ki-67 can be used to help determine the severity of CIN disease by observing their expression.Combined with immunohistochemical detection of p16 and Ki-67,diagnostic specificity and sensitivity of high-grade squamous intraepithelial lesions can be improved.