子宫颈不典型不成熟鳞化免疫组化表达的意义

目的探索子宫颈不典型不成熟鳞状化生（atypical immature metaplasia，AIM）的生物学行为。方法采用SP法免疫组化技术检测p63、CK5、Ki-67及p16在14例AIM中的表达；对照7例不成熟鳞化（immature metaplasia，IM），7例低级别鳞状上皮内病变（LSIL），3例高级鳞状上皮内病变（HSIL）和7例鳞状细胞癌（SCC）。结果p63和CK5在AIM和IM阳性率〉75％，p63在AIM与LSIL和HSIL中的表达差异有显著性（P〈0．05），与SCC差异无显著性。AIM与IM中Ki-67总平均指数及分布幅度相近，AIM（43．23％）略高于LSIL（36．95％），较明显低于HSIL（68.5％，P〉0．05），从Ki-67阳性细胞分布范围比较，AIM与LSIL及HSIL有重叠。p16在AIM表达6例强阳性、6例局灶阳性、2例阴性，7例SCC及3例HSIL全呈强阳性，3例LSIL强阳性，4例局灶阳性。结论p63和CK5佐证AIM形态特征。p63与Ki-67同样表达在异型细胞阳性。p16阳性表达与Ki-67和p63相结合，具有LSIL和HSIL的诊断价值，但p16阴性和Ki-67低表达，不排除AIM向良性转化可能。AIM是属于子宫颈上皮表现为一异质性病变。

Significance of the immunophenotype of atypical immature metaplasia in cervix

Purpose To investigate the biological behavior of atypical immature metaplasia (AIM) in cervix. Methods Immunohistochemical technique was used to detect the expression of p63,CK5,Ki-67 and p16 in 14 cases of cervical AIM. 7 cases of immature metaplasia (IM),7 low-grade squamous intraepithelial lesion (LSIL),3 high-grade squamous intraepithelial lesion (HSIL) and 7 cases of squamous cell carcinoma (SCC) in cervix were used as control. Results p63 and CK5 expression was scored as positive at more than 75% in AIM. p63 expression was significantly different(P<0.05) from LSIL and HSIL, but not from SCC. General average index and distribution range of Ki-67 between AIM and IM was close,which was slightly higher than that in LSIL,but distinctly lower than that in HSIL(P>0.05). As compared with positive ranges of Ki-67,there was an overlapped among AIM, LSIL and HSIL. p16 was scored as strong positive in 6 cases of AIM, local positive in 6 cases of AIM and negative in two cases. 7 cases of SCC and 3 HSIL and 3 LSIL were strong positive for p16. Conclusions p63 and CK5 staining proves the morphological features of AIM. p63 is also expressed in Ki-67 positive atypical cells. Positive p63 staining combined with Ki-67 and p16 has differentially diagnostic value between LSIL and HSIL,but negative p16 and low-expression of Ki-67 do not exclude the probability of the transformation of AIM to benign lesion. AIM falls into a heterogenous lesion in cervix.