作　　者： (王海瑞）; (廖光东）; (江宇）; (李雨聪）; (乔友林）; (陈汶）;

机构地区： 中国医学科学院北京协和医学院公共卫生学院,北京100730

出　　处： 《中华流行病学杂志》 2017年第9期1241-1245,共5页

摘　　要： 目的研究p16／mcm2免疫细胞化学双染在宫颈病变中的表达及其与HPV感染的关联，并探讨其在宫颈癌筛查中的应用价值。方法将2015年5—12月参加宫颈癌筛查并行高危型HPV（HR-HPV）检测和液基细胞学检查的1127名女性纳入研究，对留存细胞学标本进行p16／mcm2免疫细胞化学双染检测，并与宫颈组织病理学结果进行比较。结果p16／mcm2在HPVl6／18阳性组和其他HR．HPV阳性组的表达风险均高于HPV阴性组，OR值分别为15．95（95％CI：9．59～26．51）、10．53（95％CI：7．41—14．98）；p16／mcm2阳性率随宫颈上皮内瘤变（CIN）级别的升高而升高，且在CIN2组、CIN3组中均高于良性病变组（P〈0．05）；p16／mcm2阳性者中检出CIN2及以上（CIN2＋）和CIN3及以上（CIN3＋）病变的灵敏度分别为86．1％、92．0％，特异度分别为46．1％、44．4％；在细胞学诊断为非典型鳞状细胞和低度鳞状上皮内病变人群中检出CIN2＋和CIN3＋病变的灵敏度分别为85．7％、87．5％，特异度分别为45．5％、44．1％。结论p16／mcm2双染灵敏度高于细胞学检查，特异度优于HPV检测，可识别宫颈高度病变和指导C1N的分级，有望成为新的宫颈癌筛查标志物。 Objective To study the expression of pl6/mcm2 immunocytochemical dual staining in cervical lesions and its association with high-risk HPV infection, and discuss its clinical value in cervical cancer screening. Methods From May to December 2015, a total of 1 127 women receiving cervical cancer screening, high-risk HPV （HR-HPV） test and liquid-based cytology test were included in the study, p16/mcm2 immunocytochemical dual staining was performed on residual cytology specimens and the results were compared with histopathology results. Results pl6/mcm2 had a higher expression risk in HPV16/18 group and other HR-HPV group compared with HPV negative group, with OR of 15.95 （95%CI： 9.59-26.51） and 10.53 （95%CI： 7.41-14.98）, respectively. The positive rate of pl6/mcm2 increased with cervical intraepithelial neoplasia （CIN） severity, and was higher in both CIN2 group and CIN3 group than in benign lesion group （P〈0.05）. The overall sensitivity of pl6/mcm2 to detect CIN2 q- and CIN3 q- lesions were 86.1% and 92.0%, respectively, and the overall specificity were 46.1% and 44.4%, respectively. In group with cytologic diagnoses of atypical squamous cells （ASC） and low-grade squamous intraepithelial lesion （LSIL）, the sensitivity to detect C1N2 q- and CIN3 q- lesions were 85.7% and 87.5%, respectively, and the specificity were45.5% and 44.1%, respectively. Conclusions pl6/mcm2 dual staining has higher sensitivity than cytology test and better specificity than HPV test. It can identify high-grade cervical lesions and guide the classification of CIN. pl6/mem2 might be used as an innovative biomarker for cervical cancer screening.

关 键 词： 宫颈上皮内瘤变 人乳头瘤病毒 宫颈癌筛查