p16~(INK4a)联合TCT、高危HPV检查在宫颈疾病筛查中的应用价值研究
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摘要
目的:探讨p16~(INK4a)联合液基细胞学检查(TCT)、高危型人乳头瘤病毒DNA(HPV-DNA)在宫颈疾病筛查中的价值。方法:将200例在HPV-DNA、TCT联合检测中至少一项检查异常者作为研究对象,对剩余细胞学标本进行p16~(INK4a)检测,以阴道镜下宫颈多点活检结果为对照。对比分析p16~(INK4a)联合TCT、高危HPV检查在宫颈疾病筛查中的意义。结果:HPV-DNA+TCT+p16~(INK4a)检测灵敏度为91.26%,特异度为85.13%,准确度为87.96%,联合检测结果同病理诊断结果一致性好(Kappa=0.86),优于p16~(INK4a)、TCT、HPV-DNA单独检测及两两联合检测。结论:p16~(INK4a)联合TCT、HPV-DNA检测敏感性和特异性均较高,且提高了准确性及客观性,减少误诊及漏诊,有利于及早诊断及治疗,具有较高的临床应用价值。
Objective To explore the value of p16~(INK4 a) combined with liquid-based cytology(TCT) and high-risk human papillomavirus DNA(HPV-DNA) in cervical disease screening.Method 200 patients with at least one abnormality in the combined detection of HPV-DNA and TCT were studied.The remaining cytological specimens were detected by p16~(INK4 a),and the results of cervical multipoint biopsy under colposcopy were compared.The significance of combined examination of p16~(INK4 a),TCT and high-risk HPV in cervical disease screening was compared and analyzed.Results The sensitivity,specificity and accuracy of HPV-DNA+TCT+p16~(INK4 a) were 91.26%,85.13% and 87.96%,respectively.The combined detection results were in good agreement with pathological diagnosis results(Kappa=0.86),superior to p16~(INK4 a),TCT,HPV-DNA detection alone and HPV-DNA+TCT combined detection.Conclusion The combined detection of p16~(INK4 a),TCT and HPV-DNA has high sensitivity and specificity,and improves accuracy and objectivity,reduces misdiagnosis and missed diagnosis,which is conducive to early diagnosis and treatment,and has high clinical application value.
Objective To explore the value of p16~(INK4 a) combined with liquid-based cytology(TCT) and high-risk human papillomavirus DNA(HPV-DNA) in cervical disease screening.Method 200 patients with at least one abnormality in the combined detection of HPV-DNA and TCT were studied.The remaining cytological specimens were detected by p16~(INK4 a),and the results of cervical multipoint biopsy under colposcopy were compared.The significance of combined examination of p16~(INK4 a),TCT and high-risk HPV in cervical disease screening was compared and analyzed.Results The sensitivity,specificity and accuracy of HPV-DNA+TCT+p16~(INK4 a) were 91.26%,85.13% and 87.96%,respectively.The combined detection results were in good agreement with pathological diagnosis results(Kappa=0.86),superior to p16~(INK4 a),TCT,HPV-DNA detection alone and HPV-DNA+TCT combined detection.Conclusion The combined detection of p16~(INK4 a),TCT and HPV-DNA has high sensitivity and specificity,and improves accuracy and objectivity,reduces misdiagnosis and missed diagnosis,which is conducive to early diagnosis and treatment,and has high clinical application value.
引文
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[20] 庄粤冰,潘雪萍,陈瑞兴,等.p16INK4a免疫细胞化学染色在宫颈癌筛查中的作用[J].深圳中西医结合杂志,2018,28(12):67.
[2] 姜波玲.宫颈癌HPV预防性疫苗的研究进展[J].国际妇产科学杂志,2018,45(5):527.
[3] 张佳佳,石云,李志丽.HPV在宫颈癌前病变、宫颈癌中的表达水平及其临床意义[J].包头医学院学报,2018,34(11):56.
[4] 许驰.宫颈癌筛查方法的现状及进展[J].蚌埠医学院学报,2018,43(11):1538.
[5] 李永杰,王琛.MicroRNA联合TCT、HC2-HPV检测高危人乳头瘤病毒对早期宫颈癌的诊断价值[J].中国现代医学杂志,2018,28(9):45.
[6] 陈运春,林丽英,郑春娇,等.热带地区宫颈癌TCT筛查结果分析[J].诊断病理学杂志,2013,20(10):642.
[7] 陈倩,方绳权.高危HPV阴性宫颈癌患者的临床病理特征研究[J].中国现代医学杂志,2018,28(12):97.
[8] 赵培玉,陈敖峥,秦锦龙,等.Cervista HR-HPV DNA检测联合TCT在宫颈癌筛查中的临床价值[J].检验医学,2017,32(4):322.
[9] 张娜娜.p16蛋白在宫颈癌中的临床表达及意义[J].包头医学院学报,2018,34(12):54.
[10] 黄群欢,金绍燕,陆欢,等.P16和Ki-67与宫颈癌患者HPV持续性感染的相关性研究[J].临床医学进展,2018,8(8):776.
[11] 李月琴,徐影,翟继芳,等.大同矿区宫颈癌发病相关因素调查分析[J].中国妇幼保健,2018,33(22):5224.
[12] 丁贤彬,吕晓燕,毛德强,等.2010～2015年重庆市肿瘤登记地区宫颈癌发病与死亡趋势分析[J].中国肿瘤,2018,27(11):824.
[13] 雷林,刘维耿,王月云,等.深圳市2001～2015年常住居民子宫颈癌发病动态及趋势分析[J].中国热带医学,2018,18(11):1095.
[14] 赵宇倩,戴毅,党乐,等.适合中国人群的宫颈癌筛查技术和效果评价的真实世界研究[J].中华肿瘤杂志,2018,40(10):764.
[15] 陆晓红.宫颈新柏氏技术抹片异常患者阴道镜下活检结合检测p16、p53及Ki-67的临床意义[J].中国妇幼保健,2018,33(23):5385.
[16] 许丽俐,陈明雄,成瑜,等.P16、Ki67蛋白在TCT检查阳性患者中的表达及其意义[J].医学临床研究,2018,35(10):2021.
[17] 王艳君,张静.高危型HPV联合TCT在宫颈癌筛查中的价值研究[J].中国性科学,2017,26(12):24.
[18] 许丽俐,陈明雄,成瑜,等.P16、Ki67蛋白在TCT检查阳性患者中的表达及其意义[J].医学临床研究,2018,35(10):2021.
[19] 陈悦,张晓薇,邓志校,等.P16基因表达与宫颈癌预后相关性分析[J].实用医学杂志,2014,30(15):2417.
[20] 庄粤冰,潘雪萍,陈瑞兴,等.p16INK4a免疫细胞化学染色在宫颈癌筛查中的作用[J].深圳中西医结合杂志,2018,28(12):67.