【摘要】 目的探讨p16INK4A、Ki-67和HPV抗原表达及高危型HPV(HR-HPV)检测在宫颈上皮内瘤变(CIN)病理诊断中的意义。方法选取宫颈活检病理确诊为CIN的组织蜡块101例,重新切片,应用免疫组化两步法检测p16INK4A、Ki-67和HPV抗原表达,并取正常宫颈组织50例进行对比研究。同时,应用第二代杂交捕获法对其中25例CIN组织样品进行HR-HPV检测。结果p16INK4A蛋白表达水平在CINⅠ、CINⅡ、CINⅢ级之间差异有非常显著性(P<0.001),其表达水平随着CIN级别的增高而增加,呈现良好的线性相关性(P<0.001);Ki-67蛋白表达阳性细胞多少与CIN分级之间无显著相关性(P>0.05),但其在宫颈鳞状上皮中的位置分布与CIN级别之间却有显著相关性(P<0.05);HPV抗原免疫组化染色阳性反应仅呈现于CIN鳞状上皮表层挖空细胞内,其阳性率在不同级别CIN之间的差异无统计学意义(P>0.05);HR-HPV在CINⅠ、CINⅡ和CINⅢ级的检出率分别为81.8%、80.0%和100.0%,但其检出率在不同级别CIN之间差异也无显著性(P>0.05)。结论p16INK4A和Ki-67染色对CIN的病理诊断和分级具有一定诊断价值,对于CINⅠ级形态结构不典型的病例,HR-HPV的检测结果对病理诊断有辅助意义。更多还原

【Abstract】 Purpose To evaluate the histopathological significance of immunoexpression of p16INK4A, Ki-67 and HPV antigens and detection of HR-HPV in cervical intraepithelial neoplasia. Mothods 101 wax-embedded CIN samples were selected and re-sectioned. The expression of p16INK4A, Ki-67 and HPV antigens was!detected by immunohistochemical technique and 50 normal cervical tissue samples were treated as control. HR-HPV was probed in 25 out of 101 CIN samples using Hybrid Capture Ⅱ method. Results The expression of p16INK4A was significantly different among CIN Ⅰ, CIN Ⅱ and CIN Ⅲ(P<0.001). There was a linear relationship between lesion grades and intensity of p16INK4A staining (P<0.001). The number of Ki-67 positive cells was not related to CIN grades (P>0.05), but the location of Ki-67 positive cells in the cervical squamous epithelium was associated with CIN grades (P<0.05). Immunostaining of HPV antigens was only found in the nuclei of koilocytosis of CIN in the surface layer of cervical squamous epithelium. There was no significant difference for the immunostaining of HPV antigens among different CIN grades(P>0.05). HR-HPV was detected in 81.8% CIN Ⅰ, 80.0% CIN Ⅱand 100.0% CIN Ⅲ samples, respectively, but there was no significant difference among different CIN grades (P>0.05). Conclusion Expression of p16INK4A and Ki-67 is valuable in the histopathological diagnosis of CIN. The detection of HR-HPV should be helpful for histopathological diagnosis of CIN Ⅰ since it is difficult to determine morphologically CIN Ⅰ sometimes.更多还原