【摘要】 目的:研究p16^INK4a免疫细胞化学染色对不同基因型HPV感染者的分流价值,探讨更积极有效的分流方案。方法:将宫颈癌筛查结果异常需行阴道镜下宫颈活检的106例患者作为研究对象,对宫颈脱落细胞行p16^INK4a免疫细胞化学染色。以宫颈活检组织病理结果为金标准,与液基薄层细胞学检查（TCT）比较,评估p16^INK4a免疫细胞化学染色对HPV 16/18型阳性者和其余12种高危型HPV阳性者的分流价值。采用4种方案对HPV阳性者进行分流,方案A,p16^INK4a免疫细胞化学染色对所有HPV阳性者进行分流;方案B,TCT对所有HPV阳性者进行分流;方案C,HPV 16/18型阳性者直接转诊阴道镜,p16^INK4a免疫细胞化学染色对其余12种HPV阳性者进行分流;方案D,HPV 16/18型阳性者直接转诊阴道镜,TCT对其余12种HPV阳性者进行分流,评估不同方案对宫颈上皮内瘤变2级及以上（CIN2+）的诊断效能。结结果:p16^INK4a免疫细胞化学染色与TCT诊断HPV 16/18型阳性者中CIN2+的灵敏度（χ²=1.908,P=0.167）和特异度（χ²=0.277, P=0.599）比较差异均无统计学意义。p16^INK4a免疫细胞化学染色与TCT诊断其余12种HPV分型阳性者中CIN2+的灵敏度比较差异均无统计学意义（χ²<0.01, P=1.000）,其特异度高于TCT （χ²=23.625, P<0.01）。方案A与方案B诊断HPV阳性者中CIN2+的灵敏度比较差异均无统计学意义（χ²=2.308,P=0.129）,其特异度高于方案B （χ²=14.101, P<0.01）。方案C与方案D诊断HPV阳性者中CIN2+的灵敏度比较差异均无统计学意义（χ²<0.01,P=1.000）,其特异度高于方案D （χ²=13.807,P<0.01）。方案A与方案C诊断HPV阳性者中CIN2+的灵敏度比较差异均无统计学意义（χ²=0.855,P=0.355）,其特异度高于方案C （χ²=16.806,P<0.01）。结论:p16^INK4a免疫细胞化学染色对HPV阳性患者的分流效能高。与现有细胞学分流方法比较,采用p16^INK4a免疫细胞化学染色对HPV阳性感染者进行分流有助于降低阴道镜转诊率。更多还原

【Abstract】 Objective:To study the value of p16^INK4a immunocytochemical staining in triaging the women infected with different genotypes of HPV,and to explore a more positive and effective triage plan.Methods:A total of 106 patients with abnormal results after cervical cancer screening who needed cervical biopsy under colposcopy were selected as the research objects,and p16^INK4a immunocytochemical staining was performed in the cervical exfoliated cells. The cervical biopsy histopathological results were used as the gold standard. By comparison with thinprep cytologic test（TCT）,the values of p16^INK4a immunocytochemical staining in triaging the HPV 16/18 positive women and the women positive for12 other HPV genotypes were evaluated. In addition,four schemes were used to triage the HPV positive women in this study. Scheme A:All HPV positive women were triaged with p16^INK4a immunocytochemical staining;Scheme B:All HPV positive women were triaged with TCT;Scheme C:The HPV 16/18 positive women were directly referred to colposcopy,and the other 12 types of HPV positive women were triaged by p16^INK4a immunocytochemical staining. Scheme D:The HPV 16/18 positive patients were directly referred to colposcopy,and the other 12 types of HPV positive patients were triaged by TCT. The efficiencies of 4 kinds of schemes in diagnosis of all cervical intraepithelial neoplasia 2 or worse（CIN2+）were evaluated. Results:The sensitivity（χ²=1. 908,P=0. 167）and specificity（χ²=0. 277,P=0. 599）of p16^INK4a immunocytochemical staining were similar to those of TCT in diagnosis of CIN2+ in the HPV 16/18 positive women. The sensitivity（χ²<0. 01,P=1. 000） of p16^INK4a immunocytochemical staining was similar to that of TCT in diagnosis of CIN2+ in the other 12 types of HPV positive women,while the specificity（χ²=23. 625,P<0. 01）was higher than that of TCT. Compared with scheme B,scheme A had similar sensitivity（χ²=2. 308,P=0. 129） and higher specificity（χ²=14. 101,P<0. 01） in diagnosis of CIN2+ in the HPV positive patients. In scheme C,the sensitivity（χ²<0. 01,P=1. 000）in diagnosis of CIN2+ in the HPV positive patients was similar to that of scheme D,while the specificity（χ²=13. 807,P<0. 01）was higher than that of scheme D. Compared with scheme C,scheme A had similar sensitivity（χ²=0. 855,P=0. 355）and higher specificity（χ²=16. 806,P<0. 01）in diagnosis of CIN2+ in the HPV positive patients. Conclusion:The value of p16^INK4a immunocytochemical staining in triaging the HPV positive women is high. Compared with the existing cytological triage methods,the use of p16^INK4a immunocytochemical staining to triage HPV-positive infections is more helpful to reduce colposcopy referral rate.更多还原