【作者】 丁伟山；

【导师】 张廷国；

【作者基本信息】 山东大学 ， 病理学与病理生理学， 2012， 硕士

【摘要】 [目的]通过研究分析宫颈鳞状上皮萎缩(Cervical squamous epithelial atrophy CSEA)的细胞学及组织学特征,以及宫颈鳞状上皮萎缩中P16、Ki67的表达情况和人乳头状瘤病毒高危型别16型和18型(HPV16/18)的感染状态,并且以正常宫颈鳞状上皮、高级别宫颈鳞状上皮内瘤变(HSIL)做为对照,观察上述指标在宫颈鳞状上皮萎缩以及对照病例中的表达情况,旨在探讨宫颈鳞状上皮的细胞组织病理学特点及生物学性质,为宫颈鳞状上皮萎缩的诊断和与宫颈鳞状上皮内瘤变的鉴别诊断、治疗及预后提供有效的辅助诊断指标。[方法]本实验用免疫组织化学方法检测了p16、ki67在20例宫颈鳞状上皮萎缩(CSEA1中的表达情况,并选取对照20例,其中正常宫颈鳞状上皮10例,高级别宫颈鳞状上皮内瘤变(HSIL)10例。并且对8例伴有轻度异型的宫颈鳞状上皮萎缩、10例正常宫颈鳞状上皮和10例高级别宫颈鳞状上皮内瘤变采用原位杂交的方法进行人乳头状瘤高危型别16型和18型的检测。SPSS13.0软件进行数据处理,采用X2检验对数据进行统计学分析。[结果]1.P16的表达：P16在CSEA组、正常组、HSIL组中的阳性表达率分别为：0%、0%、100%,正常组的表达与HSIL组的表达差别有统计学意义(p=0.000,p<0.01)；CSEA组的表达与HSIL组的表达差别有统计学意义(p=0.000,p<0.01)；CSEA组的表达与正常组的表达差别无统计学意义。2.Ki67的表达：Ki67在CSEA组、正常组、HSIL组中的阳性表达率分别为：15%、10%、100%,CSEA组的表达与正常组的表达差别无统计学意义(p=0.708,p>0.05)；CSEA组的表达与HSIL组的表达差别有统计学意义(p=0.000,p<0.01)。3.HPV感染状态：高危型人乳头瘤状病毒HPV16/18在异型CSEA组、正常组、HSIL组中的阳性表达率分别为：0%、0%、80%,CSEA组的表达与HSIL组的表达差别有统计学意义(p=0.0007,p<0.01)；正常组与HSIL组的表达差别有统计学意义(p=0.0003,p<0.01)。[结论]1.P16目前被大量研究证实可做为诊断宫颈鳞状上皮高级别上皮内瘤变的辅助指标,在本研究中20例CSEA病例均为阴性表达,与HSIL组的表达差别有显著差异,支持CSEA为非肿瘤性变化。2.Ki67做为代表细胞增殖活性的指标,可在部分CSEA病例中呈阳性表达,单一的Ki67阳性表达不适宜做为鉴别CSEA与CIN的依据。3.高危型HPV感染与宫颈鳞状上皮高级别上皮内瘤变密切相关,宫颈鳞状上皮萎缩病例的高危型HPV感染率为零,与高级别宫颈上皮内瘤变的感染率有显著统计学差异,CSEA高危型HPV检测均阴性也支持其为良性反应性病变。高危HPV检测可做为困难病例辅助诊断指标。4.宫颈鳞状上皮萎缩为良性反应性病变,在伴随炎症时可有一定的细胞异型性,HE诊断中不容易同CIN鉴别,困难病例可用P16、Ki67、及检测高危型HPV16/18这一组指标来辅助诊断。更多还原

【Abstract】 [Objective] To study the cytology and histology of cervical squamous epithelium atrophy(CSEA), the expression of the P16and Ki67in20cases of CSEA, and HPV infection conditions in8cases of CSEA, compared with10cases of normal cervical tissue,10cases of high-grade squamous intraepithelial lesion(HSIL) and to find the expression regularity and effective markers combining the morphologic characters for diagnosis and differential diagnosis of cervical squamous epithelium atrophy and cervical intraepithelial neoplasia, in order to predict the prognosis of cervical squamous epithelial atrophy and adopt appropriate clinical managements.[Methods] Immunohistochemistry was used to detect the expression of P16and Ki67in20cases of cervical squamous eptithelium atrophycompared with10cases of normal cervical tissue and10cases of HSIL. In situ hybridization was used to detect HPV16/18infectiion conditions in8cases of CSEA with minimal atypia and all of control group. All the data were analyzed by SPSS13.0software for windows.[Results]1.The expression of P16in HSIL were statistically higher than that in CSEA so as in normal tissues(P=0.000,P<0.01).The difference between CSEA and normal tissues had no statistical significance.2. The positive expression rate of Ki67in CSEA, normal group, HSIL were15%,10%,100%. The difference between CSEA and HSIL had statistical significance (P<0.01), and between SCEA and normal tissue had no statistical significance (P>0.05).3.The infection rates of HPV16/18in CSEA, normal group, HSIL were0%,0%,80%.The infection rates of HPV16/18in HSIL was statistically higher than that in CSEA with minimal atypia so as in normal tissues(P<0.01). [Conclusion]1.The expression of P16were significantly associated with the CIN grade. It is supported that the CSEA are benign based on the expression state of P16.2. The expression of Ki67in a few CSEA were positive. The positive expression of Ki67cannot be alone used to distinguish diagnosis between CSEA and HSIL.3. HSIL has close relationship with high risk HPV infection. It is supported that the CSEA are benign based on the0%infection rate of HPV16/18.4. CSEA is benign change. It shares some cytohistology features with SIL, especially if inflammatory changes. P16, Ki67and HPV16/18can be useful markers for distinguish diagnosis.更多还原