stathmin、p16及Ki-67检测在子宫颈疑难病例中的应用价值

摘要

Objective To investigate the clinical application value of stathmin, p16 and Ki-67 in the cervical intractable cases. Methods Immunohistochemical method was used to detect the expressions of stathmin, p16 and Ki-67 in surgical specimens of 288 cervical intractable cases, including 30 cases of cervical benign changes, 70 cases of cervical intraepithelial neoplasia (CIN)Ⅰ, 78 cases of CINⅡ, 85 cases of CINⅢand 25 cases of squamous cell carcinoma (SCC, as control group). The application value of stathmin, p16 and Ki-67 in the cervical cases were analyzed. Results The positive expression rates of Ki-67 of cervical benign changes and CINⅠwere 20.0 % (6/30) and 54.3 % (38/70) (χ2 = 3.29, P> 0.05). The expression rates of Ki-67 in CINⅡ, CINⅢ and SCC were all 100.0 %, and compared with the cervix benign changes, the differences were statistically significant (χ2= 112, P< 0.05). The expression rates of p16 in cervical benign changes and CINⅠwere 6.7 % (2/30) and 91.4 % (64/70), and there was significantly statistical difference (χ2=50.64, P<0.05). However, the expression rates of p16 in CINⅡ, CINⅢand SCC were all 100.0%, and compared with the cervix benign changes, the differences were statistically significant (χ2= 7.18, P< 0.01). The expression rates of stathmin in cervical benign changes, CINⅠ, CIN Ⅱ, CINⅢ and SCC were 3.3 %(1/30), 5.7 % (4/70), 23.1 % (18/78), 77.0 % (67/87) and 100.0 % (25/25), respectively, and there was no statistic difference in cervical benign changes, CINⅠand CINⅡ (χ2=0.68, P>0.05), but the expression rates in CINⅢ and SCC were higher than those in cervical benign change, CINⅠand CIN Ⅱ(P< 0.01). The positive expressions of stathmin, p16 and Ki-67 in each group of CIN were positively correlated (r= 0.412, P< 0.05). Conclusions Combined detection of p16 and Ki-67 can assist in the differential diagnosis of cervical intractable cases, and provide objective indicators for the classification and accurate diagnosis of CIN. Combined detection of p16 and stathmin may help to identify high-grade, low-grade CIN and cervix benign changes for the reduction of over-treatment.%目的：探讨stathmin、p16、Ki-67检测在子宫颈疑难病例中的应用价值。方法应用免疫组织化学标志物检测288例子宫颈疑难病例标本中子宫颈良性反应性改变（30例）、子宫颈上皮内瘤变（CIN）Ⅰ级（70例）、CINⅡ级（78例）、CINⅢ级（85例）及子宫颈鳞状细胞癌（25例，对照组）中stathmin、p16、Ki-67的表达情况，并分析三者在子宫颈疑难病例中的检测价值。结果 Ki-67在子宫颈良性反应性改变和CINⅠ级中的阳性表达率为20.0%（6／30）和54.3%（38／70），差异无统计学意义（χ2＝3.29，P＞0.05）；在CINⅡ级、CINⅢ级和子宫颈癌对照组中的阳性表达率均为100.0%，与子宫颈良性反应性改变比较，差异有统计学意义（χ2＝112，P＜0.05）。 p16在子宫颈良性反应性改变和CINⅠ级中的阳性表达率为6.7%（2／30）和91.4%（64／70），差异有统计学意义（χ2＝50.64，P＜0.05）；在CINⅡ级、CINⅢ级和子宫颈癌对照组中的阳性表达率均为100.0%，与子宫颈良性反应性改变比较，差异有统计学意义（χ2＝7.18，P＜0.01）。 stathmin在子宫颈良性反应性改变、CINⅠ级、CINⅡ级、CINⅢ级和子宫颈癌对照组中的阳性表达率分别为3.3%（1／30）、5.7%（4／70）、23.0%（18／78）、78.9%（67／87）和100.0%（25／25），其中子宫颈良性反应性改变、CINⅠ级和CINⅡ级间的表达差异无统计学意义（χ2＝0.68，P＞0.05）；CINⅢ级与子宫颈癌对照组中的表达较子宫颈良性反应性改变、CINⅠ级、CINⅡ级增高，差异有统计学意义（P＜0.01）。 stathmin、p16与Ki-67的阳性表达强度与CIN分级呈正相关（r＝0.412，P＜0.05）。结论联合检测p16及Ki-67能够辅助鉴别诊断子宫颈疑难病例，为CIN的分级和精确诊断提供客观依据。联合检测p16及stathmin有助于鉴别高级别、低级别CIN和良性反应性改变，减少过度治疗。