目的 探讨不同级别宫颈病变液基细胞学标本中p16INK4a、p21和p27的表达区别及变化趋势.方法 212例高危HPV感染患者,因宫颈细胞学检测结果异常行阴道镜活检病理学明确病变级别.阴道镜活检前取宫颈液基细胞标本,采用酶联免疫吸附试验(ELISA)检测该液基细胞标本中p16INK4a、p21和p27蛋白表达数量,对比研究不同病变级别上述3种蛋白值的不同.结果 p16INK4a在正常宫颈上皮中呈现低表达,随宫颈病变级别升高,p16INK4a逐渐升高,差异显著(P＜0.01);而p21及p27下调不具有显著性差异(P＞0.05),只有宫颈癌中,p21及p27下调显著(P＜0.05).p16INK4a达到12 ng/L以上,宫颈上皮内瘤变(CIN)Ⅱ以上及CINⅢ以上病变诊断敏感度分别为89%和88%;当p16INK4a达到24 ng/L以上,CINⅡ以上及CINⅢ以上病变诊断灵敏度分别为82%和91%.结论 ELISA方法检测宫颈液基细胞p16INK4a对CINⅡ及以上宫颈病变诊断具有意义.p16INK4a上调与宫颈癌发生及演进密切相关.p21、p27下调对判断CIN进展不具有意义.%Objective To evaluate the expressions oi p16INF40,p21 and p27 in cervical intiaepithelial neoplasia( CIN )and to compare the different expression among cervical cancer, CIN and non-neoplastic cervi-rai lesions. Methods 212 high-risk HPV positive caies with all normal cytology results underwent colposco-py biopsy. A sandwich enzyme-linked immunosorbent assay(ELISA )was used to quantify the amount oi solu-bilized p16N4h,p21 and p27protein in cell lysates oi rerviral samples from the above cases. Cytology results, rolposropy pathology identiiiration results and p16INK40,p21 and p27 protein were analyzed and compared in all cases. Results There was a statistically significant diiifeience between chronic cervicitis, (,IN and cancer in terms oi pi6 a expression levels( P ＜0. 01 ),the expression oi which in normal rerviral in-tiaepithelial tissue was low; whereas, p21 and p27 down-regulated exjuession was not statistically different ( P ＞0. 05 ). On the other hand, p21 and p27 expression greatly decreased in cervical caicinoma samples (P＜0.05 ). At a cutoif value of 12 ng/L,the sensitivity of the p16INK40 ELISA for detecting CIN Ⅱ and CIN Ⅲ were 89% and 88% respectively. At a cutoif value of 24 ng/L,the sensitivity of the p16 INK40 ELISA for detecting CIN Ⅱ and CIN Ⅲ were 82% and 91% respectively. Conclusion ELISA-based quantification of solubilized p16INK40 may have high sensitivity for detecting precancer oi CIN Ⅱ and beyond in rerviral lesions. Overexpression oi p16INk40 may be much associated with progression oi rerviral cancer. p21 and p27 down-regulated expression are not useful to judge CIN progression.
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