| In the women around the world, cervical cancer ranks only second to the breast malignant tumor, but cervical cancer can be overcome. With the development of the global screening of cervical lesions, the incidence rate of cervical cancer have greatly reduced. But some remote areas with backward economy, the screening work is difficult. So many scientists are looking for an economic and effective screening program. High-risk human papillomavirus(HR-HPV) detection carried out a good predictor of the risk of cervical cancer. About 80% of the women extraordinary papilloma virus infection in their lives, but only a few people develop cervical cancer. Only relying on virus detection and cell morphology of cervical lesions is not enough to show the true state of the process, so there are biological markers to break this pattern. the human cyclin-dependent kinase 4(CDK4) inhibitor( p16) gene, a tumor suppressor gene that is P16INK4 A. but the protein is a tumor suppressor protein, with increased cervical lesions showed high levels of expression. Ki67 is a proliferation antigen, Ki67 protein expression increases legend cell proliferation activity and the probability of occurrence of malignant transformation. In recent years, studies have shown that these two biomarkers can be used to diagnose cervical high-grade lesions and cervical cancer. There are combained ways to increase sensitivity and specificity of screening, and it can reduce the costs of the patient.We selected the cervical liquid-based remaining specimens of the patients for studying, who visit to the First Affiliated Hospital of Hebei North University gynecological clinic in parallel cervical cytology and cervista HR-HPV from 2014 to 2015. There were 150 cases in the test group and 20 cases in the comparison group with the age range from 20 to 67 years. The 150 cases included 50 cases ASCUS, 50 cases LSIL and 50 cases HSIL, where HR-HPV positive cases was 141 and negative was 9. The colposcopy and biopsy were performed by specialists for all the cases.We use double immunofluorescence assay to detect the expression of P16 and Ki67 in the cervical exfoliated cell. By colposcopy biopsy results, we grouped them into chronic cervicitis, cervical intraepithelial neoplasia grade 1(CIN1), cervical intraepithelial neoplasia grade 2(CIN2), cervical intraepithelial neoplasia grade 3(CIN3) and cervical squamous cell carcinoma.The normal colposcopy and biopsy of ASCUS、LSIL、HSIL was 48%,12%, 0%, A9 group infection rates are different in pathology results for chronic cervicitis, cervical low-level lesions(CIN1), high level cervical lesions(CIN2- 3 squamous carcinoma)(P<0.05), the rates were 15.4%, 61.9%, 72.9%. In the cervical exfoliated cell of abnormal cytology, the positive rate of P16 in chronic cervicitis, CIN1, CIN2, CIN3, squamous cell carcinoma were 0, 51.9%, 70%, 87.0% and 100%. there was significant difference(Fisher’s exact test, χ2 = 73.821, P <0.05). The positive rate of Ki67 were 16.7%, 55.6%, 77.5%, 95.7%,100%, with significant difference(Fisher’s exact probability method, χ2= 60.519,P<0.05).The co-expression rate of P16 and Ki67 have significantdifference in chronic cervicitis, CIN1, CIN2, CIN3, cervical squamous cell carcinoma, were 0,33.3%,55%,87.0%,100%. In the cytology for cervical exfoliated cells of ASCUS, for the diagnosis of cervical high levels lesions, the sensitivity of P16 was 100%(16/16), the specificity was 82.4%(28/34), positive predictive value was72.7%(16/22), negative predictive value was 100%(28/28). The sensitivity of Ki67 was 93.8%(15/16), the specificity was 29.4%(10/34), positive predictive value was 38.5%(15/39), negative predictive value was 90.9%(10/11).From what has been discussed above, we concluded that A9 group infection is a major cause of cervical cancer development, the extent of infection relates the degree of cervical lesions. P16 and Ki67 have a higher diagnostic accuracy and screening value than the HPV testing in high level cervical lesions, It can significantly improve the cervical high-level lesions diagnosed rate combained with cytological examination. |
