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[摘要] 目的 探討液基细胞学检测联合P16/Ki67蛋白表达以及血清SCCA和CA125的水平在宫颈癌早期诊断中的价值。 方法 患者宫颈脱落细胞采用液基细胞学检测和P16/Ki67单克隆抗体CINtec PLUS双染法检测P16/Ki67蛋白，放射免疫法检测患者血清SCCA和CA125水平，依据液基细胞学和病理活检结果进行分组，应用ROC曲线分析液基细胞学检测和P16/Ki67蛋白CINtec PLUS双染法对宫颈癌的早期诊断价值，同时比较分析血清SCCA和CA125的水平在宫颈癌早期诊断中的价值。 结果 非典型的鳞状细胞异常ASC-US中病理学CIN1的所占比例较高，差异具有显著性（P<0.05）。液基细胞学检测结果非典型的鳞状细胞异常各分型和病理学结果有差异（P<0.05），液基细胞学结果分类ASC-US和ASC-H与病理结果有一致性。鳞状上皮病变各分型和病理学结果有差异（P<0.05），液基细胞学结果分类LSIL和HSIL和病理结果也有一致性。液基细胞学检测和P16/Ki67蛋白CINtec PLUS双染法具有一致性，但CINtec PLUS双染法灵敏度和特异度均高于液基细胞学检测。两法的平行并联试验与金标准的一致性较好，灵敏度和约登指数较两者单独试验要高，串联可提高特异度。SCCA和CA125的单独或联合敏感度和特异度均低于液基细胞学检测和P16/Ki67蛋白CINtec PLUS双染法。 结论 P16/Ki67蛋白检测和官颈液基细胞学检查联合具有更高的灵敏度，在宫颈癌早期临床筛查工作中具有临床应用价值。
[关键词] 液基细胞学;宫颈癌;P16/Ki67;SCCA;CA125
[中图分类号] R737.33 [文献标识码] B [文章编号] 1673-9701（2019）36-0120-05
Diagnostic value of liquid-based cytology combined with P16/Ki67 protein and serum SCCA and CA125 in early screening for cervical cancer
REN Ying CONG Linghua HE Yu FANG Laifu
Department of Pathology， Ningbo Yinzhou People"s Hospital， Ningbo 315040， China
[Abstract] Objective To investigate the value of liquid-based cytology combined with P16/Ki67 protein expression and serum SCCA and CA125 levels in early diagnosis of cervical cancer. Methods Cervical exfoliated cells were detected by liquid-based cytology. P16/Ki67 protein was detected by P16/Ki67 monoclonal antibody CINtec PLUS double staining method. The serum levels of SCCA and CA125 were detected by radioimmunoassay. And the patients were grouped according to liquid-based cytology and pathological biopsy. The ROC curve was used to analyze the early diagnosis value of liquid-based cytology and P16/Ki67 protein CINtec PLUS double staining method in the early diagnosis of cervical cancer. At the same time， the early diagnosis value of serum SCCA and CA125 levels in cervical cancer was compared. Results The proportion of pathological CIN1 in atypical squamous cell abnormalities ASC-US was significantly higher， and the difference was significant（P<0.05）. The results of liquid-based cytology showed that there were differences in the classification and pathological results of atypical squamous cell abnormalities（P<0.05）. The results of liquid-based cytology ASC-US and ASC-H were consistent with pathological results. The classification and pathological results of squamous epithelial lesions were different（P<0.05）， and the results of liquid-based cytology classification LSIL and HSIL were consistent with pathological results. The liquid-based cytology test was consistent with the P16/Ki67 protein CINtec PLUS double staining method， but the sensitivity and specificity of the CINtec PLUS double staining method were higher than those of the liquid-based cytology. The parallel test of the two methods was in good agreement with the gold standard， and the sensitivity and the Yoden index were higher than the two separate tests. The series connection could improve the specificity. The sensitivity or specificity of SCCA and CA125 alone or in combination was lower than that of liquid-based cytology and P16/Ki67 protein CINtec PLUS double staining. Conclusion The combination of P16/Ki67 protein detection and cervical liquid-based cytology has higher sensitivity and has clinical value in early clinical screening of cervical cancer.