Survivin蛋白与宫颈细胞形态学改变、HPV感染及宫颈上皮内瘤变

Relationship between Survivin protein and morphological changes of cervical cells,HPV infection and cervical intraepithelial neoplasia

目的:探讨Survivin蛋白与宫颈细胞形态学异常、人乳头状瘤病毒(HPV)感染和宫颈上皮内瘤变(CIN)级别的关系。方法:收集天津医科大学总医院2008年1月～2009年12月妇科门诊就诊患者中经组织学检查确诊为CINⅡ和CINⅢ并同时具备宫颈脱落细胞液基细胞学检查(LCT)和HPV检测的患者共82例为研究对象。Survivin蛋白检测采用免疫组织化学方法。结果:Survivin蛋白在正常宫颈组织呈阴性表达;在所有CINⅡ和CINⅢ的宫颈组织中均呈阳性,阳性率100%,其表达强度在CINⅢ中强于CINⅡ(P<0.05)。Survivin蛋白表达与LCT所见不同细胞形态学异常改变之间的关系为:在HSIL组表达强度强于LSIL组(P<0.001);在LSIL组以轻度阳性为主;在ASCUS组和未见上皮内病变细胞或恶性细胞(NILM)组之间的差异不具有统计学意义。82例患者HPV阳性者76例,单一基因型HPV感染较多的是HPV-16、HPV-33、HPV-58。Survivin蛋白在该3个基因型单一感染的CIN组织中的表达情况为:在HPV-16单一感染的CIN组织中呈强阳性和中度阳性表达;在HPV-33单一感染的CIN组织中呈中度阳性表达;在HPV-58单一感染的CIN组织中呈轻度阳性表达。Survivin蛋白的阳性率在以上三者之间的差异,两两比较差异均具有统计学意义(P<0.001)。结论:Survivin在CINⅡ和CINⅢ中的阳性率为100%,说明Survivin是CINⅡ和CINⅢ敏感的免疫组织化学指标,且与CINⅡ和CINⅢ的级别有关(P<0.05)。Survivin在LCT所见不同细胞形态学异常改变之间表达强度的变化表明,Survivin蛋白的表达与宫颈上皮细胞异型性的程度有关。Survivin蛋白阳性表达率在特定基因型HPV感染的CIN组织的差异表明,Survivin蛋白阳性表达与HPV-16感染存在很强的相关性。

Objective：To explore the relationship between Survivin protein and morphological changes of cervical cells,human papillomavirus（HPV） infection and cervical intraepithelial neoplasia（CIN）.Methods：82 cases diagnosed as CINⅡ and CINⅢ definitely by histological examination in outpatient department of gynecology in the hospital from January 2008 to December 2009 were collected as study objects,and all the cases received liquid-based cytological test（LCT） of cervical exfoliative cells and HPV detection.Immunohistochemical method was used to detect Survivin protein level.Results：Survivin protein did not express in normal cervical tissues;Survivin protein expressed positively in cervical tissues of CINⅡ and CINⅢ,the positive rate was 100%,the expression level of Survivin protein in cervical tissues of CINⅢ was significantly higher than that in cervical tissues of CINⅡ（P0.05）.The relationship between Survivin protein expression and morphological changes showed by LCT： the expression level of Survivin protein in high-grade squamous intraepithelial lesion（HSIL） group was significantly higher than that in low-grade squamous intraepithelial lesion（LSIL） group（P0.001）;mild positive expression of Survivin protein was found in LSIL group;there was no significant difference in expression level of Survivin protein between atypical squamous cells of undetermined significance（ASCUS） group and negative for intraepithelial lesion or malignancy（NILM） group.Among 82 patients,76 patients were found with positive HPV,the main types of HPV infection were HPV-16,HPV-33 and HPV-58.In cervical tissues of CIN with single infection of HPV-16,Survivin protein showed strong positive and moderate positive expression;in cervical tissues of CIN with single infection of HPV-33,Survivin protein showed moderate positive expression;in cervical tissues of CIN with single infection of HPV-58,Survivin protein showed mild positive expression,there was significant difference among the three groups（P0.001）.Conclusion：The positive rates of Survivin protein in cervical tissues of CINⅡ and CINⅢ are 100%,and the phenomenon indicates that Survivin protein is a sensitive immunohistochemical marker of CINⅡ and CINⅢ,which is related to the grades of CINⅡ and CINⅢ（P0.05）.The expression of Survivin protein is correlated with the degrees of atypia of cervical epithelial cells.The difference of positive expression rate of Survivin protein among cervical tissues with different subtypes of HPV infection shows that there is a significant correlation between positive expression of Survivin protein and HPV-16 infection.