HPV L1壳蛋白联合HPV分型检测在宫颈癌筛查中的价值探讨

Discussion of the value of human papillomavirus L1 caspid protein detection combined with human papillomavirus genotyping detection in screening of cervical cancer

目的:对液基薄层细胞检测系统(TCT)、HPV分型检测及HPV L1壳蛋白检测在宫颈癌筛查中的应用价值进行综合评价,并探讨其对子宫颈病变诊断的临床意义。方法:回顾性分析在郑州大学第二附属医院妇科门诊2010年7月～2011年5月因体检或发现宫颈异常的1 203例患者同时进行TCT筛查、HPV分型检测,对一项或多项异常者进行病理组织学检查。其中126例TCT结果异常的患者采用免疫细胞化学的方法检测HPV L1壳蛋白的表达,并与病理组织学结果进行比较。结果:1 203例患者的TCT宫颈脱落细胞涂片中,正常涂片214例,占17.74%,良性反应性改变863例,占71.81%,异常涂片126例,占10.45%,后者包括ASCUS 60例、ISIL 44例、HSIL 20例、SCC 2例。在1 203例患者中高危型HPV感染95例,总阳性率7.92%。感染频数前5位分别是:HVP16、18、33、45、58型,其中HPV16占46.15%(44例)、HPV 18占38.46%(37例)、HPV33占7.87%(7例)、HPV45占2.35%(3例)、HPV58占5.17%(4例)。126例异常TCT涂片阳性的患者中,HPV L1壳蛋白总阳性表达数为66例,总阳性率为52.38%,其中HPV L1壳蛋白在炎症、CINⅠ、CINⅡ、CINⅢ的阳性率分别为59.42%(41/69)、65.52%(19/29)、22.73%(5/22)、20.00%(1/5)。CINⅠ组的HPV L1壳蛋白阳性表达率明显高于CINⅡ、CINⅢ及SCC组(P<0.01)。随着宫颈病变的加重,HPV L1壳蛋白阳性表达率逐渐下降,在SCC时无阳性表达。结论:宫颈癌筛查十分必要,TCT筛查、HPV分型检测在宫颈癌筛查中有较为明确的指导价值,而HPV L1壳蛋白检测可以作为预测宫颈癌前病变进展的标志物,三者的有效结合可以及早发现宫颈早期病变,从而降低宫颈癌的死亡率。

Objective：To comprehensively evaluate the application values of thinprep-cytological test（TCT）,human papillomavirus（HPV） genotyping detection,and HPV L1 caspid protein detection in screening of cervical cancer,explore their clinical significances for diagnosis of cervical lesions. Methods：A total of 1 203 patients who were diagnosed as cervical abnormalities during physical examination in outpatient department of gynecology in the hospital from July 2010 to May 2011 received TCT and HPV genotyping detection,the patients with one or many abnormalities received histopathological examination,then the data were analyzed retrospectively.The expressions of HPV L1 caspid protein in one hundred and twenty-six patients with abnormal TCT results were detected by immunohistochemical method,then the results were compared with histopathological results. Results：Among the TCT smears of cervical exfoliative cells from 1 203 patients,the proportion of normal smears was 17.74%（214 patients）;863 patients were found with benign reactive change,accounting for 71.81%;the proportion of abnormal smears was 10.45%（126 patients）,including 60 cases with atypical squamous cells of undetermined significance（ASCUS）,44 cases with low-grade squamous intraepithelial lesion（ISIL）,20 cases with high-grade squamous intraepithelial lesion（HSIL）,and 2 cases with squamous cell carcinoma（SCC）.Among 1 203 patients,95 patients were found with high risk HPV infection,the total positive rate was 7.92%.The top five infection types of HPV were HVP 16,HVP 18,HVP 33,HVP 45,and HVP 58,the proportions of HVP 16,HVP 18,HVP 33,HVP 45,and HVP 58 were 46.15%（44 cases）,38.46%（37 cases）,7.87%（7 cases）,2.35%（3 cases）,and 5.17%（4 cases）,respectively.Among 126 patients with positive TCT smears,66 patients were found with positive HPV L1 caspid protein,the total positive expression rate was 52.38%,the positive expression rates of HPV L1 caspid protein in inflammation,cervical intraepithelial neoplasia（CIN） Ⅰ,CIN Ⅱ,and CIN Ⅲ were 59.42%（41/69）,65.52%（19/29）,22.73%（5/22）,and 20.00%（1/5）,respectively.The positive expression rate of HPV L1 caspid protein in CIN Ⅰ group was significantly higher than those in CIN Ⅱ group,CIN Ⅲ group,and SCC group（P0.01）.The positive expression rate of HPV L1 caspid protein decreased gradually with the aggravation of cervical lesions,HPV L1 caspid protein didn＇t express positively in SCC. Conclusion：Cervical cancer screening is necessary,the guiding values of TCT and HPV genotyping detection are definite in screening of cervical cancer,HPV L1 capsid protein detection can be used as a marker to predict the progression of cervical precancerous lesion,effective joint detection of triple methods can find early cervical lesions timely and reduce the mortality induced by cervical cancer.