HPV L1壳蛋白联合HPV分型、TCT检测技术对子宫颈病变进展风险的评估

Risk Assessment of Cervical Lesion by Combined Detection of Papillomavirus L1 Capsid Protein and Human Papillomavirus Genotyping,Thinprep-cytology Test

目的:探讨人乳头瘤病毒L1(human papilloma virus L1,HPV L1)壳蛋白联合HPV分型、液基薄层细胞学(thinprap cytology test,TCT)技术对预测子宫颈病变进展的风险评估以及指导临床最佳的分流管理与治疗。方法:回顾性分析2010年9月—2011年12月在郑州大学第二附属医院妇科门诊因宫颈病变就诊的1 593例有性生活的妇女,即同时进行TCT和HPV-DNA分型检测,对其中HPV阳性或TCT阳性或两项同时阳性的592例患者进行阴道镜下活检送病理组织学检查,并对HPV-DNA分型阳性者同时检测HPV L1壳蛋白的表达。结果:TCT联合HPV-DNA分型检测在宫颈上皮内瘤变Ⅲ(CINⅢ)及以上病例中检出率最高,在鳞状细胞癌(SCC)中达到了100%;HPV L1壳蛋白阳性率随着宫颈病变级别的加重呈现下降趋势,在SCC时表达为0。各组间HPV L1壳蛋白阳性表达率差别有统计学意义(P<0.05)。结论:TCT联合HPV分型检测在子宫颈病变筛查中是必不可少的指标,且HPVL1壳蛋白检测对子宫颈病变进展的风险评估有重要指导价值。三者的有效结合可以及时准确地对子宫颈病变患者进行最佳的分流管理与治疗。

Objective：To explore risk assessment of cervical lesion and guidance of the best clinical triage management and treatment by combined detection of human papillomavirus L1 c apsid protein and human papillomavirus （HPV） genotyping, thinprep cytology test （TCT）. Methods：Retrospective analysis of 1 593 women of cervical cancer screening in the gynecological clinic of the Second Affiliated Hospital of Zhengzhou University from September 2010 to December 2011, and TCT and geno- typing of HPV-DNA testing at the same time,in which 592 patients who was HPV-positive or TCT positive or both abnormal were sent to colposcopic biopsy for pathological examination and who was HPV-DNA typing-positive were detection of HPV L1 capsid protein expression. Results：TCT combined with HPV-DNA detection in cervical intraepithelial neoplasia Ⅲ （CIN Ⅲ） and the above cases had the highest rate and reached 100% positivity in squamous cell carcinoma （SCC）;the positive rate of HPV L1 capsid protein expression show a decreased trend with the increasing level of cervical lesions, the expression of HPV L1 capsid protein and SCC was 0. The positive expression rate of HPYL1 capsid protein in each group was significantly different （P〈0.05）. Conclnsions：h is an essential indicator that TCT combined HPV genotyping in cervical lesions screening,and HPVL1 capsid protein detection had important guiding value on risk assessment of cervical lesions. Three factors effective com- bination can be timely and accurate diversion and treatment of patients with cervical lesions.