p16蛋白表达及HPV检测在宫颈上皮内瘤变中的诊断意义

Significance of p16 protein expression and HPV detection in the diagnosis of cervical intraepithelial neoplasia

目的探讨p16和HPV检测在评估宫颈低度鳞状上皮内瘤变和高度鳞状上皮内瘤变分型中的价值。方法对宫颈低度鳞状上皮内瘤变和高度鳞状上皮内瘤变患者同时采用第2代杂交捕获(HC2)试验系统检测高危型HPV感染及检测p16蛋白的表达,比较宫颈低度鳞状上皮内瘤变和高度鳞状上皮内瘤变HPV-DNA负荷量和p16蛋白表达的差异。结果宫颈低度鳞状上皮内瘤变中p16表达率为36.67%(11/30),高度鳞状上皮内瘤变中表达率为100%(40/40),二者比较差异有显著性(P<0.01)。30例低度鳞状上皮内瘤变中HC2检测阳性率为63.33%(19/30),高度鳞状上皮内瘤变中为97.5%(39/40),二者比较差异有显著性(P<0.01)。HPV感染与p16表达呈正相关。结论宫颈上皮内瘤变中p16的强阳性染色和全层染色支持高度鳞状上皮内瘤变的诊断,高度鳞状上皮内瘤变与高危型HPV感染有关,对于宫颈高度上皮内瘤变的诊断,最好HPV与p16联合应用,以提高其病理诊断准确性。

Objective To explore the value of p16 and HPV in evaluating the low-grade and high-grade cervical squamous intraepithelial neoplasia. Methods The high-risk HPV infection and p16 protein expression were tested in the patients with low-grade and high-grade cervical squamous intraepithelial neoplasia by the second generation of hy- brid capture （HC2） test system. The HPV DNA load and p16 expression of the low-grade and high-grade cervical squamous intraepithelial neoplasia were analyzed and compared. Results The p16 protein expression rate of the lowgrade cervical squamous intraepithelial neoplasia was 36.67% （11/30）, while that of the high-grade cervical squamous intraepithelial neoplasia was 100 % （40/40）. So the comparative difference was statistically significant（ P 〈0.01）. Besides,the positive rate of HC2 of the cases with low-grade squamous intraepithelial neoplasia（30 cases） was 63.33% （19/30） ,and that of the high-grade cervical squamous intraepithelial neoplasia was 97.5% （39/40）. So the difference had statistical significance（ P〈0.01）, p16 expression was positively related to HPV infection. Conclusion The strong positive p16 staining and the full thickness staining of cervical intraepithelial neoplasia support the diagnosis of high grade squamous intraepithelial neoplasia. High-grade squamous intraepithelial neoplasia is associated with high risk HPV infection. It is better to combine the application of p16 and HPV so as to improve the accuracy of the pathological diagnosis of high-grade cervical lesions.