人乳头状瘤病毒L1壳蛋白对宫颈癌前病变及宫颈癌的诊断价值分析

Analysis on the value of HPV L1 capsid protein for the diagnosis of cervical lesions and cervical cancer

目的探讨人乳头状瘤病毒（HPV）LI壳蛋白在不同宫颈病变中的表达情况及相关性。方法选择2011年1月-2013年1月于新疆维吾尔自治区人民医院妇科就诊的高危型HPV阳性宫颈病变患者171例作为研究对象．其中慢性宫颈炎组23例，宫颈上皮内瘤变组121例（CINI组48例、CINII组34例、CINIII组39例）、宫颈鳞状细胞癌（SCC）组患者27例，采用免疫组化方法检测HPVL1壳蛋白在5种宫颈病变组织的表达情况。结果171例患者中，HPVL1阳性表达63例，阳性率为36．8％，其中在慢性宫颈炎患者中，HPVL1蛋白阳性表达为17例，阳性率为73．9％；CINI患者中，HPVL1蛋白阳性表达为32例，阳性率为66．7％；CINⅡ患者中，HPVLl蛋白阳性表达为12例，阳性率为35．3％；CINUI患者中，HPVL1蛋白阳性表达为2例，阳性表达率为5．1％，SCC组中无HPV L1蛋白表达。五组患者HPVL1蛋白阳性表达率整体比较，差异有统计学意义（P〈0．05）；炎症组与CINII组、CINIII组、SCC组比较，差异有统计学意义（P〈0．05）；CINI组与CINII组、CINIII组、SCC组比较，差异有统计学意义（P〈0．05）。以患者的病理检查结果作为金标准，绘制ROC曲线，面积为0．799，标准误为0．062，95％CI为0．677—0．921，灵敏度为0．769，特异度为0．750。结论HPVL1壳蛋自在宫颈上皮内瘤变中的阳性表达随病变程度的加重而呈下降趋势。提示其有望成为预测宫颈癌前病变程度的标志物，对于宫颈癌前病变的筛查和预防具有重要的意义。

Objective To study the expression and correlation of human papilloma virus （HPV） L1 capsid protein in different cervical lesions. Methods 171 cases cervical lesions patients with high-risk type of HPV infection in our hospital from Jan- uary 2011 to January 2013 were selected as the research object, and were divided into chronic eervicitis group （23 cases ）, cervical intraepithelial neoplasia group （121 cases, in which there have 48 cases in CIN I group, 34 cases in CIN II group and 39 cases in CINIII group）, squamous cell carcinoma （SCC） group （27 cases）. The expression of HPV LI capsid protein in 5 kinds of cervical tissues were measured by immunohistochemical method. Results Among 171 cases, 63 eases were HPV L1 capsid protein positive expression, the positive expression rate was 36.8%; 17 cases were HPV L1 protein positive expression among these patients with chronic cervicitis, the positive expression rate was 73.9%; 32 cases were HPV L1 capsid protein positive expression patients in CIN I group, the positive expression rate was 66.7%; 12 cases were HPV LI capsid protein positive expression in CIN I1 group, the positive expression rate was 35.3%; 2 cases were HPV L1 capsid protein positive ex- pression patients in CIN m group, the positive expression rate was 5.1%, there was no HPV L1 capsid protein expression in SCC group. HPV L1 capsid protein positive expression rate was compared overall among the five groups, the difference was statistically significant （P 〈 0.05）, compared the inflammation group with CIN II group, CIN III group and the SCC group, the difference was statistically significant （P 〈 0.05）, compared the CIN I group with CIN II group, CIN III group and the SCC group, the difference was statistically significant （P 〈 0.05）. ROC curve was drew with the results of pathologic examination as the gold standard, covers an area of 0.799, standard error was 0.062, 95% confidence interval was from 0.677 to 0.921, the sensitivity was 0.769, the specificity was 0.750. Conclusion Positive expression of HPV L1 capsid protein in cervical intraep- ithelial neoplasia descends with the procession of the cervical lesion, it is possible to be a marker to predict the degree of cer- vical lesion, and play an important role in screening of cervical precancerous lesions.