HPV L1壳蛋白在诊断宫颈上皮内瘤变及预测其转归中的临床价值

Clinical value of HPV L1 capsid protein in diagnosis of cervical intraepithelial neoplasia and forecast of its outcome

目的研究HPV L1壳蛋白检测在宫颈上皮内瘤变(CIN)诊断中的临床意义以及对CIN转归的预测价值,探索更加合理有效诊断处理CIN的方案。方法选择在南京大学医学院附属鼓楼医院行宫颈HPV-HC2检测阳性的妇女共187例,同时检查TCT、HPVL1壳蛋白检测及宫颈活检,以病理组织结果为金标准进行对照研究,并对其中继续在鼓楼医院治疗并随访的114例妇女行跟踪研究2年。结果 (1)根据宫颈活检病理结果分组,CIN1、CIN2、≥CIN3的L1壳蛋白阳性率分别是49.12%、30.00%、20.45%,运用卡方检验,χ2=10.437,P=0.015<0.05,有统计学差异。CIN1组的L1阳性率大于其他各组,而其他组别的L1阳性率之间均无统计学差异,CIN2和CIN3合并与CIN1组进行卡方检验,χ2=9.443,P=0.002<0.05,有统计学差异。(2)在2年随访结果中,CIN1未手术组L1(+)和L1(-)的HC2转阴率比较,P=0.022<0.05,有统计学差异。(3)HPVL1壳蛋白对CIN1的转归有较好的预测作用,CIN1患者中L1(+)的HPV转阴率较L1(-)的高。结论 (1)CIN1组的L1阳性率大于其他各组,而其他组别的L1阳性率之间均无统计学差异。(2)随访2年结果:未手术组L1(+)和L1(-)的HC2转阴率比较,有统计学差异(P<0.05)。(3)HPVL1壳蛋白可作为CIN1的临床预后指标。

Objective To evaluate the clinical significance of HPV L1 capsid protein detection in the diagnosis of cervical intraepithelial neoplasia （CIN） and its predictive value to disease outcome,and explore more reasonable and effective diagnosis of treatment of CIN.Methods Cervical biopsy were performed on 187 HPV-DNA （＋） women who received the testing of TCT,HPV L1 capsid protein in Drum Tower Hospital affiliated to Nanjing University.The result of histopathologic test was recognized as gold standard,and a follow-up study was done to 114 women who received treatment or review in this hospital.Results （1） Cervical biopsy in different pathological group CIN1,CIN2,CIN3,L1 positive rates were 49.12％,30.00％,20.45％ by chi-square test,x2 =10.437,P =0.015,there was a statistically significant difference.The positive rate of L1 in CIN1 group than the other groups,and several other groups showed no difference between the positive rate of L1,CIN2 and CIN3 combined with CIN1 group was the chi-square test,x2 =9.443,P =0.002,there was a statistically significant difference.（2） During 2 years of follow-up results without operation in group L1 （＋） and L1 （-） HC2 negative rates,there was significant difference,P =0.022.（3）HPV L1 capsid protein on CIN1 outcome prediction function,CIN1 in L1 patients with positive HPV negative rate was L1 negative high.Conclusions （1） The positive rate of L1 in CIN1 group was higher than the other groups,and several other groups showed no difference between the positive rate of LI.（2） Results of 2 years of follow-up without operation in group L1 （＋） and L1 （-） HC2 negative rates,there was significant difference.（3）HPV L1 capsid protein can be used as CIN1 clinical prognostic indices.