HPV L1壳蛋白联合高危型HPV检测在宫颈病变中的应用价值

The value of diction of HPV L1 capsid protein and human papilloma virus in cervical lesion

目的探讨HPV L1壳蛋白联合高危型人乳头瘤病毒(human papilloma virus,HPV)检测在细胞学异常分流管理及宫颈病变进展评估中的应用价值。方法选择2013年5月—2014年10月收治的液基细胞学(thinprep cytologic test,TCT)结果异常且高危型HPV HC2阳性患者144例作为研究对象,同时行HPV L1壳蛋白检测及宫颈活检,病理检查结果为诊断的金标准。计数资料采用χ2检验,HPV L1壳蛋白阳性率与宫颈病变严重程度的关系采用Spearman相关分析,P<0.05为差异有统计学意义。结果 TCT结果为意义未明的非典型鳞状细胞(atypical squamous cells of undetermined significance,ASCUS)、不能排除高度上皮内瘤变的不典型鳞状细胞(atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion,ASC-H)、轻度鳞状上皮内病变(lower-grade squamous intraepithelial lesions,LSIL)、高度鳞状上皮内病变(high-grade squmous intraepithelial lesions,HSIL)、鳞癌(squamous cell carcinoma,SCC)的HPV阳性率分别为52.78%、57.89%、75.61%、86.67%、100.00%,TCT不同结果患者HPV阳性率比较差异有统计学意义(P<0.05)。HPV L1壳蛋白在宫颈炎、宫颈上皮内瘤变Ⅰ级(cervical intraepithelial neoplasiaⅠ,CINI)、宫颈上皮内瘤变Ⅱ级(cervical intraepithelial neoplasiaⅡ,CINⅡ)、宫颈上皮内瘤变Ⅲ级(cervical intraepithelial neoplasiaⅢ,CINⅢ)、SCC中的表达阳性率分别为52.63%、63.27%、23.08%、9.09%、0,不同病理阶段HPV L1壳蛋白的表达阳性率比较差异有统计学意义(P<0.05)。HPV L1壳蛋白阳性率与宫颈病变严重程度呈负相关(r=-0.912)。结论 HPV L1壳蛋白对宫颈病变风险的评估有重要的指导意义。HPV L1壳蛋白联合高危型HCV检测能对细胞学异常患者进行有效的分流管理与治疗。

Objective To study the clinical value of HPV L1 capsid protein and human papilloma virus（HPV） in clinical triage management and predicting outcome of cervical lesion.Methods 144 patients with HPV DNA detection positive and thinprep cytologic test（TCT） detection abnormal from May 2013 to October 2014 were selected.The HPV L1 caspid protein in cytologic specimens was detected by using immunochemistry and cervical biopsy were performed.All diagnoses were confirmed in histology.Count data was processed by chi square test,the relatiouship between positive rate of HPV L1 capsid protein and severity of cervical cancer were processed by Spearman,P〈0.05 was considered statistically significant.Results The positive rate of HPV in atypical squamous cells of undetermined significance（ASCUS）,atypical squamous cells cannot exclude high- grade squamous intraepithelial lesion（ASC- H）,lower- grade squamous intraepithelial lesions（LSIL）,high- grade squmous intraepithelial lesions（HSIL）,squamous cell carcinoma（SCC） were 52.78%,57.89%,75.61%,86.67%,100.00%,the difference was statistically significant（P〈0.05）.The positive rate of HPV L1 capsid protein in cervicitis, cervical intraepithelial neoplasia Ⅰ（CINⅠ）,cervical intraepithelial neoplasia Ⅱ（CINⅡ）,cervical intraepithelial neoplasia Ⅲ（CINⅢ）,SCC were 52.63%,63.27%,23.08%,9.09%,0,the difference was statistically significant（P〈0.05）.The relationship between positive rate of HPV L1 capsid protein and severity of cervical cancer were negative correlation（r=- 0.912）.Conclusion HPV L1 capsid protein detection had important guiding value on risk assessment of cervical lesions.Diction of HPV L1 capsid protein and HPV can accurate diversion and treatment of patients with cervical lesions.