宫颈癌及癌前病变患者HPV感染与机体免疫状态的研究

HPV infection and immune status in cervical carcinoma and cervical intraepithelial neoplasia

目的探讨宫颈癌及癌前病变患者HPV感染及全身细胞免疫功能状态。方法选择2014年8月至2015年1月妇产科门诊就诊的宫颈癌及癌前病变患者271例,进行液基细胞学(TCT)、HPV-DNA和阴道镜下病理检查,同时行流式细胞术检测外周血淋巴细胞亚群。结果宫颈炎、宫颈上皮内瘤变Ⅰ级(CINⅠ)、宫颈上皮内瘤变Ⅱ级(CINⅡ)、宫颈上皮内瘤变Ⅲ级(CINⅢ)及宫颈鳞状细胞癌(SCC)患者随着宫颈病变程度的加重,HPV阳性率明显升高(P<0.05);随着病理分期的进展,HPV阳性率也明显升高(P<0.01)。CINⅠ、CINⅡ、CINⅢSCC组CD3^+T细胞比例与宫颈炎组比较差异均无统计学意义(均P>0.05),CD4^+T细胞比例逐渐下降,且SCC组与宫颈炎组相比有统计学差异(P<0.05),而CD8^+T细胞比例有逐渐增加的趋势,且CINⅡ、CINⅢ、SCC组与宫颈炎组相比均有统计学差异(均P<0.05)。SCC及CINⅠ、CINⅡ、CINⅢ组CD19^+B细胞比例比较差异均无统计学意义(均P>0.05),而NK细胞比例的差异与宫颈炎组比较均有统计学意义(均P<0.05),且随着病理分期进展逐渐递增。结论宫颈病变患者体内存在明显的淋巴细胞亚群偏移,可能与HPV病毒逃避免疫监视有关,了解这一变化可为免疫治疗干预癌前病变提供帮助。

Objective To investigate HPV infection and immune status in squamous cervical carcinoma （SCC） and cervical intraepithelial neoplasia （CIN）. Methods Two hundred and seventy one patients with cervical lesions visiting outpatient department from August 2014 to January 2015 were included in the study. TCT, HPV-DNA tests and colposcopic cervical biopsies were performed, and peripheral blood lymphocyte subsets were examined with flow cytometry in all patients. Results In patients with chronic cervicitis, CIN Ⅰ , CIN Ⅱ, CIN Ⅲ and SCC the positives of HPV expression were increased with the progress of cervical diseases （P〈0.05）. And with the progress of the pathological staging, the positive rates of HPV were increased （P〈0.01）. There was no significant difference in CD3^＋ T-lymphocytes among chronic cervicitis, CIN and SCC （all P 〉 0.05）. CD4^＋ T-lymphocytes were decreased with the progress of cervical diseases（P〈0.05）, while CD8^＋ T-lymphocytes were increased（allP〈0.05）. There was no significant difference in CD19^＋ B-lymphocytes（all P 〉0.05）, while significant difference in NK cells among different cervical diseases（all P〈0.05）, the degree of positivity was correlated with clinicopathological stages. Conclusion HPV infection rate is increased with the progress of cervical lesions, which is associated with the decreased immune status of patients.