人乳头瘤病毒L1壳蛋白在宫颈脱落细胞中的表达及其临床意义

Expression and clinical value of human papillomavirus L1 caspid protein in cervical disease

目的：研究人乳头瘤病毒（human papillomavirus,HPV）L1壳蛋白在各级宫颈病变脱落细胞中的表达及其临床意义。方法：选择2013年7月至2015年3月,重庆市妇幼保健院宫颈病专科薄层液基细胞学检测（thinprep cytologic test,TCT）结果异常和/或高危型HPV-DNA检测[采用第二代杂交捕获法（hybrid captureⅡ,HC-2）]结果阳性,且阴道镜检查疑有宫颈病变的妇女共248例,所有研究对象均行HPV L1壳蛋白检测及宫颈活检,并对患者进行跟踪研究。结果：在正常宫颈、宫颈上皮内病变（cervical intraepithelial neoplasia,CIN）Ⅰ级、CINⅡ/Ⅲ级和宫颈鳞癌（squamous cell carcinoma,SCC）患者中,HPV L1壳蛋白阳性率分别为13.04%（3/23）、28.36%（19/67）、11.92%（18/151）、0%（0/7）,其中CINⅠ组L1壳蛋白阳性表达率明显高于CINⅡ/Ⅲ组,差异有统计学差异（χ2=8.898,P=0.003）。将患者以年龄30岁为界分为2组,在年龄〈30岁组（共76例）中,各组织学分组之间L1壳蛋白阳性表达率差异均无统计学意义;在年龄≥30岁组（共172例）中,CINⅠ组（13/45,28.89%）与CINⅡ/Ⅲ组（12/104,11.54%）比较L1壳蛋白阳性表达率明显增高,差异有统计学意义（χ2=6.772,P=0.009）;HPV负荷量〉100 RLU/CO组HPV L1壳蛋白表达率（27/82,32.93%）高于HPV负荷量≤100 RLU/CO组（13/166,7.83%）,差异有统计学意义（χ2=25.553,P=0.000）;83例CIN患者随访12～24个月,HPV L1壳蛋白表达阴性组病变进展率（23/62,37.10%）大于阳性表达组（2/21,9.52%）,差异有统计学意义（χ2=4.432,P=0.035）。结论：HPV L1壳蛋白在CINⅡ/Ⅲ中阳性表达率较CINⅠ呈下降趋势,HPV L1壳蛋白阳性表达组病变进展率低,可作为预测宫颈病变进展风险的临床参考指标。

Objective：To evaluate the expression and clinical significance of human papillomavirus L1 capsid protein（HPV L1 capsid protein） in cytologic specimens of the cervix. Methods：HPV L1 capsid protein in cytologic specimens of the cervix and cervical biopsy were performed on 248 women with abnormal results of TCT and/or HPV-HC2 and colposcopy,which were treated in the department of cervical diseases in the Maternal and Child Health Center of Chongqing from July 2013 to March 2015. The result of histopathologic test was recognized as gold standard,and a follow-up study was done. Results：The positive expression rate of HPV L1 capsid protein was 13.04%,28.36%,11.92% and 0% in the normal cervix,CINⅠ,CINⅡ/Ⅲ and SCC respectively. The positive expression of HPV L1 capsid protein in group CINⅠwas much higher than that in group CINⅡ/Ⅲ（χ~2=8.898,P=0.003）. All cases were divided into two groups by taking 30-year-old as the cutting point,and there was no significant difference in the HPV L1 positive staining between subgroups in those under the age of 30. However,in the group aged more than 30,the positive expression of HPV L1 capsid protein was much higher in group CINⅠ than in group CINⅡ/Ⅲ（28.89% vs. 11.54%,χ~2=6.772,P=0.009）. The positive expression of HPV L1 capsid protein was significantly higher in the over-100 RLU/CO viral load group than in the under-100 RLU/CO viral load group（32.93% vs. 7.83%,χ~2=25.553,P =0.000）. HPV L1-positive patients showed progression in 9.52% cases,whereas HPV L1-negetive patients had progression in 37.10% cases（χ~2=4.432,P =0.035）. Conclusion：The positive expression of HPV L1 capsid protein is significantly decreased in CINⅡ/Ⅲ than in CINⅠ.HPV L1-positive patients show significantly reduced progression than HPV L1-negetive patients. HPV L1 capsid protein can be a useful marker in the assessment and prediction for cervical disease progression.