高危型HPV分型和p16蛋白表达在宫颈病变诊断中的临床意义

Clinical significance of high-risk HPV typing and p16 protein expression in diagnosis of cervical lesions

目的:了解HPV高危型阳性的高级别鳞状上皮内瘤变(high-grade squamous intraepithelial lesion,HSIL)(CIN Ⅱ-Ⅲ)、慢性炎症及宫颈癌中HPV感染分型的不同分型和p16在不同组织中的表达情况,并分析其与HPV的相关性。方法:收集海南省人民医院就诊的海南籍宫颈疾病患者,其中包括HPV高危型阳性的HSIL患者100例、HPV高危型阳性慢性宫颈炎和宫颈癌患者各25例和HPV阴性慢性宫颈炎25例,收集宫颈病理组织,进行HPV分型和p16蛋白表达检测。结果:HPV高危型阳性宫颈病变中,检测出全部13种高危型亚型,主要为HPV16(16.67%)、HPV52(15.33%)、HPV58(12.67%)、HPV31(12.0%),不同宫颈病变HPV分型结果具有高度统一性,差异不具有统计学意义(P=0.999);HPV阴性慢性宫颈炎症组织、HPV高危型阳性慢性宫颈炎症组织、HSIL组织、宫颈癌组织中p16蛋白表达阳性率分别为12.0%、72.0%、84.0%、100.0%,不同宫颈病变p16蛋白表达差异具有统计学意义(P<0.001),随着宫颈病变的进展,p16蛋白表达逐渐增加,p16蛋白表达与宫颈病变的恶性程度具有正相关性。结论:海南籍宫颈病变患者其高危型HPV感染分型分布与目前研究一致,随着宫颈疾病进展加重,p16蛋白表达增加,HPV分型和p16蛋白联合检测对于诊断不同宫颈疾病具有重要价值。

Objective：To investigate the different subtypes of HPV infection in HPV positive cervical HSIL（CIN II-III）,chronic inflammation and cervical cancer and the expression of p16 in different tissues,and to analyze the correlation with HPV.Methods：Patients with cervical disease were collected from Hainan General Hospital,including 100 cases of high-risk HPV positive patients with cervical intraepithelial neoplasia,25 cases of high-risk HPV positive chronic cervicitis ,25 cases of cervical cancer and 25 cases of HPV negative chronic cervicitis.Cervical tissues were collected to detect the expression of HPV typing and p16 protein.Results：In HPV high risk HPV positive cervical lesions,13 high-risk subtypes were detected,mainly for HPV16,HPV52,HPV58 and HPV31.Different cervical lesions HPV typing results had a high degree of unity,and the difference was not statistically significant（P=0.999）.The expression of p16 protein in cervical lesions was statistically significant difference（P〈0.001）,with the progress of cervical lesions,p16 expression increased.The expression of p16 protein was positively correlated with the degree of cervical lesions with evil.Conclusion：The type of Hainan cervical lesions in high-risk HPV infection is consistent with current research,and with the aggravation of cervical disease,the expression of p16 protein increased.Combined detection of p16 protein and HPV typing has important value for the diagnosis of cervical disease.