高危型HPV E7蛋白在宫颈鳞状上皮内病变中的表达及意义

Significance of High-risk HPV E7 Protein Expression in Cervical Squamous Intraepithelial Lesions

目的检测细胞蜡块、组织蜡块中宫颈鳞状上皮内病变中E7表达及与P16和Ki-67表达的相关性,探讨E7在辅助诊断宫颈鳞状上皮内病变中的临床意义。方法应用免疫组化方法检测E7、P16和Ki-67在71例宫颈液基细胞蜡块及相对应组织蜡块中的表达,其中未见上皮内病变或细胞(NILM)组11例、低度鳞状上皮内病变(LSIL)组34例[包括非典型鳞状细胞-不能明确意义(ASC-US)12例及LSIL22例]、高度鳞状上皮内病变及以上病变(HSIL+)组26例,包括非典型鳞状细胞-不除外高度鳞状上皮内病变(ASC-H)2例、高度鳞状上皮内病变(HSIL)20例及鳞状细胞癌(SCC)4例。结果在宫颈细胞蜡块NILM、LSIL、HSIL+组中,E7的阳性率分别为0、0和61.5%;P16的阳性率分别为0、0和50.0%;Ki-67的阳性率分别为0、5.9%和76.9%。在相对应的组织蜡块NILM、LSIL、HSIL+组中,E7的阳性率分别为6.7%、51.9%和89.7%;P16的阳性率分别为0、18.5%和89.7%;Ki-67的阳性率分别为0、18.5%和86.2%。与NILM组及LSIL组比较,无论在细胞蜡块或组织蜡块中,HSIL+组E7、P16和Ki-67的表达均显著增高(P<0.05),并且E7与P16/Ki-67的表达均呈正相关。E7检测较P16/Ki-67检测有较高的敏感度,E7联合P16/Ki-67检测的敏感度和阴性预测值高于P16/Ki-67检测。结论E7可用于HSIL+的诊断和鉴别诊断,E7有望成为P16/Ki-67在辅助诊断HSIL+的补充标志物。

Objective To detect the expression of E7 protein in cellular wax block of cervical liquid-based cytology and cervical tissue wax block and its correlation with the expression of P16 and Ki-67,and to study the clinical significance of E7 protein in assistant diagnosis of high-grade squamous intraepithelial lesions of cervical.Methods The expression of E7,P16 and Ki-67 were detected by immunohistochemistry in 71 cases of cellular wax block of cervical liquid-based cytology and corresponding tissue wax block,including 11 cases of negative for intraepithelial lesion or malignacy(NILM),34 cases of low-grade squamous intraepithelial lesion(LSIL)[including 12 cases of atypical squamous cells of undetermined significance(ASC-US),22 cases of LSIL],26 cases of high-grade squamous intraepithelial lesion and above(HSIL+)[including 2 cases of atypical squamsus cells cannot exclude HSIL(ASC-H),20 cases of high-grade squamous intraepithelial lesion(HSIL)and 4 cases of squamous cells cancer(SCC)].Results In cellular wax block of cervical liquid-based cytology,the E7 positive rates for NILM,LSIL and HSIL+groups were 0,0,61.5%respectively,the P16 positive rates were 0,0,50.0%respectively and the Ki-67 positive rates were 0,5.9%,76.9%respectively.In corresponding tissue wax block,the E7 positive rates for NILM,LSIL and HSIL+groups were 6.7%,51.9%,89.7%respectively,the P16 positive rates were 0,18.5%,89.7%respectively and the Ki-67 positive rates were 0,18.5%,86.2%respectively.Compared with NILM group and LSIL group,the expressions of E7,P16 and Ki-67 in HSIL+group were significantly increased(P<0.05)and the expressions of E7 and P16/Ki-67 were in a positive correlation in cellular wax blocks and tissue wax blocks.The sensitivity of E7 was higher than that of P16/Ki-67.The sensitivity and negative predictive value of E7 combined with P16/Ki-67 were higher than the ones of P16/Ki-67.Conclusion E7 can be used in the diagnosis and differential diagnosis of HSIL+and E7 is expected to be a complementary marker for P16/Ki-67 in the auxiliary diagnosis of HSIL+.