人乳头状瘤病毒L1蛋白在宫颈上皮内瘤样病变中的表达及临床意义

Expression and Clinical Significance of Human Papillomavirus L1 Protein in Cervical Intraepithelial Neoplasia

目的通过研究人乳头状瘤病毒(Human Papilloma Virus,HPV)Ll蛋白在不同级别宫颈上皮内瘤样病变(Cervical Intraepithelial Neoplasia,CIN)中的表达,探讨HPV L1蛋白在临床上的应用价值。方法选取2013年12月至2015年12月北京市垂杨柳医院收治的经病理结果确诊为CIN合并高危HPV感染的76例患者作为研究对象,免疫组化方法检测不同级别CIN中HPV L1蛋白的表达,并与液基薄层细胞检测(TCT)比较预测结果。结果76例患者中,HPV Ll蛋白总阳性率26.32%(20/76)。低级别鳞状上皮内病变(LSIL)HPV L1蛋白的阳性率为44.12%(15/34),高级别鳞状上皮内病变(HSIL)为11.90%(5/42),差异有统计学意义(P<0.05)。在高危型HPV阳性妇女中,HPV L1蛋白及TCT预测组织学诊断HSIL病变敏感度分别为88.10%、50.00%,二者的阴性预测值分别为75.00%、55.32%,HPV L1蛋白的数值均高于TCT(P<0.05),但二者的特异度44.12%、76.47%,HPV L1低于TCT(P<0.01)。结论HPV L1蛋白可能成为高危型HPV阳性患者的一种合适的分流方法,在提高宫颈上皮内瘤样病变的筛查率中具有一定的临床价值。

Objective To investigate the expression of human papilloma virus(HPV)L1 protein in different grades of cervical intraepithelial neoplasia(CIN),and to explore the clinical application value of HPV L1 protein.Methods From December 2013 to December 2015 of Beijing Chuiyangliu Hospital,76 patients with CIN complicated with high-risk HPV infection were selected as the research objects.The expression of HPV L1 protein in different levels of CIN was detected by immunohistochemistry,and the predicted results were compared with liquid based thin layer cell detection(TCT).Results The total positive rate of HPV Ll protein was 26.32%(20/76).The positive rate of HPV Ll protein in low-grade squamous intraepithelial lesion(LSIL)was 44.12%(15/34)and that of highgrade squamous intraepithelial lesion(HSIL)was 11.90%(5/42),the difference was statistically significant(P<0.05).In high-risk HPV positive women,the sensitivity of HPV L1 protein and TCT in predicting HSIL lesions was 88.10%,50.00%and negative predictive value was 75.00%,55.32%,which the number of HPV L1 were all higher than those of TCT(P<0.05),but their specificity was 44.12%,76.47%,which the number of HPV L1 was lower than that of TCT(P<0.01).Conclusion HPV L1 protein has a certain value in CIN screening of high-risk HPV positive women,and may become an appropriate shunt method for high-risk HPV positive women.