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目的探讨人乳头状瘤病毒(HPV)L1壳蛋白在宫颈不同病变脱落细胞中的表达和临床意义。方法收集2008年1月至2009年5月到北京大学深圳医院宫颈门诊就诊患者的宫颈脱落细胞标本309例,其中正常或慢性宫颈炎33例、宫颈上皮内瘤变(CIN)Ⅰ级168例、CINⅡ/Ⅲ级84例和鳞状细胞癌(SCC)24例,用免疫细胞化学法检测HPV L1壳蛋白在宫颈脱落细胞中的表达。结果在正常宫颈或慢性宫颈炎、CINⅠ、CINⅡ/Ⅲ和SCC中,HPV L1壳蛋白阳性表达率分别为27.3%(9/33)、66.7%(112/168)、25.0%(21/84)、0%(0/24)。其中CINⅠ组、SCC组与正常或慢性宫颈炎组比较,CINⅠ组与CINⅡ/Ⅲ组比较,CINⅠ、CINⅡ/Ⅲ组与SCC组比较差异均有统计学意义(均P<0.01),随病变程度的加重,HPV L1壳蛋白阳性表达率呈下降的趋势。分别以30岁和40岁为界分组,不同年龄组间HPV L1壳蛋白的表达差异均无统计学意义(均P>0.05)。在高危型HPV DNA负荷量≥1 000 RLU/PC组HPV L1壳蛋白表达率为73.1%,与负荷量<1 000 RLU/PC的各组相比,其表达率明显增加(均P<0.05)。HPV L1壳蛋白检测CINⅡ/Ⅲ以上病变的敏感度、特异度、阳性预测值和阴性预测值分别为80.6%、60.2%、52.1%和85.2%。结论HPV L1壳蛋白在CIN和SCC中的阳性表达率随着病变程度加重呈下降趋势,有望成为预测宫颈癌前病变进展的生物学标志物。
Objective To investigate the expression of human papillomavirus (HPV) L1 capsid protein in exfoliated cells of different cervical lesions and its clinical significance. Methods A total of 309 cervical exfoliated cells were collected from patients in the cervical clinic of Peking University Shenzhen Hospital from January 2008 to May 2009, of which 33 cases were normal or chronic cervicitis, 168 cases were grade Ⅰ cervical intraepithelial neoplasia (CIN) 84 cases of CINⅡ / Ⅲ grade and 24 cases of squamous cell carcinoma (SCC). Immunocytochemistry was used to detect the expression of HPV L1 capsid protein in cervical exfoliated cells. Results The positive rates of HPV L1 capsid protein in normal cervix or chronic cervicitis, CINⅠ, CINⅡ / Ⅲ and SCC were 27.3% (9/33), 66.7% (112/168) and 25.0% (21/84), respectively , 0% (0/24). There was significant difference between CINⅠand CINⅡ / Ⅲgroups and SCC group (all P <0.01). Compared with CINⅠand CINⅡ / Ⅲgroups, CINⅠand CINⅡ / Ⅲgroups showed significant difference as compared with normal or chronic cervicitis group , The positive rate of HPV L1 capsid protein showed a decreasing trend. There were no significant differences in the expression of HPV L1 capsid protein between different age groups (P> 0.05). The HPV L1 capsid protein expression was 73.1% in high-risk HPV DNA load ≥1 000 RLU / PC group, and significantly higher than that in all groups with load <1000 RLU / PC (all P <0.05) . The sensitivity, specificity, positive predictive value and negative predictive value of HPV L1 capsid protein in detecting CINⅡ / Ⅲ lesions were 80.6%, 60.2%, 52.1% and 85.2% respectively. Conclusions The positive rate of HPV L1 capsid protein in CIN and SCC is decreasing with the severity of lesions, which is expected to be a biomarker for predicting the progression of cervical precancerous lesions.