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目的探讨宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅰ级组织中HPV病毒载量与P16蛋白表达的相关性及二者用于预测CINⅠ转归的可行性。方法选择2008年5月至2010年1月,重庆市妇幼保健院宫颈专科门诊,经组织学确诊为CINⅠ患者103例,确诊CINⅠ同时以第二代杂交捕获法(hybrid captureⅡ,HC-2)检测高危型HPV(HR-HPV)病毒载量,采用免疫组化S-P法检测其相应宫颈组织中P16蛋白表达,分析二者相关性。分别于随访6、12、18、24个月复查细胞学、阴道镜,必要时重复宫颈活检。以随访第24个月组织学检查结果为病变转归结局,分析HPV病毒载量及P16蛋白表达作为CINⅠ病变转归预测指标的可行性。结果①CINⅠ组织中HPV阳性率为69.90%(72/103),P16蛋白阳性表达率为38.83%(40/103),P16蛋白表达与HPV病毒载量二者之间呈正相关(rs=0.568 8,P<0.01);②随访24个月,CINⅠ病变总进展率为11.65%(12/103);③以P16蛋白表达评分≥6分作为CINⅠ进展的预测指标,其敏感性、特异性及阴性预测值分别为91.67%、96.70%、98.88%(P<0.01);以HR-HPV病毒载量≥100 RLU/CO为预测指标,其敏感性、特异性和阴性预测值分别为58.33%、81.32%、93.67%(P<0.01)。结论 P16蛋白表达强度及HR-HPV病毒载量与CINⅠ病变转归密切相关,可以作为CINⅠ进展风险的预测指标。
Objective To investigate the correlation between HPV viral load and the expression of P16 protein in cervical intraepithelial neoplasia (CIN) and the feasibility of the two in predicting the prognosis of CINⅠ. Methods From May 2008 to January 2010, Chongqing Municipal Maternal and Child Health Hospital cervical specialist clinics, histologically confirmed 103 patients with CIN Ⅰ, confirmed CIN Ⅰ by the second generation hybrid capture (hybrid capture Ⅱ, HC-2) test High-risk HPV (HR-HPV) viral load was detected by immunohistochemical SP method corresponding cervical tissue P16 protein expression, analysis of the correlation between the two. Respectively 6,12,18,24 months follow-up cytology, colposcopy, if necessary, repeated cervical biopsy. The results of histological examination at the 24th month after follow-up were the outcomes of the pathological changes, and the feasibility of HPV viral load and P16 protein expression as predictors of the prognosis of CINⅠ were analyzed. Results ① The positive rate of HPV in CINⅠ was 69.90% (72/103) and the positive rate of P16 protein was 38.83% (40/103). There was a positive correlation between the expression of P16 protein and HPV viral load (rs = 0.568 8, (P <0.01); ②The 24-month follow-up showed that the overall rate of CINⅠ disease progression was 11.65% (12/103); ③ The P16 protein expression score ≥6 was the predictor of the progression of CINⅠ, the sensitivity, specificity and negative predictive value The sensitivity, specificity and negative predictive value of HR-HPV viral load≥100 RLU / CO were 58.33% and 81.32% respectively, which were 91.67%, 96.70% and 98.88% respectively (P <0.01) , 93.67% (P <0.01). Conclusion The expression of P16 protein and HR-HPV viral load are closely related to the prognosis of CINⅠ, which can be used as a predictor of the progression risk of CINⅠ.