宫颈脱落细胞HPVL1蛋白监测在高危型HPV阳性妇女分流中的应用

目的：探讨高危型人乳头瘤病毒(HPV)阳性的妇女采用宫颈脱落细胞HPV L1蛋白检测的临床实际意义。方法选择2014年10月至2015年10月期间我院妇科收治的386例高危型HPV阳性患者，收集患者的宫颈脱落细胞，采用液基薄层细胞学检查(TCT)、免疫组化两种方法检测HPV L1蛋白，同时对所有患者进行阴道镜检测，可疑部分取活检进行病理检查。对比HPV L1蛋白在正常妇女及不同的病理组织学病变患者中的表达情况。以此评估宫颈脱落细胞HPVL1蛋白检测对筛查子宫病变的临床实际价值。结果386例高危型HPV阳性患者中，发现正常子宫颈162例，低度鳞状上皮内病变94例，高度鳞状上皮内病变128例，而子宫颈鳞癌2例，统计后发现高度内皮病变者、宫颈鳞癌者的HPV L1蛋白阳性率明显低于正常者和低度内皮病变者。此外，宫颈脱落细胞的HPV L1蛋白检测中的组织学诊断关于高度内皮病变者、宫颈鳞癌者两种类型的敏感度、阴性预测值均明显高于TCT检查，但是在特异度一项中，组织学诊断则明显低于TCT检查，差异均有统计学意义(P<0.05)，而两项检查中对于阳性预测结果差异无统计学意义(P>0.05)；高危型HPV阳性患者中，HSIL、SCC患者的HPV L1蛋白阳性比例为19.2%，而正常以及LSIL者的蛋白阳性比例高达66.4%，差异均有统计学意义(P<0.05)；宫颈脱落细胞额HPV L1蛋白检测中的组织学诊断关于高度内皮病变者、宫颈鳞癌者两种类型的敏感度、阴性预测值均明显高于TCT检查，但是在特异度一项中，组织学诊断则明显低于TCT检查，差异均有统计学意义(P<0.05)。结论对高危型HPV阳性的妇女患者而言，子宫颈脱落细胞HPV L1蛋白检测具有一定的筛查意义，能够为临床提供多一种且适宜的分流方案。

Application of HPV L1 protein monitoring of cervical exfoliated cells in high-risk HPV-positive women

Objective To discuss the clinical significance of human papillomavirus (HPV) L1 protein of cervi-cal cells in detection of high-risk HPV-positive women. Methods A total of 386 high-risk HPV-positive women, who admitted to our hospital from October 2014 to October 2015, were selected, and cervical exfoliated cells of these patients were collected. HPV L1 protein was detected by using liquid based cytology test (TCT) and immunohistochemistry. At the same time, patients were given vaginal examination, and suspicious part took biopsy for pathological examination. The expressions of HPV L1 protein in normal women and patients with different histopathological lesions were com-pared. The clinical value of HPV L1 protein monitoring of cervical exfoliated cells in screening of uterine lesions was evaluated. Results Among 386 high-risk HPV-positive patients, there were 162 patients with normal cervix, 94 patients with low grade squamous intraepithelial lesions, 128 patients with high grade squamous intraepithelial lesions, and 2 pa-tients with cervical squamous cell carcinoma. The positive rates of HPV L1 protein of patients with high endothelial le-sion and patients with cervical squamous cell carcinoma were significantly lower than those of normal women and pa-tients with low grade endothelial lesions. In addition, the sensitivity and the negative predictive value of patients with high endothelial lesion and patients with cervical squamous cell carcinoma in histologic diagnosis of HPV L1 protein monitoring of cervical exfoliated cells were significantly higher than those of TCT examination (P<0.05);but in specific-ity, histological diagnosis was significantly lower than that of TCT examination (P<0.05);there was no significant differ-ence between the positive predictive results of two tests (P>0.05). In high-risk HPV-positive patients, the proportion of positive HPV L1 protein in HSIL and SCC patients was 19.2%, while the proportion of positive HPV L1 protein in normal women and LSIL patients were up to 66.4%, with statistically significant difference (χ2=5.392, P<0.05). The sensitivity and negative prediction value of tissue diagnosis on high endothelial lesions and squamous cell carcinoma of the uterine cervix by cervical exfoliated cell amount of HPV L1 protein were significantly higher than those of TCT (χ2=6.492 3.013, P<0.05);but in the specificity, the histological diagnosis was significantly lower than TCT (χ2=5.286, P<0.05). Conclusion For high-risk HPV-positive women, HPV L1 protein monitoring of cervical exfoliated cells has a certain screening significance, which provides a suitable diversion scheme in clinic.