HPV及亚型在不同子宫颈腺癌中的表达及临床病理研究

目的：探讨HPV及亚型在不同子宫颈腺癌中的表达以及HPV阳性表达与临床病理特征的关系。方法：选取192例不同组织亚型的宫颈腺癌患者以及78例正常宫颈女性作为研究对象,通过巢式PVR检测HPV各亚型以及不同组的阳性率,并通过免疫组织化学检测P16蛋白的表达情况,分析宫颈腺癌与正常宫颈女性的HPV阳性率,HPV在不同组织亚型的分布,宫颈腺癌P16表达与HPV感染及其型别的关系以及宫颈腺癌不同临床病理特征与HPV阳性率的关系。结果：宫颈腺癌患者HPV阳性率明显高于正常宫颈女性;宫颈腺癌不同组织亚型间HPV阳性率的比较为宫颈粘液腺癌〉子宫内膜样腺癌〉透明细胞腺癌,三者间比较,差异均具有统计学意义（P〈0.05）;宫颈腺癌组织中HPV各亚型中以HPV16和HPV18的阳性率最高,其次为合并HPV感染,且各宫颈腺癌组织亚型均以HPV16和HPV18多见,合并感染和单一感染HPV发生率在三种不同组织亚型间比较,差异无统计学意义（P〉0.05）;HPV阳性组中P16阳性表达以2分和3分为主;而HPV阴性组中以P16阴性表达或1分阳性表达为主,两组在P16阳性表达率上具有统计学差异（P〈0.05）;HPV各亚型间P16阳性表达率未见明显差异（P〉0.05）,且均以2分和3分阳性表达为主;在其他临床病理特征上,HPV阳性率在年龄和临床分期中无显著性差异（P〉0.05）,而在分化程度上有显著性差异（P〈0.05）。结论：HPV阳性与宫颈腺癌的组织亚型以及分化程度有关,在不同组织亚型中阳性率不同,对HPV阳性检测可指导临床诊断并治疗宫颈腺癌。

The expression and clinical pathological study of HPV and subtype in different cervical ade- nocarcinoma

Objective; To explore the expression of HPV and subtype in different cervical adenocarcinoma and the relationship between the positive HPV expression and clinical pathological study. Methods： A total of 192 cases with different subtypes of cervical adenocarcinoma and normal cervical tissue from 78 healthy women were collected. Nest PCR was used to detect the positive expression and subtypes of HPV and immunohistochemistry was used for detecting the expression of P16 protein. Results.. The positive rate of HPV was significantly higher in cervical adenocarcinoma cases than that in normal cervix uteri （P〈0.05）. The comparison of HPV positive rate in different tissue subtypes of cervical adenocarcinoma is that the cervical mucus gland carcinoma 〉 endometrioid adenocarcinoma 〉 clear cell adenocarcinoma, and there are all significant difference among three groups （P all 〈0.05）. Among different HPV subtypes, the HPV 16 and HPV 18 showed the highest positive rates followed by combined HPV infection. HPV 16 and HPV 18 infection occurred most frequently, and there were significant difference among different types or combined infection （P〉0.05）. In HPV positive group, the positive expression of P16 mainly involved of grade 2 and 3 cases, while negative expression and grade 1 accounted more in HPV negative group, the difference in positive rate of P16 was significant （P〈0.05）. There were no statistical significance among each HPV subtype in P16 positive expression （P〉0.05） and grade 2 and 3 accounted more. In other clinical pathological features, no significant difference between patients with different ages and clinical stages （P〉0.05） while significant difference was found between cases with differentiated degree （P〈0.05）. Conclusions： The HPV positive rate was related to the tissue subtypes and differentiated degree and different positive rates of HPV in different tissue subtypes indidate it can be used for diagnosis of cervical adenocarcinoma.