HPV L1衣壳蛋白在不同宫颈病变的表达及临床意义

目的 探讨人乳头状瘤病毒（human papillomavirus,HPV）L1衣壳蛋白在不同宫颈病变脱落细胞中的表达及临床意义.方法 收集2012年1月至2013年7月在我院经第二代杂交捕获法检测HPV DNA阳性患者的宫颈脱落细胞标本312份,采用CytoReact HPV L1试剂盒检测壳蛋白在宫颈脱落细胞中的表达,并追踪其组织病理结果.结果 HPV L1衣壳蛋白定位于细胞核,阳性细胞其细胞核着色为红褐色颗粒,位于鳞状细胞的表层,基底细胞无表达.312份宫颈液基细胞学标本中有105份HPV L1衣壳蛋白呈阳性表达,总阳性率为33.65％（105/312）,其中未见上皮内病变或恶性细胞（negative for intraepithelial lesion or malignancy,NILM）为27.33％ （47/172）;未明确意义的非典型鳞状上皮细胞（atypical squamous cell of undermined significance,ASC-US）为36.92％（24/65）;不排除高度鳞状上皮病变的非典型鳞状上皮细胞（ASC of can not exclude high-grade squamous intraepithelial lesion,ASC-H）为21.43％（3/14）;低度鳞状上皮内病变（low-grade squamous intraepithelial lesion,LSIL）为69.44％（25/36）;高度鳞状上皮内病变（high-grade squamous intraepithelial lesion,HSIL）为28.57％（6/21）;鳞癌（squamous cell carcinoma,SCC）为0.00％ （0/4）.六组间HPV L1衣壳蛋白阳性表达率差异有统计学意义（P＜0.05）,其中LSIL与HSIL相比,ASC-US/LSIL与ASC-H/HSIL相比,LSIL与HSIL/SCC相比,LSIL/ASC-H与HSIL/SCC相比,NILM与LSIL相比,HPV L1衣壳蛋白阳性表达率差异均有统计学意义（P均＜ 0.05）,且随宫颈细胞学病变程度的加重,HPV L1衣壳蛋白表达呈下降趋势.312例患者中有143例追踪到组织学结果,其中HPV L1衣壳蛋白阳性表达的有46例,总阳性率为32.17％ （46/143）,其中慢性宫颈炎为27.08％（13/48）,宫颈上皮内瘤样病变Ⅰ级（cervical intraepithelial neoplasia Ⅰ,CIN Ⅰ）为48.84％（21/43）,CINⅡ为33.33％ （8/24）,CINⅢ为17.39％ （4/23）,SCC为0.00％（0/5）.五组间HPVL1衣壳蛋白阳性表达率差异有统计学意义（P＜0.05）.CIN Ⅰ与CINⅡ/CINⅢ相比,慢性宫颈炎与CIN Ⅰ相比HPV L1衣壳蛋白阳性率差异均有统计学意义（P均＜0.05）,且随宫颈组织学病变程度加重,HPVL1衣壳蛋白表达呈下降趋势.以30岁为界将患者分为两组,其中≤30岁组HPV L1衣壳蛋白阳性率为44.00％（44/100）;＞30岁组HPV L1衣壳蛋白阳性率为28.77％（61/212）,两组间差异有统计学意义（P＜0.05）.结论 随宫颈病变程度加重,HPV L1衣壳蛋白表达呈下降趋势,HPV L1衣壳蛋白检测对宫颈鳞状上皮内病变有一定的预测作用.

The expression and clinical significance of human papillomavirus L1 caspid protein in different cervical lesions

Objective To explore the expression and clinical significance of human papillomavirus （HPV） LI caspid protein in cytologic specimens of the different cervical lesions. Methods 312 patients in our hospital during Jan 2012 to Jun 2013, received examinations of liquid-based cytology and were confirmed high risk HPV positive by hybrid capture II method at the same time. HPV L1 caspid protein in cytologic spec- imens of cervix were detected by immune tissue/cell chemical technology, and followed-up the histopathological results. Results HPV L1 caspid protein localized in nucleus, which was brunneus grains. It＇s expressed on squamocellular ecdron, not on basal cell. In 312 samples, 105 cases HPV L1 protein were positive in exfoliated cervical ceils, the total positive rate was 33.65% （105/312）, in which negative for intraepithelial lesion or malignancy （NILM）was27.33%（47/172）, atypical aquamous cell of undermined significance （ASC-US） was 36.92% （24/65）, ASC of can not exclude high-grade squamous intraepithelial lesion （ASC-H） was 21.43% （3/14）, low-grade squaroous intraepithelial lesion （LSIL） was 69.44% （25/36）, high-grade squa- mous intraepithelial lesion （HSIL） was 28.57% （6/21） and squamous cell carcinoma （SCC） was 0.00% （0/4）. There was significant difference between LSIL and HSIL, ASC-US/LSIL and ASC-H/HSIL, LSIL and HSIL/ SCC, LSIL/ASC-H and HSIL/SCC, NILM and LSIL （Pall〈 0.05）. With the cervical lesions degree aggravating, the expression of HPV L1 protein was on the decline. In 312 patients with 143 cases traced to the histologic results, and there were 46 cases with the HPV L1 protein positive, the total positive rate was 32.17% （46/ 143）, in which chronic cervicitis was 27.08% （13/48）, cervical intraepitheical neoplasia I （CIN I ） was 48,84% （21/43）, CIN I1 was 33.33% （8/24）, CIN m was 17.39% （4/23） and SCC was 0.00% （0/5）. There was significant difference between CIN I and CIN 11/CIN m, chronic cervicitis and CIN I （Pall〈 0.05 ）. The expression level of HPV L1 capsid protein showed a decreasing trend with aggravation of cervical lesions. 312 cases were divided into two groups by 30 years of age, and there was significant difference in the HPV L1 caspid protein expression between two age groups （P〈 0.05 ）. Conclusion The positive rate of HPV L1 caspid protein is decreased with the cervical lesion progression. HPV L1 caspid protein detection has certain predict effection to the cervical squamous intraepithelial lesions.