人乳头瘤病毒L1壳蛋白在筛查宫颈鳞状上皮内病变中的应用

目的:探讨人乳头瘤病毒(HPV)L1壳蛋白筛查HPV阳性妇女宫颈脱落细胞中宫颈鳞状上皮内病变的应用价值。方法:选取2012年5月至2014年12月就诊于温州市人民医院的妇女212例,收集宫颈脱落细胞并行HPV L1壳蛋白检测、HPV DNA分型、TCT(液基细胞学)及阴道镜下活检,比较HPV阳性妇女的宫颈脱落细胞中HPV L1壳蛋白的表达情况。结果:212例细胞学标本中HPV L1壳蛋白阳性率为33.9%,其中未见上皮内病变/恶性细胞组(NILM)、无明确诊断意义的鳞状上皮细胞病变组(ASCUS)、低度鳞状上皮内病变组(LSIL)、不能排除高度鳞状上皮内病变组(ASC-H)、高度鳞状上皮内病变组(HSIL)中阳性率分别为47.1%、35.1%、54.2%、29.2%、16.1%,各组比较差异有统计学意义(P0.05);两两比较,HSIL组与LSIL组和NILM组比较,差异均有统计学意义(P均0.005);进行数据合并后,LSIL/ASCUS组与ASC-H/HSIL组比较差异有统计学意义(P=0.001)。178例宫颈细胞学异常患者中,宫颈低级别病变和宫颈高级别病变的HPV L1壳蛋白阳性率比较,在ASCUS组(P=0.000)、LSIL组(P=0.004)中均有差异,在ASC-H组(P=0.127)、HSIL组(P=0.515)中均无差异。HPV 16/18感染患者的HPV L1壳缺失同宫颈高级别病变有更紧密的关系(P=0.003)。结论:子宫颈脱落细胞HPV L1壳蛋白检测在HPV阳性妇女的子宫颈病变筛查中具有一定的价值,可能成为一种合适的分流方法。

Clinical significance of human papillomavirus L1 capsid protein test in cervical intraepi-thelial neoplasia of women

Objective:To investigate the expression of human papillomavirus ( HPV ) L1 capsid protein in cervical cytology with HPV infection and explore the clinical significance of human papillomavirus L1 capsid protein in Cervical intraepithelial neoplasia of women. Meth-ods:212 HPV positive cases were enrolled as eligible women from Wenzhou people ' s hospital from May 2012 to Dec. 2014. We performed immunocytochemistry for HPV L1 and liquid-based cytology and HPV by DNA genotyping test followed by colposcopy. Biopsies were taken if indi-cated in 212 cervical cytology samples. Results:33. 9% were immunocytochemically positive for HPV L1 . The immunocytochemical expression rates of HPV L1 in intraepithelial lesion or malig-nancy( NILM) ,in atypical squamous cells of unknown significance ( ASCUS) ,low-grade squa-mous intraepithelial lesions( LSIL) ,ASC of can not exclude high-grade squamous intraepithelial lesion(ASC-H),high-grade squamous intraepithelial lesions (HSIL),were 47. 1%,35. 1%,54. 2%,29. 2%,16. 1%,respectively. LSILs exhibited the highest rate of HPV L1 positivity(P<0 . 05 ) . HSILs was significantly lower than NILMs and LSILs in HPV L1-positive cytology samples(P<0. 005). LSIL/ASCUSs exhibited the higher rate of HPV L1 positivity than ASC-H/HSILs(P=0. 001). The absence of HPV L1 expression in ASCUS and LSIL was significantly associated with high-grade(≥HSIL) than low-grade (≤LSIL) histopathology diagnoses(P<0 . 05 ) . The absence of HPV L1 expression in HPV16/18 infection was significantly associated with high-grade(≥HSIL) than low-grade (≤LSIL) histopathology diagnoses (P=0. 003). Conclusions:HPV L1 capsid detection in cervical exfoliated cells play a role in cervical lesions screening in HPV positive women,and may be a promising triage for women.