HPV L1壳蛋白在宫颈病变诊断及随访中的临床意义

目的：探讨宫颈脱落细胞HPV L1壳蛋白检测在宫颈病变诊断及随访中的临床意义。方法：选取2013年1月至2014年6月在温州市中心医院宫颈液基细胞学检查（TCT）诊断≥未明确诊断意义的不典型鳞状上皮细胞（ASCUS），HPV病毒基因分型检测高危型HPV阳性276例患者，检测HPV L1壳蛋白在子宫颈病变中表达情况。结果：①HPV L1壳蛋白在低度鳞状上皮内病变（LSIL）、ASCUS、非典型鳞状上皮-不除外高度病变（ASC-H）/高度鳞状上皮内病变（HSIL）/鳞状上皮浸润癌（SCC）中的表达率分别是70.09%、55.46%、10.00%，3者间比较差异有统计学意义（P＜0.05）。②HPV L1壳蛋白在组织病理学诊断慢性子宫颈炎（CC）、CINI、CINII-III和SCC中的阳性表达率分别是63.55%、75.32%、21.59%、0.00%，不同组间的HPV L1壳蛋白表达率差异有统计学意义（P＜0.05）。③在高危型HPV基因阳性妇女中，HPV L1壳蛋白联合TCT及单独TCT对诊断组织病理学≥CINII的敏感度、特异度、阳性预测值、阴性预测值分别是88.89%、46.73%；88.65%、96.20%；71.43%、86%和96.15%、78.32%。④对31例CINI妇女随访1年，结果发现CINI妇女中HPV L1壳蛋白阳性者和HPV L1壳蛋白阴性者相比，1年病变自然消退率高，差异有统计学意义（P＜0.05）；HPV L1壳蛋白预测CINI患者病变消退的敏感度、特异度、阳性预测值、阴性预测值分别为91.67%、57.89%、57.89%、91.67%。结论：①HPV L1壳蛋白随着子宫颈病变程度增高表达率下降；②在高危型HPV基因阳性妇女中，宫颈脱落细胞HPV L1壳蛋白检测联合TCT比单独TCT预测组织学病理≥CINII有更高的敏感度（88.89% vs 46.73%）和阴性预测值（96.15% vs 78.32%）；③在CINI随访妇女中，HPV L1壳蛋白阳性妇女CINI自然消退率更高，有较高的预测CINI病变消退的敏感度和阴性预测值，值得临床推广。

Clinical significance of HPV L1 capsid protein detection in cervical exfoliated cell in cervical intraepithelial neoplasm

Objective: To explore the clinical significance of HPV L1 capsid protein detection in cervical exfoliated cell in cervical intraepithelial neoplasm in diagnosis and follow up. Methods: Select 276 patients with high-risk human papilloma virus who used to be in Wenzhou Centrol Hospital between January 2013 and June 2013 and the cytological diagnosis was atypical squamous epithelial cell without certain diagnosis significance. All patients accept HPV L1 capsid protein detection in cervical exfoliated cell and colposcope cervical biopsy. Results: ①The expression rate of HPV L1 capsid protein in cytological diagnosis LSIL was up to 70.09% (75/107), followed by ASCUS with the expression rate of 55.46% (66/119), and the expression rate in ASC-H, HSIL, SCC was 10% (5/50) with the significant difference (P<0.05). ②The positive expression rate of HPV L1 capsid protein in CC, CIN I, CIN II-III and SCC was 63.55% (68/107), 75.32% (58/77), 21.59% (19/88), and 0 (0/4) respectively, and there was significant statistical difference (P>0.05). The expression of HPV L1 in CC and CIN I was significantly higher than that in CIN II-III and SCC. ③In high-risk HPV positive women, sensitivity of single TCT inspection and TCT combined with HPV L1 detection on histopathology≥CIN II screening was 46.73% and 88.89%; specificity was 96.20% and 88.65%; positive predictive values were 86% and 71.43%; negative predictive values were 78.32% and 96.15%, respectively. ④In follow-up 31 women with CIN I for 1 year, our fiangdings showed that these two HPV L1 immunostaining results exhibited clearly opposite progression and regression trends that were statistically significant (P<0.05). The sensitivity, specificity, positive predictive values, negative predictive values were 91.67%, 57.89%, 57.89% and 91.67%, respectively. Conclusion: ①The expression rate of HPV L1 capsid protein decreases with the increase of cervical lesions degree; ②In high-risk HPV positive women, TCT combining with HPV L1 detection has higher sensitivity (88.89% vs 46.73%) and negative predictive (96.15% vs 78.32%) than single TCT inspection on histopathology≥CIN II screening; ③It is predicted that there are higher value of sensitivity and negative predictive to predict the spontaneous regression of CIN I of HPV L1 positive ones, which is worth promoting.