CAJ | 학술논문

目的探讨人乳头状瘤病毒(HPV)L1壳蛋白在宫颈不同病变脱落细胞中的表达和临床意义.方法收集2008年1月至2009年5月到北京大学深圳医院宫颈门诊就诊患者的宫颈脱落细胞标本309例,其中正常或慢性宫颈炎33例、宫颈上皮内瘤变(CIN)I级168例、CIN Ⅱ/Ⅲ级84例和鳞状细胞癌(SCC)24例,用免疫细胞化学法检测HPV L1壳蛋白在宫颈脱落细胞中的表达.结果在正常宫颈或慢性宫颈炎、CINI、CINⅡ/Ⅲ和SCC中,HPV L1壳蛋白阳性表达率分别为27.3%(9/33)、66.7%(112/168)、25.0%(21/84)、0%(0/24).其中CINI组、SCC组与正常或慢性宫颈炎组比较,CINI组与CINⅡ/HI组比较,CINI、CINⅡ/Ⅲ组与SCC组比较差异均有统计学意义(均P<0.01),随病变程度的加重,HPV L1壳蛋白阳性表达率呈下降的趋势.分别以30岁和40岁为界分组,不同年龄组间HPV L1壳蛋白的表达差异均无统计学意义(均P>0.05).在高危型HPV DNA负荷量≥1 000 RLU/PC组HPV L1壳蛋白表达率为73.1%,与负荷量<1 000 RLU/PC的各组相比,其表达率明显增加(均P<0.05).HPV L1壳蛋白检测CINⅡ/Ⅲ以上病变的敏感度、特异度、阳性预测值和阴性预测值分别为80.6%、60.2%、52.1%和85.2%.结论 HPV L1壳蛋白在CIN和SCC中的阳性表达率随着病变程度加重呈下降趋势,有望成为预测宫颈癌前病变进展的生物学标志物.
목적 탐토인유두상류병독(HPV)L1각단백재궁경불동병변탈락세포중적표체화림상의의.방법 수집2008년1월지2009년5월도북경대학심수의원궁경문진취진환자적궁경탈락세포표본309례,기중정상혹만성궁경염33례、궁경상피내류변(CIN)I급168례、CIN Ⅱ/Ⅲ급84례화린상세포암(SCC)24례,용면역세포화학법검측HPV L1각단백재궁경탈락세포중적표체.결과 재정상궁경혹만성궁경염、CINI、CINⅡ/Ⅲ화SCC중,HPV L1각단백양성표체솔분별위27.3%(9/33)、66.7%(112/168)、25.0%(21/84)、0%(0/24).기중CINI조、SCC조여정상혹만성궁경염조비교,CINI조여CINⅡ/HI조비교,CINI、CINⅡ/Ⅲ조여SCC조비교차이균유통계학의의(균P<0.01),수병변정도적가중,HPV L1각단백양성표체솔정하강적추세.분별이30세화40세위계분조,불동년령조간HPV L1각단백적표체차이균무통계학의의(균P>0.05).재고위형HPV DNA부하량≥1 000 RLU/PC조HPV L1각단백표체솔위73.1%,여부하량<1 000 RLU/PC적각조상비,기표체솔명현증가(균P<0.05).HPV L1각단백검측CINⅡ/Ⅲ이상병변적민감도、특이도、양성예측치화음성예측치분별위80.6%、60.2%、52.1%화85.2%.결론 HPV L1각단백재CIN화SCC중적양성표체솔수착병변정도가중정하강추세,유망성위예측궁경암전병변진전적생물학표지물.
Objective To evaluate the expression and clinical significance of human papillomavirus(HPV)L1 caspid protein in cytologic specimens of the cervix.Methods The HPV L1 caspid protein in cytologic specimens of the cervix was detected by using immunochemistry in 309 women treated in Shenzhen Hospital of Peking University from Jan.2008 to May 2009.According to histological biopsy,of 309 liquid-based cytologic smears,there were 33 cases of normal cervixes or chronic cervititis,168 cases of grade I of cervical intraepithelial neoplasia(CIN I),84 cases of grade Ⅱ/Ⅲof CIN,and 24 cases of squamous cell carcinomas(SCC).Results The positive expression rate of HPV L1 caspid protein was 27.3%,66.7%,25.0%,and 0 in the normal cervixes or chronic cervititis,CIN I and CIN Ⅱ/Ⅲ,and SCC respectively.There was significant difference between CIN I or SCC and the normal cervixes or chronic cervititis,between CIN I with CIN Ⅱ/Ⅲ,and between CIN I or CIN Ⅱ/m with SCC(all P<0.0 1).The positive expression rate of HPV L1 caspid protein was reduced with the lesion progression from CIN I to CINⅡ/Ⅲ to SCC.309 cases were divided into two groups by 30 and 40 years of age,and there was no significant difference in the HPV L1 caspid protein expression between different age groups(P>0.05).The positive expression rate of HPV L1 caspid protein in the over-1000 RLU/PC viral load group was significantly higher than in the under-1000 RLU/PC viral load group(P<0.05).The sensitivity,specificity,positive predictive value,negative predictive value of HPV L1 caspid protein for detecting high-grade cervical lesions were 80.6%,60.2%,52.1% and 85.2%,respectively.Conclusion The positive rate of HPV L1 caspid protein is decreased with the lesion progression from CIN I to CIN Ⅱ/Ⅲto SCC.HPV L1 caspid protein among HPV-positive women can be a helpful molecular biomarker in risk assessment and prognostic prediction.