Ⅰ级宫颈上皮内瘤变中HPV病毒载量与P16蛋白表达的相关性及预后意义  

Correlation of high-risk HPV quantitation and P16 expression in cervical intra-epithelial neoplasia Ⅰ and its prognostic value: a prospective controlled study

作　　者：杨君[1] 王彬[2] 周德平[1] 张轩珍[2] 刘玉明[1] 王敏[1] 

机构地区：[1]重庆市妇幼保健院妇产科,重庆400013 [2]重庆市妇幼保健院病理科重庆市宫颈病特色专科,重庆400013

出　　处：《第三军医大学学报》2012年第15期1556-1559,共4页Journal of Third Military Medical University

基　　金：重庆市卫生局面上项目(2010-2-326)~~

摘　　要：目的探讨宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)Ⅰ级组织中HPV病毒载量与P16蛋白表达的相关性及二者用于预测CINⅠ转归的可行性。方法选择2008年5月至2010年1月,重庆市妇幼保健院宫颈专科门诊,经组织学确诊为CINⅠ患者103例,确诊CINⅠ同时以第二代杂交捕获法(hybrid captureⅡ,HC-2)检测高危型HPV(HR-HPV)病毒载量,采用免疫组化S-P法检测其相应宫颈组织中P16蛋白表达,分析二者相关性。分别于随访6、12、18、24个月复查细胞学、阴道镜,必要时重复宫颈活检。以随访第24个月组织学检查结果为病变转归结局,分析HPV病毒载量及P16蛋白表达作为CINⅠ病变转归预测指标的可行性。结果①CINⅠ组织中HPV阳性率为69.90%(72/103),P16蛋白阳性表达率为38.83%(40/103),P16蛋白表达与HPV病毒载量二者之间呈正相关(rs=0.568 8,P<0.01);②随访24个月,CINⅠ病变总进展率为11.65%(12/103);③以P16蛋白表达评分≥6分作为CINⅠ进展的预测指标,其敏感性、特异性及阴性预测值分别为91.67%、96.70%、98.88%(P<0.01);以HR-HPV病毒载量≥100 RLU/CO为预测指标,其敏感性、特异性和阴性预测值分别为58.33%、81.32%、93.67%(P<0.01)。结论 P16蛋白表达强度及HR-HPV病毒载量与CINⅠ病变转归密切相关,可以作为CINⅠ进展风险的预测指标。Objective To investigate the correlation of the viral load quantitation of high-risk HPV and P16 expression in cervical intraepithelial neoplasia（CIN）Ⅰ patients and its prognosis value.Methods A total of 103 inpatients with CINⅠ diagnosed by immunohistochemistry analysis in our health center from May 2008 to Jan.2010 were enrolled in this study.All of the patients were analyzed the viral load quantitation of high-risk HPV by hybrid capture Ⅱ（HC-2）.The expression of P16 in the cervix tissue were detected by immunohistochemistry at the same time.All of the patients were followed up for 6,12,18 and 24 months after first diagnosis for the examination of cytology,colposcopy,and cervical re-biopsy if necessary.The final histological results obtained at the last follow-up were considered as the sequel of CINⅠ.The correlation of the quantitation of high-risk HPV and P16 expression was evaluated for prediction of the evolvement of CINⅠ.Results The positive rate of high-risk HPV and P16 expression in CINⅠ were 69.90%（72/103） and 38.83%（40/103） respectively.The expression of P16 was positively correlated with the quantitation of HR-HPV in CINⅠ（rs=0.568 8,P〈0.01）.In the last follow-up（24 months）,12 cases（11.65%,12/103） were deteriorated into lesions over CINⅡ.When P16 expression with the grade ≥6 was regarded as predicting indicator for the deterioration of CINⅠ,the sensitivity,specificity and negative predictive value（NPV）were 91.67%,96.70%,and 98.88%,respectively（P〈0.01）.Whereas these values were 58.33%,81.32%,and 93.67%,respectively（P〈0.01） when the quantitation of HR-HPV ≥ 100 RLU/CO regard as cut-off value.Conclusion Both of the expression of P16 and the quantitation of HR-HPV are closely correlation with the prognosis of CINⅠ,and they can be considered as predict indictors for CIN deterioration.

关 键 词：人乳头瘤病毒 P16 宫颈上皮内瘤变 宫颈癌 

分 类 号：R363.23[医药卫生—病理学] R711.74[医药卫生—基础医学]