TERC基因联合阴道镜及HPV检测在早期宫颈病变诊断中的应用  

Application of TERC Gene Combined with Colposcopy and Human Papillomavirus Test on Diagnosing the Early Cervical Lesions

作　　者：杨志慧[1] 李桂梅[1] 梅佳[1] 顾飞飞[1] 

机构地区：[1]中国人民解放军第八一医院病理科,南京210002

出　　处：《国际妇产科学杂志》2013年第4期318-320,338,F0003,共5页Journal of International Obstetrics and Gynecology

摘　　要：目的:探讨阴道镜、人端粒酶RNA组分(hTERC)基因扩增和人乳头瘤病毒(HPV)分型检测在早期宫颈病变诊断中的临床意义。方法:对经阴道镜初步诊断为宫颈病变的219例患者,应用荧光染色体原位杂交(FISH)技术检测hTERC基因扩增、表面等离子谐振技术(SPR)检测HPV感染情况,并进行统计学分析。结果:①阴道镜诊断宫颈CINⅠ级59例,CINⅡ级76例,CINⅢ级56例,宫颈癌28例,与组织学最终诊断相比较,两种方法有相关性(P<0.05)。②hTERC基因在宫颈炎性病变、CINⅠ、CINⅡ、CINⅢ及宫颈鳞癌中的阳性扩增率分别为7.9%,10.9%,44.6%,63.2%和82.6%,各组间比较差异有统计学意义(P<0.000 1)。③132例进行HPV分型检测的患者中,高危亚型感染54例,低危亚型感染29例,阴性49例,HPV阳性患者的感染类型同宫颈上皮内瘤变等级有关(P=0.041 9)。④同时进行hTERC基因及HPV检测患者中,54例HPV高危亚型患者hTERC基因发生异常扩增者33例,29例低危亚型中发生异常扩增7例,组间比较差异有统计学意义(P<0.01)。结论:阴道镜作为宫颈病变的初诊手段有一定的漏诊和过度诊断;HPV高危亚型感染可能是导致hTERC基因异常扩增的因素之一;hTERC基因扩增和HPV感染与宫颈高级别病变的进展密切相关,可能是导致宫颈癌发生的直接诱因;阴道镜、HPV和hTERC基因联合检查是判断早期宫颈病变进展并做出诊断的有效手段。Objective：We tested the amplification of TERC gene and HPV infection at all grade cervical lesions combined with colposcopy,and discussed the clinical value.Methods：219 patients were preliminarily diagnosed as cervical lesions with colposcopy.hTERC gene amplification（n =219） was tested by Fluorescence in situ hybridization（FISH）,and HPV infection（n=132）by SPR assay.The results were statistically analyzed.Results：①59 cases were diagnosed CIN I,76 cases CIN II,56 cases CIN III and 28 cases cervical cancer.There had correlation between the colposcopic diagnosis and histological diagnosis（P0.05）.②The positive amplification rates of hTERC gene at all levels of cervical lesions were 7.9%,10.9%,44.6%,63.2%,82.6% respectively,the differences among the groups were statistically significant（P0.000 1）.③Among 132 patients,there were 54 cases of high-risk HPV infection,29 cases of low-risk HPV infection,49 case of HPV negative.There was a statistically difference between HPV Isoforms infection and cervical intraepithelial neoplasia（P0.05）.④At the same time,the hTERC gene and HPV were tested also.In 54 cases with infection of high risk HPV,33 cases were with abnormal hTERC gene amplification.And in 27 cases for low-risk HPV there were 7 cases with abnormal hTERC gene amplification.There was statistically difference between groups（P 0.001）.Conclusions：Colposcopy,as one method for diagnosing early cervical lesions,maybe leads to missed diagnosis or over-diagnosis.High risk HPV subtype infection may be one of factors which lead to abnormal hTERC gene amplification.hTERC gene amplification and HPV infection is closely related to the progress of high-grade cervical lesions,which may be the direct cause of cervical cancer.Colposcopy combined with HPV and hTERC gene may be an effective means for diagnosing early cervical lesions.

关 键 词：宫颈肿瘤 宫颈上皮内瘤样病变 阴道镜检查 端粒 末端转移酶 人乳头状瘤病毒科 

分 类 号：R737.33[医药卫生—肿瘤]