CINⅠ的转归及p16INK4a蛋白表达在分流CINⅠ中的临床意义  

The natural history of cervical intraepithelial neoplasia Ⅰ and the clinical significance of p16INK4a protein as a marker of progression in cervical intraepithelial neoplasiaⅠ

作　　者：王荣敏[1] 李雪洁[2] 钱敏 钮江华[4] 尤志学[5] 

机构地区：[1]南京医科大学第一临床医学院妇产科,210029 [2]南京医科大学第一临床医学院病理科,210029 [3]江苏省昆山市第一人民医院产科 [4]南京医科大学附属江苏盛泽医院妇科 [5]南京医科大学第一附属医院妇科

出　　处：《中华妇产科杂志》2015年第3期210-215,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨子宫颈上皮内瘤变（CIN）Ⅰ的转归，分析影响CINⅠ病变进展的相关因素，并评价p16INK4a蛋白表达在预测CINⅠ病变进展中的价值。方法回顾性分析2010年8月—2013年7月在南京医科大学第一附属医院就诊，初次液基薄层细胞学检查（TCT）结果为≤低度鳞状上皮内病变[LSIL；包括正常、未明确诊断意义的不典型鳞状上皮细胞（ASCUS）和LSIL]且高危型HPV阳性，并经阴道镜下子宫颈活检组织病理诊断为CINⅠ的患者104例，随访1年观察病变的转归，同时对患者年龄、初次TCT结果、高危型HPV DNA载量、子宫颈脱落细胞中HPV L1壳蛋白及子宫颈组织中p16INK4a蛋白表达情况与CINⅠ病变进展的关系行单因素及多因素分析。结果（1）104例CINⅠ患者中，初次检查TCT结果正常者15例、ASCUS 78例、LSIL 11例；1年后随访时复查：TCT结果正常且高危型HPV阴性者52例，高危型HPV阳性和（或）TCT结果≥正常但经阴道镜检查评估并行子宫颈活检组织病理检查诊断为正常者30例、CINⅠ10例、CINⅡ5例、CINⅢ7例。78.8%（82/104）的患者病变消退；9.6%（10/104）的患者病变持续；11.5%（12/104）的患者病变进展，其中4.8%（5/104）病变进展为CINⅡ，6.7%（7/104）进展为CINⅢ，无一例进展为子宫颈浸润癌。（2）104例CINⅠ患者中，行p16INK4a蛋白检测者88例，其中30例（34%，30/88）p16INK4a蛋白呈阳性表达，58例（66%，58/88）p16INK4a蛋白呈阴性表达；行免疫细胞化学HPV L1壳蛋白检测者94例，其中49例（52%，49/94）HPV L1壳蛋白阳性表达，45例（48%，45/94）HPV L1壳蛋白阴性表达。（3）单因素分析显示，患者年龄、高危型HPV DNA载量、初次TCT结果、HPV L1壳蛋白表达与CINⅠ病变进展无明显相关关系（P〉0.05），而p16INK4a蛋白阳性表达与CINⅠ病变进展明显相关（P〈0.05）。多因素分析显示，p16INK4a蛋白阳性表达是影响CIN�Objective To describe the natural history of cervical intraepithelial neoplasia（CIN）Ⅰand the biologic factors associated with the progression of CINⅠ and to analyze the predictive values of p16INK4a protein for the progression of CINⅠ. Methods From August 2010 to July 2013, 104 patients＆nbsp;referred for abnormal cytology [≤ low-grade squamous intraepithelial lesion （LSIL）; including negative for intraepithelial lesion or malignancy （NILM）, atypical squamous cells of undetermined significance （ASCUS）, LSIL] and high-risk （HR） HPV positive,and were diagnosed CINⅠ by colposcopy-assisted biopsy and followed at 1-year intervals in the First Affiliated Hospital of Nanjing Medical University. In order to analyze the relationship between the progression of CINⅠ with clinical biologic factors, including patient age, cervical cytology before colposcopy, loads of HR HPV, HPV L1 capsid protein, p16INK4a protein,χ2 tests was used to compare the different frequencies of factors in groups of progressed and persisted/regressed CINⅠ, then five factors with progressed CINⅠwere processed into binary logistic regression analysis. Results （1） In the first year of follow-up, among 104 patients（including 15 cases NILM,78 cases ASCUS,11 cases LSIL）, 52 cases of them were NILM and HR HPV negative, 30 cases were negative for intraepithelial lesion, 10 cases were CINⅠ, 5 cases were CINⅡand 7 cases were CINⅢ. In total, 82 cases （78.8%,82/104） cases had regressed, 10 cases （9.6%,10/104） persisted, 12 cases （11.5%,12/104） progressed [including 5 cases （4.8%,5/104） progressed to CIN Ⅱ, 7 cases （6.7%,7/104） progressed to CIN Ⅲ, none progressed to invasive cancer]. （2） All patients, 88 cases of them accepted immunohistochemical detection the expression of p16INK4a protein. The result shown that 30 cases （34%,30/88） were positive and 58 cases （66%,58/88） were negative. And 94 cases accepted immunocytochemical detection the expression of HPV L1 capsid protein

关 键 词：宫颈上皮内瘤样病变 周期素依赖激酶抑制剂p16 癌基因蛋白质类 病毒性 衣壳蛋白质类 随访研究 

分 类 号：R737.33[医药卫生—肿瘤]