宫颈局部炎性因子和T细胞亚群改变对高危型HPV感染的影响  

Effect of inflammatory factors in local cervix and changes of T-cell subsets on high-risk HPV infection

作　　者：李梅[1] 姚路[1] 杨素芬[1] 董迅[1] 王露艳 崔淑岭 LI Mei;YAO Lu;YANG Sufen(Department of Gynecology,The Affiliated Hospital of Medical School of Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学医学院附属医院妇科,浙江宁波315020 [2]宁波鄞州第三医院妇产科

出　　处：《全科医学临床与教育》2019年第6期516-519,共4页Clinical Education of General Practice

基　　金：2017年宁波市医学科技计划项目(2017A65);2015年宁波大学校级课题(XYY15208)

摘　　要：目的研究宫颈局部炎性因子和T细胞亚群改变对高危型人乳头瘤病毒(HPV)感染及宫颈病变的影响。方法选择高危HPV阳性的102例宫颈上皮内瘤变(CIN)患者,其中CINⅠ28例、CINⅡ32例、CINⅢ42例,宫颈癌患者40例,选择34例HPV阴性的体检者为对照组。检测所有患者宫颈分泌物CD4^、CD8^T淋巴细胞亚群水平、干扰素γ(INF-γ)、白细胞介素2(IL-2)、IL-4、肿瘤坏死因子(TNF-α)炎性因子水平。结果宫颈癌组HPV多重感染率明显高于CINⅠ、CINⅡ、CINⅢ级患者,差异均有统计学意义(χ^2分别=9.11、4.91、3.53,P均<0.05)。HPV多重感染率与CIN病变程度无明显相关性(χ^2=1.89,P>0.05)。宫颈癌组CD4^+和CD4^+/CD8^+值均低于CIN各组及对照组(q分别=10.74、6.59、2.68、15.14;23.52、9.24、4.25、34.24,P均<0.05);IL-4、TNF-α水平明显高于CIN各组及对照组(q分别=18.12、13.65、8.94、24.41;12.37、10.25、5.41、18.20,P均<0.05);INF-γ、IL-2明显低于CIN各组及对照组(q分别=32.38、25.36、12.13、45.58;32.18、14.60、10.11、53.91,P均<0.05)。随CIN病变程度加重,CD4^+、CD4^+/CD8^+、INF-γ、IL-2值均降低(q分别=4.23、8.52、4.18;14.17、20.26、5.44;7.44、21.31、13.95;17.62、23.84、5.35,P均<0.05);而IL-4值明显升高(q分别=4.82、10.37、5.47,P均<0.05)。CIN各组之间TNF-α值呈上升趋势,其中CINⅠ与CINⅢ、CINⅡ与CINⅢ组间比较,差异有统计学意义(q分别=7.78、5.40,P均<0.05)。结论高危型HPV多重混合感染增加了CIN及宫颈癌的风险,同时,随CIN病变程度加重,宫颈局部CD4^+、CD4^+/CD8^+、INF-γ、IL-2表达量下降,IL-4、TNF-α表达量升高,宫颈局部免疫功能下降,更易导致高危型HPV持续感染,进一步加重宫颈病变。Objective To study the effect of inflammatory factors in local cervix and changes of T-cell subsets on high-risk human papilloma virus(HPV)infection and cervical lesions.Methods A total of 102 patients with cervical intraepithelial neoplasia(CIN)of high-risk HPV positive were included,including 28 cases of CIN Ⅰ,32 cases of CIN Ⅱ,42 cases of CIN Ⅲ.Totally 40 cases of cervical cancer were enrolled as the cervical cancer group and 34 normal cases with negative HPV were set as the control group.The levels of T lymphocyte subsets such as CD4+ and CD8+,the interferon γ(INF-γ),interleukin 2(IL-2),IL-4 and tumor necrosis factor-α(TNF-α)were detected.Results The multiple infection rate of HPV of cervical cancer group was significantly higher than that of CIN Ⅰ group,CINⅡ group and CINⅢ group(χ^2=9.11,4.91,3.53,P<0.05).The multiple infection rate of HPV was not statistically related to the degrees of CIN(χ^2=1.89,P>0.05).The levels of CD4^+,CD4^+/CD8^+,INF-γ,and IL-2 in the cervical cancer patients were significantly lower than those in the CIN Ⅰ group, CIN Ⅱ group,CIN Ⅲ group and control group (q= 10.74,6.59,2.68,15.14;23.52,9.24,4.25, 34.24;32.38,25.36,12.13,45.58;32.18,14.60, 10.11,53.91,P<0.05),while the levels of IL-4 and TNF -α were significantly higher (q=18.12, 13.65,8.94,24.41;12.37,10.25,5.41,18.20,P<0.05).The values of CD4^+,CD4^+/CD8^+,INF-γ and IL-2 decreased with the severity of CIN(q=4.23,8.52,4.18;14.17,20.26,5.44;7.44,21.31,13.95;17.62,23.84,5.35,P< 0.05),while the IL-4 levels increased with the severity of CIN(q=4.82,10.37,5.47,P<0.05).The TNF-α level was significantly different between CINⅠ group and CINⅢ group as well as between CINⅡ group and CINⅢ group(q= 7.78,5.40,P<0.05).Conclusion Multiple mixed infection of high risk HPV increase the risk of CIN and cervical cancer. With the aggravation of CIN,the expression of CD4^+,CD4^+/CD8^+,INF-γ and IL-2 in cervix decreased,the expression of IL -4 and TNF-alpha increased,and the local immune function of cervix decreased,

关 键 词：宫颈癌 人乳头瘤病毒 CD4^+T淋巴细胞 CD8^+T淋巴细胞 宫颈分泌物干扰素-γ 白细胞介素-2 

分 类 号：R737.33[医药卫生—肿瘤]