HPVL1壳蛋白联合MCM2检测对HPV DNA阳性患者宫颈病变的诊断及预后意义  

The study of diagnosis and prognosis of the combined HPVL1 and MCM2 in patients with HPV DNA positive cervical lesions

作　　者：王登山[1] 曹磊[1] 钱金林 陈剑瑛 金雷[1] 刘华 Wang Dengshan;Cao Lei;Qian Jinlin;Chen Jianying;Jin Lei;Liu Hua(Department of Pathology,Shanghai University of Medicine&Health Sciences Affiliated Pudong New Area People's Hospital,Shanghai 201299,China.)

机构地区：[1]上海健康医学院附属浦东新区人民医院病理科

出　　处：《现代肿瘤医学》2020年第2期287-292,共6页Journal of Modern Oncology

基　　金：上海市浦东新区卫计委卫生科技项目(编号:PW2012A-19)

摘　　要：目的:探讨HPVL1壳蛋白联合MCM2检测对HPV DNA阳性患者宫颈病变的诊断及随访的临床意义。方法:选取2010年1月至2015年1月门诊及住院患者,共531例。先行HPV DNA分型检测及活检确定病理类型,检测HPVL1和MCM2在宫颈组织中的表达情况。结果:≥45岁的HPV DNA阳性患者宫颈病变发病数量明显增加;HPVL1壳蛋白表达阳性率随宫颈病变恶性程度的增加而降低;随着宫颈病变加重,MCM2阳性比率逐渐上升,联合HPVL1检测,当同时HPVL1阴性,LSIL和HSIL两组中MCM2的阳性率分别为66.92%和90.91%(P=0.000)。HPVL1壳蛋白阳性病例自然消退22例(78.57%),持续存在5例(17.86%),进展1例(3.57%);HPVL1壳蛋白阴性病例自然消退13例(14.94%),持续存在67例(77.01%),进展7例(8.05%)。LSIL患者中HPVL1壳蛋白阳性和HPVL1壳蛋白阴性者相比,2年自然消退率HPVL1壳蛋白阳性者高(P=0.000)。结论:HPV DNA持续性感染是宫颈病变的高危因素;HPVL1壳蛋白表达的阳性率与宫颈病变的恶性程度呈负相关;通过联合检测HPVL1和MCM2,对判断和预测宫颈病变,尤其是区分LSIL和HSIL,比单独进行两项检测的价值更高;HPVL1壳蛋白在预测LSIL转归中可能有重要意义。Objective:To explore the diagnosis and prognosis of the combined HPVL1 and MCM2 in patients with HPV DNA positive cervical lesions.Methods:A total of 531 outpatients and inpatients from January 2010 to January 2015 in our hospital were selected.HPV DNA typing and the biopsypathological types were determined.The expression of HPVL1 and MCM2 in cervical tissues was examined.Results:The incidence of cervical lesions in HPV DNA positive patients aged≥45 years old was significantly increased.The positive rate of HPVL1 protein expression decreased with the increase of malignant degree of cervical lesions.With the increase of cervical lesions,the positive rate of MCM2 increased gradually.When HPVL1 was negative,the positive rates of MCM2 in LSIL and HSIL were 66.92%and 90.91%,respectively(P=0.000).The HPVL1 positive patients had 22 cases(78.57%)of natural resolution,5 cases(17.86%)persisted,and 1 case(3.57%)progressed.HPVL1 negative patients had spontaneous regression of 13 cases(14.94%),67 cases(77.01%)persisted and 7 cases(8.05%)progressed.Among the LSIL group,the 2-year spontaneous regression rate in HPVL1 protein positive were higher in the HPVL1 negative(P=0.000).Conclusion:HPV persistent infection was a high risk factor for cervical lesions.The positive rate of HPVL1 expression was negatively correlated with the degree of malignancy of cervical lesions.Combining detection of HPVL1 and MCM2 was more valuable to predict cervical lesions than performing two proteins alone,especially to distinguish LSIL and HSIL.HPVL1 protein may play an important role in predicting the outcome of LSIL.

关 键 词：HPV DNA HPVL1壳蛋白 宫颈鳞状上皮内病变 宫颈鳞癌 MCM2 预后 

分 类 号：R737.33[医药卫生—肿瘤]