HPV E6/E7 mRNA和TOP2A对宫颈高级别鳞状上皮内病变锥切术后复发的影响  

Effect of HPV E6/E7 mRNA and TOP2A on the recurrence of cervical high-grade squamous intraepithelial lesion after conization

作　　者：吴晨鹏[1] 刘颖 李雪梅[1] 刘宝利 张志勇[1] 李小华[3] WU Chenpeng;LIU Ying;LI Xuemei;LIU Baoli;ZHANG Zhiyong;LI Xiaohua(Department of Pathology,Tangshan Gongren Hospital,Tangshan,Hebei 063000,China;Department of Laboratory,Tangshan Gongren Hospital;Department of Pathology,Tangshan Maternal and Child Health Care Hospital,Tangshan,Hebei 063000)

机构地区：[1]唐山市工人医院病理科,河北唐山063000 [2]唐山市工人医院检验科 [3]唐山市妇幼保健院病理科,河北唐山063000

出　　处：《徐州医科大学学报》2023年第6期420-424,共5页Journal of Xuzhou Medical University

基　　金：河北省国际科技合作专项(18397725D);河北省医学科学研究课题计划(20201515)。

摘　　要：目的分析宫颈高级别鳞状上皮内病变(HSIL)冷刀锥切术后复发的影响因素。方法收集唐山市工人医院和唐山市妇幼保健院2015年1月—2020年6月368例宫颈HSIL患者的临床病理及随访资料,所有患者均行冷刀锥切术,术前均行人乳头瘤病毒(HPV)E6/E7 mRNA检测并定期复查,应用免疫组织化学方法检测宫颈组织ⅡA型拓扑异构酶(TOP2A)和p16表达情况,分析术后复发的影响因素。结果HPV E6/E7 mRNA持续感染组复发率(25.4%)显著高于未持续感染组(6.3%),TOP2A高表达组复发率(12.5%)显著高于TOP2A低表达组(2.9%),差异均有统计学意义(P<0.05)。年龄、象限受累范围、腺体受累、组织学分级、p16表达与复发无关(P>0.05)。Logistic回归分析显示HPV E6/E7 mRNA持续感染和TOP2A高表达是术后复发的独立危险因素(OR=4.989,OR=3.883;均P<0.05)。不同型别HPV持续感染复发率的差异无统计学意义(P>0.05)。HPV E6/E7 mRNA持续感染与TOP2A的高表达呈正相关(P<0.05)。结论HPV E6/E7 mRNA持续感染与TOP2A高表达是宫颈HSIL冷刀锥切术后复发的高危因素,二者可能在复发机制上存在内在联系,检测HPV E6/E7 mRNA持续感染情况及TOP2A表达对宫颈HSIL的术后临床管理具有指导意义。Objective To analyze the influencing factors of the recurrence of cervical high-grade squamous intraepithelial lesion(HSIL)after cold knife conization.Methods A total of 368 patients with HSIL who were admitted to Tangshan Gongren Hospital and Tangshan Maternal and Child Health Care Hospital from January 2015 to June 2020 were enrolled and their clinicopathological and follow-up data were analyzed.All the patients underwent cold knife conization.The levels of human papillomavirus(HPV)E6/E7 mRNA were detected before operation and after operation regularly.The expression of typeⅡA topoisomerase(TOP2A)and p16 was detected by immunohistochemistry.The risk factors of recurrence were analyzed.Results The recurrence rate of the HPV E6/E7 mRNA persistent infection group was significantly higher than that without persistent infection(25.4%vs 6.3%,P<0.05).The recurrence rate of the TOP2A high expression group was significantly higher than that with TOP2A low expression(12.5%vs 2.9%,P<0.05).Age,quadrant involvement,gland involvement,histological grade and p16 expression were not associated with recurrence(P>0.05).Logistic regression analysis showed that HPV E6/E7 mRNA persistent infection and high expression of TOP2A were the independent risk factors for postoperative recurrence(OR=4.989,OR=3.883,P<0.05).There was no difference in the recurrence rate among different types of HPV persistent infection(P>0.05).HPV E6/E7 mRNA persistent infection was positively related to high expression of TOP2A(P<0.05).Conclusions HPV E6/E7 mRNA persistent infection and high expression of TOP2A are the high risk factors for recurrence of cervical HSIL after cold knife conization,and the two factors may have intrinsic relationship in the mechanism of recurrence.Detection of HPV E6/E7 mRNA persistent infection and expression of TOP2A can facilitate the postoperative management of cervical HSIL.

关 键 词：宫颈高级别鳞状上皮内病变 冷刀锥切术 HPV E6/E7 mRNA TOP2A 复发 

分 类 号：R737.33[医药卫生—肿瘤]