HPVL1壳蛋白及p16蛋白在高危型HPV持续感染的宫颈低级别鳞状上皮内病变患者临床转归中的意义  

The significance of HPV L1 capsid protein and p16 protein in the clinical outcomes of cervical low-grade squamous intraepithelial lesion with persistent high-risk HPV infection

作　　者：罗燕艳[1] 代新珍 廖燕婷[1] 罗小婉[1] 符丽华[1] LUO Yanyan;DAI Xinzhen;LIAO Yanting;LUO Xiaowan;FU Lihua(Department of Gynecology,Bo’ai Hospital of Zhongshan,Zhongshan 528403,Guangdong,China;Department of Pathology,Bo’ai Hospital of Zhongshan,Zhongshan 528403,Guangdong,China)

机构地区：[1]中山市博爱医院妇科,广东中山528403 [2]中山市博爱医院病理科,广东中山528403

出　　处：《中国现代医生》2024年第36期12-16,21,共6页China Modern Doctor

基　　金：广东省中山市社会公益科技研究项目(2022B1017)。

摘　　要：目的探讨人乳头瘤病毒(human papilloma virus,HPV)L1壳蛋白及p16蛋白在高危型HPV持续感染的宫颈低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)患者临床转归中的意义。方法选取2022年1月至7月在中山市博爱医院妇科宫颈病变中心就诊的114例高危型HPV持续感染且病理确诊为LSIL患者的宫颈组织进行HPV L1、p16免疫组化分析及随访。结果114例LSIL患者累计进展率21.93%,HPV L1、p16阳性率分别为25.44%、39.47%。单独检测中,HPVL1(+)表达者的消退率最高达68.97%,与进展组、持续组间的差异有统计学意义(P<0.05);联合检测中,HPVL1(+)/p16(+)、HPVL1(+)/p16(–)、HPVL1(–)/p16(+)表达者疾病累计消退率分别为60.00%、78.57%、43.64%,与累计进展率、持续率的差异均有统计学意义(P<0.05)。分层分析发现,单独检测中,HPVL1(+)表达者在第24个月时的消退率高于p16(+)表达者,差异有统计学意义(P<0.05)。联合检测中,HPVL1(–)/p16(+)表达者在第6、12个月时的进展率高于其他患者;而HPVL1(+)/p16(–)表达者在第24个月时的消退率高于其他组,差异均有统计学意义(P<0.05)。二分类Logistic回归分析结果表明,HPV16/18、p16(+)是LSIL进展的危险因素,OR分别为3.242(95%CI:1.261~8.336)、2.714(95%CI:1.055~6.980)。结论高危型HPV持续感染型别分析、HPVL1壳蛋白及p16蛋白免疫组化检测在高危型HPV持续感染的LSIL患者临床转归中有一定临床价值,有助于指导临床医师对高危型HPV持续感染的LSIL患者进行个体化随访及分流管理。Objective To explore the significance of human papilloma virus(HPV)L1 capsid protein and p16 protein in the clinical outcomes of cervical low-grade squamous intraepithelial lesions(LSIL)with persistent high-risk HPV infection.Methods Immunohistochemical analysis of HPV L1 and p16 was conducted on cervical tissues from 114 patients with persistent high-risk HPV infection and pathologically confirmed LSIL who were treated at the Cervical Disease Center of Department of Gynecology,Bo’ai Hospital of Zhongshan from January to July 2022,and follow-up was conducted.Results The cumulative progression rate of 114 LSIL patients was 21.93%,and the positive rates of HPV L1 and p16 were 25.44%and 39.47%,respectively.In the single detection,the regression rate of HPV L1(+)expression was as high as 68.97%,which was significantly different from the progression group and the persistent group(P<0.05);In the combined detection,the cumulative regression rates of HPV L1(+)/p16(+),HPV L1(+)/p16(–),and HPV L1(–)/p16(+),were 60.00%,78.57%,and 43.64%,respectively.There were statistically significant differences in the cumulative progression rate and persistence rate(P<0.05).Stratified analysis revealed that among individuals with HPV L1(+)expression,the regression rate at 24 months was higher than that of individuals with p16(+)expression,with a statistically significant difference(P<0.05).In the combined detection,the progression rate of HPV L1(–)/p16(+)expression in the 6th and 12th months was higher than that of other groups;The regression rate of HPV L1(+)/p16(–)expression in the 24th month was higher than that of other groups,and the differences were statistically significant(P<0.05).The results of the binary Logistic regression analysis indicate that the presence of HPV16/18 and p16 is a risk factor for the progression of LSIL,with OR values of 3.242(95%CI:1.261-8.336)and 2.714(95%CI:1.055-6.980),respectively.Conclusion The analysis of persistent infection types of high-risk HPV,as well as immunohistochemical detection of

关 键 词：宫颈低级别鳞状上皮内病变 人乳头瘤病毒 HPVL1壳蛋白 P16蛋白 转归 

分 类 号：R711.74[医药卫生—妇产科学]