通讯作者: 罗燕艳, luoyanyan80@sina.com

DOI：10.12201/bmr.202410.00056

LUO Yan-yan1, DAI Xin-zhen2, LIAO Yan-ting1, LUO Xiao-wan2, FU Li-hua1

• 摘要：目的 探讨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患者临床转归中的意义。方法 对2022年1月至2022年7月在中山市博爱医院宫颈病变中心就诊的 114名高危型HPV持续感染并病理确诊为LSIL患者的宫颈组织进行HPV L1、p16免疫组化分析及随访。随访结果分为：进展、持续、消退三种。 结果 114例LSIL患者有25例进展至HSIL，累积进展率21.93%（25/114），其中HPV16/18阳性者、其他型别阳性者分别为14例（14/37，37.84%）、11例（11/77，14.29%），两者间的差异有统计学意义（χ2=8.097，p=0.004）；HPV L1、p16阳性率分别为25.44%（29/114）、39.47%（45/114）；单独检测中，HPV L1（+）表达者在消退组中最高达68.97%，与进展组、持续组间的差异有统计学意义（χ2=24.931，p=0.000）；p16（+）表达者三组间的差异无统计学意义。联合检测中，HPV L1（+）/p16（+）、HPV L1（+）/p16（-）、HPV L1（-）/p16（+）表达者疾病累积消退率分别为60.00%、78.57%、43.64% ，与累积进展率、持续率的差异均存在统计学意义。分层分析发现，单独检测时，HPV L1（+）表达者在第24个月时的消退率高于p16（+）表达者，差异存在统计学意义（χ2=4.270，p=0.038）。联合检测时，HPV L1（-）/p16（+）表达者在第6、12个月时的进展率高于其他免疫组化组，差异有统计学意义；HPV L1（+）/p16（-）表达者在第24个月时的消退率高于其他免疫组化组，差异有统计学意义（χ2=8.045，p=0.045）。二分类Logistics回归分析结果表明，HPV16/18、p16阳性是LSIL进展的危险因素，其OR值分别为：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的临床价值，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。

  关键词： 宫颈低级别鳞状上皮内病变；人乳头瘤病毒；HPV L1壳蛋白；p16蛋白；转归; ; ; ; 

   

  Abstract: Objective: To explore the significance of HPV L1 capsid protein and p16 protein in the clinical outcomes of cervical low-grade squamous intraepithelial lesions with persistent high-risk HPV infection. Method: 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 Zhongshan Boai Hospital from January 2022 to July 2022, and follow-up was conducted. The follow-up results are divided into three categories: progression, persistence, and regression. Results:25 out of 114 LSIL patients progressed to HSIL, with a cumulative progression rate of 21.93% (25/114). Among them, 14 cases (14/37, 37.84%) were positive for HPV16/18 and 11 cases (11/77, 14.29%) were positive for other types, with statistically significant differences between the two (χ2=8.097, p=0.004). The positive rates of HPV L1 and p16 were 25.44% (29/114) and 39.47% (45/114), respectively; In individual testing, HPV L1 (+) expression was highest in the regression group at 68.97%, with statistically significant differences between the progression group and the persistence group (χ2=24.931, p=0.000); there was no statistically significant difference in p16 (+) expression among the three groups.In joint testing, the cumulative regression rates of HPV L1 (+)/p16 (+), HPV L1 (+)/p16 (-), and HPV L1 (-)/p16 (+) expression were 60.00%, 78.57%, and 43.64%, respectively, with statistically significant differences in cumulative progression rate and persistence rate. Stratified analysis revealed that when tested individually, the regression rate of HPV L1(+) expression at 24 months was higher than that of p16(+) expression, with a statistically significant difference ((χ2=4.270, p=0.038). When combined detection was performed, the progression rate of HPV L1 (-)/p16 (+) expression at 6 and 12 months was higher than that of other immunohistochemical groups, and the difference was statistically significant; The regression rate of HPV L1 (+)/p16 (-) expression in the 24th month was higher than that of other immunohistochemical groups, and the difference was statistically significant ((χ2=8.045, p=0.045) .The results of binary Logistic regression analysis showed that HPV16/18 and p16 positive were risk factors 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 HPV L1 capsid protein and p16 protein, have certain clinical value in the clinical outcomes of LSIL patients with persistent infection of high-risk HPV, which can help guide clinical physicians to conduct individualized follow-up and triage management of LSIL patients with persistent infection of high-risk HPV.

  Key words: low-grade squamous intraepithelial lesion of the cervix; human papillomavirus; HPV L1 capsid protein; p16 protein; outcome

  提交时间：2024-10-19

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  1	2024-09-28	bmr.202410.00056V1	下载

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