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目的:探讨Survivin蛋白与宫颈细胞形态学异常、人乳头状瘤病毒(HPV)感染和宫颈上皮内瘤变(CIN)级别的关系。方法:收集天津医科大学总医院2008年1月～2009年12月妇科门诊就诊患者中经组织学检查确诊为CINⅡ和CINⅢ并同时具备宫颈脱落细胞液基细胞学检查(LCT)和HPV检测的患者共82例为研究对象。Survivin蛋白检测采用免疫组织化学方法。结果:Survivin蛋白在正常宫颈组织呈阴性表达;在所有CINⅡ和CINⅢ的宫颈组织中均呈阳性,阳性率100%,其表达强度在CINⅢ中强于CINⅡ(P<0.05)。Survivin蛋白表达与LCT所见不同细胞形态学异常改变之间的关系为:在HSIL组表达强度强于LSIL组(P<0.001);在LSIL组以轻度阳性为主;在ASCUS组和未见上皮内病变细胞或恶性细胞(NILM)组之间的差异不具有统计学意义。82例患者HPV阳性者76例,单一基因型HPV感染较多的是HPV-16、HPV-33、HPV-58。Survivin蛋白在该3个基因型单一感染的CIN组织中的表达情况为:在HPV-16单一感染的CIN组织中呈强阳性和中度阳性表达;在HPV-33单一感染的CIN组织中呈中度阳性表达;在HPV-58单一感染的CIN组织中呈轻度阳性表达。Survivin蛋白的阳性率在以上三者之间的差异,两两比较差异均具有统计学意义(P<0.001)。结论:Survivin在CINⅡ和CINⅢ中的阳性率为100%,说明Survivin是CINⅡ和CINⅢ敏感的免疫组织化学指标,且与CINⅡ和CINⅢ的级别有关(P<0.05)。Survivin在LCT所见不同细胞形态学异常改变之间表达强度的变化表明,Survivin蛋白的表达与宫颈上皮细胞异型性的程度有关。Survivin蛋白阳性表达率在特定基因型HPV感染的CIN组织的差异表明,Survivin蛋白阳性表达与HPV-16感染存在很强的相关性。
Objective: To investigate the relationship between Survivin protein and cervical cell morphology, human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN). Methods: Patients with histologically confirmed CIN II and CIN Ⅲ and cervical cytology (LCT) and HPV testing were collected from gynecological clinic patients from January 2008 to December 2009 in the General Hospital of Tianjin Medical University. A total of 82 cases for the study. Survivin protein detection using immunohistochemical methods. Results: Survivin protein was negative in normal cervical tissue, positive in all CINⅡ and CINⅢ cervical tissues, the positive rate was 100%. The expression of Survivin was stronger in CIN Ⅲ than that in CIN Ⅲ (P <0.05). The relationship between the expression of Survivin and the abnormal cell morphological changes seen in LCT was that the expression intensity of Survivin in HSIL group was stronger than that of LSIL group (P <0.001), mild in LSIL group, The difference between intraepithelial lesion cells or malignant cell (NILM) group was not statistically significant. Among the 82 patients, 76 were HPV positive, and HPV-16, HPV-33 and HPV-58 were the most common genotype HPV infections. The expression of Survivin protein in CIN tissues with single genotypes of the three genotypes was strongly and moderately positive in CIN tissues infected by HPV-16 alone, moderate in HPV-33 single-infected CIN tissues Degrees positive expression; mild positive expression in HPV-58 single infection of CIN tissue. Survivin protein positive rate in the above three differences between each two were statistically significant differences (P <0.001). CONCLUSIONS: The positive rate of Survivin in CINⅡ and CINⅢ is 100%, which indicates that Survivin is an immunohistochemical index sensitive to CINⅡand CINⅢ, which is related to the grade of CINⅡ and CINⅢ (P <0.05). Survivin in LCT showed changes in the expression of different cell morphological changes between the intensity of the change that Survivin protein expression and cervical epithelial cell atypia degree. Survivin protein positive rate in specific genotypes of HPV infected CIN tissue differences show that the positive expression of Survivin protein and HPV-16 infection there is a strong correlation.