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目的探讨HPV L1壳蛋白联合高危型人乳头瘤病毒(human papilloma virus,HPV)检测在细胞学异常分流管理及宫颈病变进展评估中的应用价值。方法选择2013年5月—2014年10月收治的液基细胞学(thinprep cytologic test,TCT)结果异常且高危型HPV HC2阳性患者144例作为研究对象,同时行HPV L1壳蛋白检测及宫颈活检,病理检查结果为诊断的金标准。计数资料采用χ2检验,HPV L1壳蛋白阳性率与宫颈病变严重程度的关系采用Spearman相关分析,P<0.05为差异有统计学意义。结果 TCT结果为意义未明的非典型鳞状细胞(atypical squamous cells of undetermined significance,ASCUS)、不能排除高度上皮内瘤变的不典型鳞状细胞(atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion,ASC-H)、轻度鳞状上皮内病变(lower-grade squamous intraepithelial lesions,LSIL)、高度鳞状上皮内病变(high-grade squmous intraepithelial lesions,HSIL)、鳞癌(squamous cell carcinoma,SCC)的HPV阳性率分别为52.78%、57.89%、75.61%、86.67%、100.00%,TCT不同结果患者HPV阳性率比较差异有统计学意义(P<0.05)。HPV L1壳蛋白在宫颈炎、宫颈上皮内瘤变Ⅰ级(cervical intraepithelial neoplasiaⅠ,CINI)、宫颈上皮内瘤变Ⅱ级(cervical intraepithelial neoplasiaⅡ,CINⅡ)、宫颈上皮内瘤变Ⅲ级(cervical intraepithelial neoplasiaⅢ,CINⅢ)、SCC中的表达阳性率分别为52.63%、63.27%、23.08%、9.09%、0,不同病理阶段HPV L1壳蛋白的表达阳性率比较差异有统计学意义(P<0.05)。HPV L1壳蛋白阳性率与宫颈病变严重程度呈负相关(r=-0.912)。结论 HPV L1壳蛋白对宫颈病变风险的评估有重要的指导意义。HPV L1壳蛋白联合高危型HCV检测能对细胞学异常患者进行有效的分流管理与治疗。
Objective To investigate the diagnostic value of HPV L1 capsid protein combined with high-risk human papilloma virus (HPV) in the assessment of abnormal cytology and cervical lesions. Methods A total of 144 patients with abnormal HCT-positive HPV26 positive results from May 2013 to October 2014 were enrolled in this study. HPV L1 capsid protein and cervical biopsy were performed at the same time. Pathological examination results for the gold standard of diagnosis. Count data using χ2 test, HPV L1 capsid protein positive rate and the severity of cervical lesions using Spearman correlation analysis, P <0.05 for the difference was statistically significant. Results TCT results showed that atypical squamous cells of undetermined significance (ASCUS) could not exclude high-grade squamous intraepithelial lesion (ASC) -H), lower-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL), squamous cell carcinoma (SCC) The positive rates of HPV were 52.78%, 57.89%, 75.61%, 86.67% and 100.00%, respectively. There was significant difference in the positive rate of HPV among different results of TCT (P <0.05). HPV L1 capsid protein in cervicitis, cervical intraepithelial neoplasia Ⅰ (CINI), cervical intraepithelial neoplasia Ⅱ (CIN Ⅱ), cervical intraepithelial neoplasia Ⅲ (cervical intraepithelial neoplasia Ⅲ, The positive rates of HPV L1 capsid protein in different pathological stages were 52.63%, 63.27%, 23.08%, 9.09%, 0 respectively (P <0.05). The positive rate of HPV L1 capsid protein was negatively correlated with the severity of cervical lesions (r = -0.912). Conclusion HPV L1 capsid protein has an important guiding significance for the assessment of the risk of cervical lesions. HPV L1 capsid protein combined with high-risk HCV testing can be effective in patients with abnormal cytology diversion management and treatment.