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目的:探讨P16、P53蛋白联合人乳头状瘤病毒(HPV)检测在宫颈病变鉴别诊断中的价值。方法:收集上海市长宁区中心医院病理科2006～2010年行阴道镜活检的患者360例,根据组织学诊断结果分为6组,采用免疫组化Elivision两步法检测了P16、P53蛋白表达,并且进行了HPV定量及分型检测。结果:P16蛋白在正常组罕见表达,而病变组仅表达在病变部位,高级别病变组与低级别病变组表达比较,差异有统计学意义(P<0.05);P53蛋白在正常组与病变组均有表达,低级别病变组表达弱阳性,高级别病变组表达强阳性,差异有统计学意义(P<0.05)。HPV定量检测显示病毒载量在各病变组的差异无统计学意义(P>0.05),而分型检测表明,HPV16是病变组中感染最多的亚型,且随着病变加重,感染率增加(P<0.05)。相关性分析显示,HPV感染与P16阳性表达(r=0.99)、P53强阳性表达(r=0.74)存在正相关。P16对高级别上皮内病变的诊断效能与HCⅡ接近。结论:HPV与P16、P53蛋白共同作用参与了宫颈癌的发生发展,P16蛋白联合HPV定量或分型检测对于宫颈高级别上皮内病变具有一定的鉴别诊断价值。
Objective: To investigate the value of P16, P53 protein combined with human papillomavirus (HPV) in the differential diagnosis of cervical lesions. Methods: 360 cases of colposcopy biopsy from 2006 to 2010 in Department of Pathology, Changning District Central Hospital were collected and divided into 6 groups according to the results of histological diagnosis. The expressions of P16 and P53 protein were detected by immunohistochemical Elivision two-step method. And carried out the HPV quantitative and typing test. Results: The expression of P16 protein was rare in normal group, while the lesion group was only expressed in lesion site. The expression of P53 protein in normal group was significantly lower than that in low grade lesion group (P <0.05) (P <0.05). There was a strong positive expression in the low-grade group and weak-positive group in the high-grade group. The difference was statistically significant (P <0.05). The quantitative detection of HPV showed no significant difference in each group (P> 0.05), while the typing test showed that HPV16 was the most infected subtype in the diseased group, and the infection rate increased as the disease progressed P <0.05). Correlation analysis showed that there was a positive correlation between HPV infection and the positive expression of P16 (r = 0.99) and strong positive expression of P53 (r = 0.74). The diagnostic efficacy of P16 for high-grade intraepithelial lesions is close to that of HCII. Conclusion: HPV and P16, P53 protein are involved in the development of cervical cancer. The detection of P16 protein combined with HPV quantitative or typing has some differential diagnostic value for cervical intraepithelial high grade intraepithelial lesion.