Objective To investigate the clinical significance of combined detection of human papillomavirus (HPV) L1 capsid protein,thinprep cytoligic test (TCT) and HPV genotyping on the early diagnosis of cervical cancer.Methods A total of 1 260 patients with sexual life history and cervical lesions were detected of HPV genotyping and TCT,then one or both in the two indicators was tested by biopsy.Meanwhile the expression of HPV L1 capsid protein was detected in patients with abnormal TCT.Contrasted TCT,HPV genotyping,HPV L1 capsid protein and histopathological diagnosis.Results The positive rate of cervical intraepithelial neoplasia (CIN) and more gradually of no definitive diagnosis significance of atypical squamous cells (ASCUS),low-grade squamous epithelial cell lesions (LSIL),the height of squamousintraepithelial lesion (HSIL),squamous cell carcinoma (SCC) was respectively 19.0％ (11/58),63.4％ (26/41),84.6％ (22/26) and 7/7,which increased with TCT-level rise,and there was significant difference (P ＜ 0.01).Low risk HPV-positive were mainly seen in low-grade lesions,with the TCT-level rise,high risk HPV-positive rate was significantly higher,which was respectively 36.2％ (21/58),56.1％ (23/41),73.1％(19/26) and 7/7,and there was significant difference (P＜0.05).The rate ofinflammation,CIN Ⅰ in HPV L1 capsid protein-positive was higher than HPV L1 capsid protein-negative [59.2％ (42/71) vs.39.3％ (24/61),29.6％(21/71) vs.14.8％(9/61)],pathological diagnosis of SCC were negative in HPV L1 capsid protein expression.With the increased level of pathology,the positive rate of HPV L1 capsid protein decreased.Conclusions That TCT liquid-based cytology and HPV genotyping can significantly reduce high-risk groups and significantly improve the detection rate of cervical cancer,and to detect HPV L1 capsid protein of HPV infection may provide the basis for the status and prognosis.Combination of the three indicators can provide the basis for early diagnosis of cervical cancer.%目的 探讨人乳头瘤病毒(HPV)L1壳蛋白、薄层液基细胞学检测(TCT)和HPV分型联合检测在宫颈癌早期诊断中的临床意义.方法 对1 260例有性生活史的宫颈病变患者行TCT和HPV分型检测,两者中任何一项阳性或2项均阳性者行病理组织学检测.同时对TCT异常者行HPV L1壳蛋白的检测.将TCT、HPV分型、HPV L1壳蛋白结果与病理组织学结果进行比较.结果 TCT结果中未明确诊断意义的不典型鳞状上皮细胞(ASCUS)、低度鳞状上皮细胞内病变(LSIL)、高度鳞状上皮细胞内病变(HSIL)、鳞状细胞癌(SCC)在病理组织学宫颈上皮内瘤变(CIN)及以上的阳性率分别为19.0％(11/58),63.4％(26/41),84.6％(22/26),7/7,随TCT级别的升高,病理组织学CIN及以上阳性率逐渐升高,差异有统计学意义(P＜0.01).低危型HPV阳性主要见于低度病变,随TCT级别的升高,高危型HPV阳性率逐渐升高,分别为36.2％(21/58),56.1％(23/41),73.1％(19/26),7/7,各级别间比较差异有统计学意义(P＜0.05).HPV L1壳蛋白阳性患者病理组织学诊断炎性反应、CIN Ⅰ比例高于HPV L1壳蛋白阴性患者[59.2％(42/71)比39.3％ (24/61)、29.6％(21/71)比14.8％(9/61)],病理组织学诊断SCC患者HPV L1壳蛋白表达均阴性.随病理组织学级别升高,HPV L1壳蛋白阳性率逐渐降低.结论 TCT和HPV分型检测能显著缩小高风险人群,提高宫颈癌的检出率,而HPV L1壳蛋白的检测可为HPV感染的状态及预后提供依据.三个指标联合检测可为宫颈癌的早期诊断提供依据.
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