Papillomavirus

乳头瘤病毒
  • 文章类型: Journal Article
    天津发生了一场关于养殖中国舌底的大规模死亡事件,中国,病原体仍然未知。这里,通过电子显微镜从患病的鱼中同时分离并鉴定了一种新型的半乳头瘤病毒(CsPaV)和细小病毒(CsPV),病毒分离,基因组测序,实验挑战,和荧光原位杂交(FISH)。电子显微镜显示,患病鱼的组织中存在大量病毒颗粒。在比目鱼g细胞(FG)中分离和繁殖的病毒会诱导典型的细胞病变效应(CPE)。给予腹膜内注射的鱼的累积死亡率在7dpi时达到100%。CsPaV和CsPV的完整基因组包括5939bp和3663bp,分别,基因组与其他病毒没有核苷酸序列相似性。基于L1和NS1蛋白序列的系统发育分析表明,CsPaV和CsPV是乳头状病毒科和细小病毒科的新成员。FISH结果显示感染鱼的脾脏组织中存在阳性信号,两种病毒都可以共同感染单个细胞。这项研究代表了在养殖海洋养殖鱼类中发现新型乳头瘤病毒和细小病毒的第一份报告,为进一步研究新发病毒性疾病的防治提供了依据。
    A massive mortality event concerning farmed Chinese tongue soles occurred in Tianjin, China, and the causative agent remains unknown. Here, a novel Cynoglossus semilaevis papillomavirus (CsPaV) and parvovirus (CsPV) were simultaneously isolated and identified from diseased fish via electron microscopy, virus isolation, genome sequencing, experimental challenges, and fluorescence in situ hybridization (FISH). Electron microscopy showed large numbers of virus particles present in the tissues of diseased fish. Viruses that were isolated and propagated in flounder gill cells (FG) induced typical cytopathic effects (CPE). The cumulative mortality of fish given intraperitoneal injections reached 100% at 7 dpi. The complete genomes of CsPaV and CsPV comprised 5939 bp and 3663 bp, respectively, and the genomes shared no nucleotide sequence similarities with other viruses. Phylogenetic analysis based on the L1 and NS1 protein sequences revealed that CsPaV and CsPV were novel members of the Papillomaviridae and Parvoviridae families. The FISH results showed positive signals in the spleen tissues of infected fish, and both viruses could co-infect single cells. This study represents the first report where novel papillomavirus and parvovirus are identified in farmed marine cultured fish, and it provides a basis for further studies on the prevention and treatment of emerging viral diseases.
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  • 文章类型: Journal Article
    目的总结人乳头瘤病毒(HPV)与HPV相关疾病的类型分布,并通过总结谱系的流行情况,探讨HPV52和58高流行的潜在原因。次谱系,和中国女性的变异。我们搜索了PubMed,EMBASE,CNKI,和万方从一月开始,2012年6月,2023年确定所有符合条件的研究。我们排除了接受HPV疫苗接种的患者。数据汇总在表格和云/雨地图中。共提取102项报告HPV分布的研究和15项报告HPV52/HPV58变体的研究。在中国女性中,与宫颈癌(CC)相关的前5种流行HPV类型为HPV16,18,58,52和33.在患有阴道癌和癌前病变的患者中,最常见的HPV类型为16和52,其次为58.对于患有尖锐湿疣(CA)的女性,最常见的HPV类型是11和6.在中国患有HPV感染的女性中,谱系B在HPV52中最突出,谱系A在HPV58中最常见。除了全球流行的HPV16型,我们的研究结果揭示了在患有HPV相关疾病的中国女性中HPV52/58的独特高患病率.HPV52变体主要偏向于谱系B和亚谱系B2,并且HPV58变体强烈偏向于谱系A和亚谱系A1。需要进一步研究HPV52/58中的高流行谱系和亚谱系与癌症风险之间的关联。我们的发现强调了在中国接种九价HPV疫苗的重要性。
    To summarize the distribution of types of human papillomavirus (HPV) associated with HPV-related diseases and investigate the potential causes of high prevalence of HPV 52 and 58 by summarizing the prevalence of lineages, sub-lineages, and mutations among Chinese women. We searched PubMed, EMBASE, CNKI, and WanFang from January, 2012 to June, 2023 to identify all the eligible studies. We excluded patients who had received HPV vaccinations. Data were summarized in tables and cloud/rain maps. A total of 102 studies reporting HPV distribution and 15 studies reporting HPV52/HPV58 variants were extracted. Among Chinese women, the top five prevalent HPV types associated with cervical cancer (CC) were HPV16, 18, 58, 52, and 33. In patients with vaginal cancers and precancerous lesions, the most common HPV types were 16 and 52 followed by 58. For women with condyloma acuminatum (CA), the most common HPV types were 11 and 6. In Chinese women with HPV infection, lineage B was the most prominently identified for HPV52, and lineage A was the most common for HPV58. In addition to HPV types 16, which is prevalent worldwide, our findings revealed the unique high prevalence of HPV 52/58 among Chinese women with HPV-related diseases. HPV 52 variants were predominantly biased toward lineage B and sub-lineage B2, and HPV 58 variants were strongly biased toward lineage A and sub-lineage A1. Further investigations on the association between the high prevalent lineage and sub-lineage in HPV 52/58 and the risk of cancer risk are needed. Our findings underscore the importance of vaccination with the nine-valent HPV vaccine in China.
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  • 文章类型: Journal Article
    有效的抗肿瘤T细胞应答和有效的肿瘤内T细胞浸润是治疗性癌症疫苗的主要挑战。为了解决这些问题,已经设计了一种纳米疫苗系统来促进抗肿瘤T细胞反应,在各种小鼠肿瘤模型中检查了肿瘤内浸润。携带人乳头瘤病毒(HPV)-16E7抗原的纳米圆盘的皮下注射可在循环中引起高达〜32%的E7特异性CD8αT细胞反应,代表比可溶性肽疫苗接种提高了29倍。重要的是,纳米圆盘疫苗接种还能促进肿瘤内T细胞浸润,并消除粘膜部位表达HPV16E6/E7的TC-1肿瘤,包括肺,内唇,和阴道内组织。在一项用活李斯特菌疫苗联合抗PD-1IgG的基准研究中,nanodisks+抗PD-1免疫检查点阻断引发具有抗肿瘤功效的相当水平的T细胞应答。此外,与完全弗氏佐剂联合破伤风类毒素相比,在HLA-A02小鼠中的纳米圆盘疫苗接种产生针对来自HLA-A02黑素瘤患者的新抗原的>200倍更强的IFN-γ+T细胞应答。总的来说,这些结果表明,nanodisk系统是一个有前途的癌症疫苗平台,用于诱导抗肿瘤T细胞反应。
    Potent anti-tumor T cell response and efficient intratumoral T cell infiltration are the major challenges for therapeutic cancer vaccines. To address these issues, a nano-vaccine system has been designed to promote anti-tumor T cell responses, and intratumoral infiltration was examined in various murine tumor models. Subcutaneous vaccination with nanodiscs carrying human papillomavirus (HPV)-16 E7 antigen elicits as high as ~32% E7-specific CD8 α + T cell responses in circulation, representing a 29-fold improvement over the soluble peptide vaccination. Importantly, nanodisc vaccination also promotes robust intratumoral T cell infiltration and eliminates HPV16 E6/E7-expressing TC-1 tumors at mucosal sites, including lungs, inner lip, and intravaginal tissues. In a benchmark study with a live Listeria vaccine combined with anti-PD-1 IgG, nanodiscs plus anti-PD-1 immune checkpoint blockade elicits comparable levels of T cell responses with anti-tumor efficacy. Furthermore, compared with Complete Freund\'s Adjuvant combined with tetanus toxoid, nanodisc vaccination in HLA-A02 mice generates >200-fold stronger IFN-γ+ T cell responses against a neoantigen from an HLA-A02 melanoma patient. Overall, these results show that the nanodisc system is a promising cancer vaccine platform for inducing anti-tumor T cell responses.
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  • 文章类型: Journal Article
    BACKGROUND: Papillomaviruses can be of great medical importance as they infect humans and animals such as Equus species, other livestock and pets. They are responsible for several papillomas and benign tumours in their host.
    OBJECTIVE: To describe a novel equid papillomavirus detected in oral swab samples collected from donkeys (Equus asinus) found on the Northwest plateau of China.
    METHODS: Cross-sectional.
    METHODS: Swab samples collected from the oral mucosa of 32 donkeys in the Gansu Province of China, were subjected to viral metagenomic analysis to detect the presence of Papillomavirus. After de novo assembly, a novel papillomavirus genome designated as Equus asinus papillomavirus 3 (EaPV3) was identified in the studied samples. Additional bioinformatic analysis of the assembled genome was done using the Geneious prime software (version 2022.0.2).
    RESULTS: The complete circular genome of EaPV3 is 7430 bp in length with a GC content of 50.8%. The genome was predicted to contain five ORFs coding for three early proteins (E7, E1, and E2) and two late proteins (L1 and L2). Phylogenic analysis of the nucleotide sequences of the concatenated amino acid sequences of the E1E2L1L2 genes revealed that EaPV3 is most closely related to Equus asinus papillomavirus 1 (EaPV1). The genome analysis of EaPV3 revealed similar genome organisation with other equine papillomavirus and the presence of E7 papillomavirus oncoprotein.
    CONCLUSIONS: Since there were no warts in the oral cavity of the donkeys in this study, and no biopsy samples taken, we are unable to conclusively link the novel virus to any clinical condition in the donkeys.
    CONCLUSIONS: The Comparative characterisation of EaPV3 and its closest relatives, as well as phylogenetic analysis demonstrated that it is a novel virus specie that clusters within the Dyochipapilloma PV genus.
    UNASSIGNED: O papilomavírus pode apresentar uma importância médica significante por poder infectar humanos e animais, incluindo animais da espécie Equus, animais de produção e animais domésticos. Esse vírus é responsável por vários papilomas e tumores benignos em seus hospedeiros.
    OBJECTIVE: Descrever um novo papilomavírus detectado em amostras de swab oral coletados de Equus asinus no Noroeste da China.
    UNASSIGNED: Estudo transversal.
    METHODS: Amostras de swab coletadas da mucosa oral de 32 jumentos da província de Gansu na China foram submetidos para análise metagenômica viral para detectar a presença de papilomavírus. Após a montagem de novo, um novo papilomavírus, denominado Equus asinus papilomavírus 3 (EaPV3), foi identificado nas amostras estudadas. Análise bioinformática adicional foi realizada para montar o genoma desse vírus usando o Geneious prime software (version 2022.0.2).
    RESULTS: O genoma circular completo do EaPV3 possui 7.430 bp, e apresenta 50.8% de conteúdo GC. Foi previsto que o genoma possui cinco codificações ORFs para três proteínas precoces (E7, E1 e E2) e duas proteínas retardas (L1 2 L2). Análise filogenética da sequência de nucleotídeos dos genes E1E2L1L2 dos amino ácidos concatenados revelaram que o EaPV3 é bastante similar aos EaPV1. A análise genômica do EaPV3 revelou uma organização genômica similar com outros papilomavírus equinos e a presença da oncoproteína E7. PRINCIPAIS LIMITAÇÕES: Como não havia nenhuma verruga na cavidade oral dos jumentos investigados neste estudo, e nenhuma biópsia foi realizada, não é possível concluir uma associação entre este novo vírus e qualquer condição clínica em jumentos. CONCLUSÕES: A caracterização comparativa do EaPV3 com outros vírus similares e a análise filogenética demonstraram que este é um novo vírus que assemelha-se com os papilomavírus do gene Dyochipapilloma.
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  • 文章类型: Journal Article
    这里,使用病毒宏基因组方法,一种新型鲸鱼乳头瘤病毒(暂时命名为wPV,GenBank登录号OP856597)是在鲸鱼(Delphinapterusleuas)咽宏基因组文库中发现的。wPV的全基因组大小为7179bp,GC含量为54.4%,核苷酸组成为23.4%A,22.3%T,28.4%G,和25.9%C。病毒基因组具有典型的乳头状瘤病毒组织模式,并预测了五个ORF,包括两个编码L1和L2的晚期基因和三个编码E1、E2和E6的早期基因。基于L1基因序列的成对序列比较和系统发育分析表明,wPV可能是Dyodeltapillomavirus属中的新物种。此外,wPV的E2区被预测具有潜在的重组事件。这种新型乳头瘤病毒的发现增加了我们对海洋哺乳动物病毒生态学的认识,提供对未来可能的传染病的见解。
    Here, using viral metagenomic method, a novel whale papillomavirus (temporarily named wPV, GenBank accession number OP856597) was discovered in a whale (Delphinapterus leucas) pharyngeal metagenomic library. The complete genome size of wPV is 7179 bp, with GC content of 54.4% and a nucleotide composition of 23.4% A, 22.3% T, 28.4% G, and 25.9% C. The viral genome has a typical papillomavirus organization pattern, and five ORFs were predicted, including two late genes encoding L1 and L2, and three early genes encoding E1, E2, and E6. Pairwise sequence comparison and phylogenetic analysis based on the L1 gene sequence indicated that wPV may be a novel species within genus Dyodeltapapillomavirus. In addition, the E2 region of wPV was predicted to have a potential recombination event. The discovery of this novel papillomavirus increases our understanding of the viral ecology of marine mammals, providing insights into possible future infectious diseases.
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  • 文章类型: Journal Article
    未经证实:人乳头瘤病毒(HPV)类型特异性策略在预防宫颈上皮内瘤变(CIN)中起关键作用,但是关于CIN中HPV类型特异性患病率的证据有限.
    UNASSIGNED:这项多中心研究估计了2017-2018年中国高危型HPV在CIN病例中的患病率以及HPV感染模式与高级别CIN的关联。
    UNASSIGNED:基于人群的预防策略应优先考虑HPV-16和18,而非16/18高危HPV的策略对于消除宫颈癌至关重要。
    UNASSIGNED: Human papillomavirus (HPV) type-specific strategies play a key role in the prevention of cervical intraepithelial neoplasia (CIN), but evidence on the HPV type-specific prevalence in CIN is limited.
    UNASSIGNED: This multicentric study estimates the prevalence of high-risk HPV types in CIN cases and the associations of HPV infection patterns with high-grade CIN in China in 2017-2018.
    UNASSIGNED: Population-based prevention strategies should give preference to HPV-16 and 18, and strategies for non-16/18 high-risk HPV are essential for the elimination of cervical cancer.
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  • 文章类型: Journal Article
    病毒是人体的重要组成部分。越来越多的证据表明,他们参与了宿主的生理和疾病状态。尽管阴道微生物组参与人乳头瘤病毒(HPV)感染和宫颈癌(CC)进展,人们对阴道病毒的作用知之甚少。在这项探索性试验研究中,使用无偏见的病毒宏基因组学,我们的目的是调查不同程度的宫颈病变的女性的阴道真核细胞病毒,并检查它们与不同宫颈疾病状态的关联。在具有不同水平的病变和乳杆菌谱的女性中观察到改变的真核病毒。Anellovirus和乳头瘤病毒是最常见的检测到的阴道病毒的真核病毒。较高的anellovirus和乳头瘤病毒的丰度和丰富度与低度鳞状上皮内病变(LSIL)和CC相关。此外,较高的anellovirus丰度还与乳酸杆菌耗尽的微生物组概况和细菌群落状态(CST)IV型相关。此外,在宫颈疾病严重程度从LSIL到CC升高的女性中,锥病毒科和乳头状瘤病毒科之间的相关性增加.这些数据表明不同微生物以及宿主生理学之间的潜在相互作用。LSIL和CC共有的囊膜病毒和乳头状瘤病毒的丰度和多样性较高,表明囊膜病毒可用作潜在的辅助生物标志物来预测HPV持续感染和/或CC的风险。未来的研究需要集中在anellovirus丰度与宫颈疾病状态的临床相关性,并评估其作为预测和预测CC的新辅助生物标志物的潜力。
    Viruses are important components of the human body. Growing evidence suggests that they are engaged in the physiology and disease status of the host. Even though the vaginal microbiome is involved in human papillomavirus (HPV) infection and cervical cancer (CC) progression, little is known about the role of the vaginal virome. In this pilot exploratory study, using unbiased viral metagenomics, we aim to investigate the vaginal eukaryotic virome in women with different levels of cervical lesions, and examine their associations with different cervical disease status. An altered eukaryotic virome was observed in women with different levels of lesions and Lactobacillus profiles. Anelloviruses and papillomaviruses are the most commonly detected eukaryotic viruses of the vaginal virome. Higher abundance and richness of anelloviruses and papillomaviruses were associated with low-grade squamous intraepithelial lesion (LSIL) and CC. Besides, higher anellovirus abundance was also associated with lactobacillus-depleted microbiome profiles and bacterial community state (CST) type IV. Furthermore, increased correlations between Anelloviridae and Papillomaviridae occurred in the women with increased cervical disease severity level from LSIL to CC. These data suggest underlying interactions between different microbes as well as the host physiology. Higher abundance and diversity of both anelloviruses and papillomaviruses shared by LSIL and CC suggest that anellovirus may be used as a potential adjunct biomarker to predict the risk of HPV persistent infection and/or CC. Future studies need to focus on the clinical relevance of anellovirus abundance with cervical disease status, and the evaluation of their potential as a new adjunct biomarker for the prediction and prognoses of CC.
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  • 文章类型: Journal Article
    大约5%的人类癌症可归因于人乳头瘤病毒(HPV)感染。尽管有预防性HPV疫苗,但HPV相关疾病和癌症仍然是全球重大的公共卫生和经济负担。HPV相关疾病和癌症的当前诊断和治疗主要基于细胞/组织形态学检查和/或针对高风险HPV类型的存在的测试。缺乏稳健的靶标/标志物来提高诊断和治疗的准确性。已经建立了几种天然存在的动物乳头瘤病毒模型作为研究HPV发病机理的替代。其中,棉尾兔乳头瘤病毒(CRPV)模型已被称为黄金标准。该模型在目前可用于预防HPV感染的疫苗的成功开发中发挥了关键作用。在过去的八十年里,CRPV模型已广泛应用于研究HPV癌变。利用一大组具有不同功能的突变CRPV基因组,可重复,和可预测的表型,我们对肿瘤进展过程中的病毒-宿主相互作用有了更深入的了解.近年来,将全基因组RNA-seq分析应用于CRPV模型,使我们能够了解和验证与HPV相关癌症中报道的相似的变化.此外,我们已经建立了一些基因修饰的兔系,以促进机理研究和新型治疗策略的开发.在当前的审查中,我们总结了一些重要发现,这些发现促进了我们对HPV发病机制的理解,并强调了新型基因修饰兔的发展对未来机制研究的意义.
    Approximately 5% of all human cancers are attributable to human papillomavirus (HPV) infections. HPV-associated diseases and cancers remain a substantial public health and economic burden worldwide despite the availability of prophylactic HPV vaccines. Current diagnosis and treatments for HPV-associated diseases and cancers are predominantly based on cell/tissue morphological examination and/or testing for the presence of high-risk HPV types. There is a lack of robust targets/markers to improve the accuracy of diagnosis and treatments. Several naturally occurring animal papillomavirus models have been established as surrogates to study HPV pathogenesis. Among them, the Cottontail rabbit papillomavirus (CRPV) model has become known as the gold standard. This model has played a pivotal role in the successful development of vaccines now available to prevent HPV infections. Over the past eighty years, the CRPV model has been widely applied to study HPV carcinogenesis. Taking advantage of a large panel of functional mutant CRPV genomes with distinct, reproducible, and predictable phenotypes, we have gained a deeper understanding of viral-host interaction during tumor progression. In recent years, the application of genome-wide RNA-seq analysis to the CRPV model has allowed us to learn and validate changes that parallel those reported in HPV-associated cancers. In addition, we have established a selection of gene-modified rabbit lines to facilitate mechanistic studies and the development of novel therapeutic strategies. In the current review, we summarize some significant findings that have advanced our understanding of HPV pathogenesis and highlight the implication of the development of novel gene-modified rabbits to future mechanistic studies.
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  • 文章类型: Journal Article
    The goal of this study was to identify human papillomavirus (HPV) type 52 genetic and epigenetic changes associated with high-grade cervical precancer and cancer. Patients were selected from the HPV Persistence and Progression (PaP) cohort, a cervical cancer screening program at Kaiser Permanente Northern California (KPNC). We performed a nested case-control study of 89 HPV52-positive women, including 50 cases with predominantly cervical intraepithelial neoplasia grade 3 (CIN3) and 39 controls without evidence of abnormalities. We conducted methylation analyses using Illumina sequencing and viral whole genome Sanger sequencing. Of the 24 CpG sites examined, increased methylation at CpG site 5615 in HPV52 L1 region was the most significantly associated with CIN3, with a difference in median methylation of 17.9% (odds ratio (OR) = 4.8, 95% confidence interval (CI) = 1.9-11.8) and an area under the curve of 0.73 (AUC; 95% CI = 0.62-0.83). Complete genomic sequencing of HPV52 isolates revealed associations between SNPs present in sublineage C2 and a higher risk of CIN3, with ORs ranging from 2.8 to 3.3. This study identified genetic and epigenetic HPV52 variants associated with high risk for cervical precancer, improving the potential for early diagnosis of cervical neoplasia caused by HPV52.
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  • 文章类型: Journal Article
    Objective: To evaluate the value of p16INK4a detected by p16INK4a immunostaining as a new generation of cervical cytology for primary screening and secondary screening in population-based cervical cancer screening, and in improving cytological diagnosis. Methods: Between 2016 and 2018, 5 747 non-pregnant women aged 25-65 years with sexual history were recruited and underwent cervical cancer screening via high-risk (HR)-HPV/liquid-based cytological test (LCT) test in Shenzhen and surrounding areas. All slides were immuno-stained using p16INK4a technology, among them, 902 cases were offered p16INK4a detection during primary screening, and the remaining 4 845 cases were called-back by the virtue of abnormal HR-HPV and LCT results for p16INK4a staining. Participants with complete LCT examination, HR-HPV test, p16INK4a staining and histopathological examination results were included in this study. The performance of p16INK4a in primary and secondary screening, and in assisting cytology to detect high grade squamous intraepithelial lesion [HSIL, including cervical intraepithelial neoplasia (CIN) Ⅱ or Ⅲ] or worse [HSIL (CIN Ⅱ)+ or HSIL (CIN Ⅲ)+] were analyzed. Results: (1) One-thousand and ninety-seven cases with complete data of p16INK4a and histology were included. Pathological diagnosis: 995 cases of normal cervix, 37 cases of low grade squamous intraepithelial lesion (LSIL), 64 cases of HSIL and one case of cervical cancer were found. Among them, 65 cases of HSIL (CIN Ⅱ)+ and 34 cases of HSIL (CIN Ⅲ)+ were detected. The positive rate of p16INK4a in HSIL (CIN Ⅱ)+ was higher than that in CINⅠ or normal pathology (89.2% vs 10.2%; P<0.01). (2) p16INK4a as primary screening for HSIL (CIN Ⅱ)+ or HSIL (CIN Ⅲ)+ was equally sensitive to primary HR-HPV screening (89.2% vs 95.4%, 94.1% vs 94.1%; P>0.05), but more specific than HR-HPV screening (89.8% vs 82.5%, 87.7% vs 80.2%; P<0.05). p16INK4a was equally sensitive and similarly specific to cytology (≥LSIL; P>0.05). (3) The specificity of LCT adjunctive p16INK4a for detecting HSIL (CIN Ⅱ)+ or HSIL (CIN Ⅲ)+ were higher than that of LCT alone or adjunctive HR-HPV (P<0.01), while the sensitivity were similar (P>0.05). (4) p16INK4a staining as secondary screening: p16INK4a was significantly more specific (94.1% vs 89.7%, 91.9% vs 87.4%; P<0.01) and comparably sensitive (84.6% vs 90.8%, 88.2% vs 91.2%; P>0.05) to cytology for triaging primary HR-HPV screening. HPV 16/18 to colposcopy and triage other HR-HPV with p16INK4a was equally sensitive (88.2% vs 94.1%; P=0.500) and more specific (88.3% vs 83.0%; P<0.01) than HPV 16/18 to colposcopy and triage other HR-HPV with LCT≥ atypical squamous cells of undetermined significance (ASCUS), and the referral rate decreased (14.0% vs 19.4%; P=0.005). Conclusions: For primary screening, p16INK4a is equally specific to cytology and equally sensitive to HR-HPV screening. p16INK4a alone could be an efficient triage after primary HR-HPV screening. In addition, p16INK4a immunostaining could be used as an ancillary tool to cervical cytological diagnosis, and improves its accuracy in cervical cancer screening.
    目的: 探讨p16INK4a免疫细胞化学染色(p16INK4a染色)作为新一代子宫颈细胞学检查技术在人群子宫颈癌初筛与辅助常规细胞学检查及高危型(HR)-HPV初筛后的二次筛查中的价值。 方法: 募集2016—2018年深圳及周边地区25~65岁有性生活的非妊娠期妇女5 747例,采用HR-HPV联合子宫颈液基细胞学检查(LCT)进行子宫颈癌初筛;并行p16INK4a染色,其中902例在初筛的同时进行p16INK4a染色,其余4 845例为HR-HPV与LCT初筛阳性回叫行阴道镜检查时取样进行p16INK4a染色。将具有完整LCT检查、HR-HPV检测、p16INK4a染色及子宫颈活检后病理诊断结果者纳入本研究。以组织学病理诊断为“金标准”,评价p16INK4a染色作为子宫颈癌初筛、辅助LCT检查及HR-HPV初筛后的二次分流方案检出子宫颈病变[即高级别鳞状上皮内病变(HSIL)],包括HSIL[子宫颈上皮内瘤变(CIN)Ⅱ]及以上级别病变[HSIL(CIN Ⅱ)+]、HSIL(CIN Ⅲ)及以上级别病变[HSIL(CIN Ⅲ)+]的筛查效率。 结果: (1)具有完整LCT检查、HR-HPV检测、p16INK4a染色及子宫颈活检病理诊断结果者共1 097例,纳入本研究。病理诊断:正常子宫颈995例,低级别鳞状上内病变(LSIL)37例、HSIL 64例及子宫颈癌1例,其中HSIL(CIN Ⅱ)+ 65例,HSIL(CIN Ⅲ)+ 34例。HSIL(CIN Ⅱ)+患者的p16INK4a阳性率(89.2%,58/65)显著高于CINⅠ或正常子宫颈者(10.2%,105/1 032;P<0.01)。(2)p16INK4a染色作为初筛方案:与HR-HPV检测比较,p16INK4a染色检出HSIL(CIN Ⅱ)+、HSIL(CIN Ⅲ)+的敏感度均无显著差异(95.4%与89.2%,94.1%与94.1%;P>0.05),但其特异度均显著增高(82.5%与89.8%,80.2%与87.7%;P<0.05);而与LCT结果≥LSIL比较,p16INK4a染色检出HSIL(CIN Ⅱ)+、HSIL(CIN Ⅲ)+的敏感度、特异度均无显著差异(P>0.05)。(3)p16INK4a染色辅助LCT检查:与单独LCT检查或HR-HPV检测辅助LCT检查比较,p16INK4a染色辅助LCT检查检出HSIL(CIN Ⅱ)+、HSIL(CIN Ⅲ)+的特异度均显著增高(P<0.01),而敏感度均无显著差异(P>0.05)。(4)p16INK4a染色作为二次分流方案:HR-HPV初筛后以p16INK4a阳性作为二次分流指标与LCT结果≥ASCUS作为二次分流指标比较,检出HSIL(CIN Ⅱ)+、HSIL(CIN Ⅲ)+的敏感度均无显著差异(84.6%与90.8%,88.2%与91.2%;P>0.05),而特异度均有显著差异(94.1%与89.7%,91.9%与87.4%;P<0.01);作为二次分流方案,HPV 16和(或)18型(HPV 16/18型)阳性与p16INK4a阳性序贯的方案,HPV 16/18型阳性与LCT结果≥ASCUS序贯的方案,两种方案比较,检出HSIL(CIN Ⅲ)+的敏感度无显著差异(分别为88.2%、94.1%,P=0.500),而前者的特异度显著增高(分别为88.3%、83.0%,P<0.01),且前者的阴道镜转诊率显著降低(分别为14.0%、19.4%,P=0.005)。 结论: p16INK4a染色作为子宫颈癌初筛方案检出子宫颈病变的敏感度与HR-HPV检测相当、特异度与LCT检查相当;且在HR-HPV阳性患者的二次分流中具有优势,并可辅助LCT检查进行诊断分级,提高了子宫颈细胞学筛查的准确率。.
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