2025 年第 9 期 第 20 卷

细胞周期蛋白依赖性激酶抑制剂2A和B淋巴细胞诱导的成熟蛋白1在宫颈高级别鳞状上皮内病变中的表达及与病情进展的相关性

Expression of cyclin-dependent kinase inhibitor 2A and B lymphocyte-induced mature protein 1 in cervical high-grade squamous intraepithelial lesions and its correlation with disease progression

作者：于春香闫美红李艳杜奕霏

英文作者：Yu Chunxiang Yan Meihong Li Yan Du Yifei

单位：山西省妇幼保健院山西省儿童医院妇产科，太原030002

英文单位：Department of Obstetrics and Gynaecology Shanxi Children′s Hospital Shanxi Maternal and Child Health Hospital Taiyuan 030002 China

关键词：高级别鳞状上皮内病变；宫颈癌；细胞周期蛋白依赖性激酶抑制剂2A；B淋巴细胞诱导的成熟蛋白1

英文关键词：High-gradesquamousintraepitheliallesion；Cervicalcancer；Cyclin-dependentkinaseinhibitor2A；Blymphocyte-inducedmatureprotein1

• 摘要：

• 目的 探讨宫颈高级别鳞状上皮内病变（HSIL）组织中细胞周期蛋白依赖性激酶抑制剂2A（CDKN2A）和B淋巴细胞诱导的成熟蛋白1（Blimp-1）表达及与病情进展的关系。方法 选取2019年1月至2022年1月山西省儿童医院收治的接受宫颈锥切术治疗的 815 例HSIL患者，根据术后病理结果将患者分为进展组和非进展组。取手术切除的宫颈组织，检测CDKN2A mRNA、Blimp-1 mRNA表达。采用Pearson方法分析CDKN2A mRNA与Blimp-1 mRNA的相关性。多因素Logistic回归分析HSIL病情进展的危险因素。受试者工作特征曲线分析CDKN2A mRNA、Blimp-1 mRNA诊断HSIL病情进展的价值。结果815例HSIL患者中97例（11.9%）在术后病理证实进展为宫颈癌，为进展组，其余718例（88.1%）为非进展组。进展组宫颈组织CDKN2A mRNA表达水平低于非进展组［（0.53±0.13）比（1.43±0.27）］，Blimp-1 mRNA表达水平高于非进展组［（2.65±0.71）比（1.27±0.24）］，差异均有统计学意义（均P＜0.001）。宫颈组织CDKN2A mRNA表达与Blimp-1 mRNA表达呈负相关（r=-0.650，P＜0.05）。人乳头瘤病毒16/18感染、宫颈上皮内瘤变3级、高表达Blimp-1 mRNA是HSIL病情进展为宫颈癌的危险因素（均P＜0.05），高表达CDKN2A mRNA是保护因素（P＜0.05）。CDKN2A mRNA、Blimp-1 mRNA诊断HSIL病情进展的曲线下面积分别为0.777、0.759，联合诊断曲线下面积为0.920，高于单独诊断（均P＜0.05）。结论 宫颈组织中CDKN2A mRNA低表达和Blimp-1 mRNA高表达是HSIL进展为宫颈癌的危险因素，联合CDKN2A mRNA、Blimp-1 mRNA可预测HSIL病情进展的风险。

• Objective To investigate the expression of cyclin-dependent kinase inhibitor 2A (CDKN2A) and B lymphocyte-induced mature protein 1 (Blimp-1) in cervical high-grade squamous intraepithelial lesion (HSIL) and their relationship with the progression of HSIL. Methods A total of 815 patients with HSIL who underwent cervical conization in Shanxi Children′s Hospital from January 2019 to January 2022 were selected. According to the postoperative pathological results , the patients were divided into progressive group and non-progressive group. The surgically resected cervical tissues were taken to detect the expression of CDKN2A mRNA and Blimp-1 mRNA. Pearson method was used to analyze the correlation between CDKN2A mRNA and Blimp-1 mRNA. Multivariate Logistic regression was used to analyze the risk factors for the progression of HSIL. Receiver operating characteristic curve was used to analyze the value of CDKN2A mRNA and Blimp-1 mRNA in the diagnosis of HSIL progression. Results Among 815 patients with HSIL, 97 cases (11.9%) were confirmed to progress to cervical cancer by postoperative pathology, which was the progressive group, and the remaining 718 cases (88.1%) were the non-progressive group. The expression level of CDKN2A mRNA in cervical tissue of progressive group was lower than that of non-progressive group ［(0.53±0.13) vs (1.43±0.27)］, and the expression level of Blimp-1 mRNA was higher than that of non-progressive group ［(2.65±0.71) vs (1.27±0.24)］(all P＜0.001). The expression of CDKN2A mRNA was negatively correlated with the expression of Blimp-1 mRNA in cervical tissues (r=-0.650, P＜0.05). Human papillomavirus 16/18 infection, cervical intraepithelial neoplasia grade 3 and high expression of Blimp-1 mRNA were risk factors for HSIL progression to cervical cancer (all P＜0.05), and high expression of CDKN2A mRNA was a protective factor (P＜0.05). The area under the curve of CDKN2A mRNA and Blimp-1 mRNA in the diagnosis of HSIL progression was 0.777 and 0.759, respectively. The area under the curve of combined diagnosis was 0.920, which was higher than that of single diagnosis (both P＜0.05). Conclusion Low expression of CDKN2A mRNA and high expression of Blimp-1 mRNA in cervical tissues are risk factors for the progression of HSIL to cervical cancer. The combination of CDKN2A mRNA and Blimp-1 mRNA can predict the risk of HSIL progression.