人乳头瘤病毒感染检测及其临床意义

Clinical analysis of the infection with human papillomavirus in women

目的探讨宫颈癌及癌前病变、尖锐湿疣与人乳头瘤病毒感染的关系,为早期防治宫颈癌提供临床依据。方法标本来源于2004年1月至2005年8月期间重庆第三军医大学西南医院皮肤科、妇产科和解放军三○二医院皮肤科就诊的1086例患者,在未接受任何检查及治疗、无任何干预措施的情况下,采用荧光定量PCR技术对病变标本HPV-DNA进行检测;用上述方法无法明确HPV型别的标本,采用基因芯片技术检测。结果CINⅠ、CINⅡ和宫颈鳞癌的标本中,HPV的检测率均为100%,以HPV16型感染为主,但存在两种以上HPV型别感染。在子宫内膜癌中主要是HPV18,仍然存在HPV多种型别混合感染。636例女阴尖锐湿疣中,HPV阳性率为96·70%,其中以HPV6(44·97%)和HPV11(29·40%)为主,少数患者是HPV16和(或)HPV18感染,也有少数为两种以上甚至四重HPV感染。结论子宫及宫颈瘤变主要以高危型HPV16和18为主,外阴生殖道的尖锐湿疣以低危型HPV6和HPV11为主,但两者都可合并有多种型别的HPV混合感染,给临床治疗和患者机体病理生理改变造成一定的复杂性。对HPV感染型别进行早期鉴定和监测,对提高广大妇女的生活质量有重大意义。

Objective To determine the relationship between human papillomavirus infection, cervical carcinoma, pre-cancerous lesion and condyloma acuminatum. Methods From January 2004 to August 2005, 1086 inpatients in department of dermatology and department of gynaecology and obstetrics in Southwest Hopspital and No.302 hospital with cervical lesions and condyloma were reviewed. All specimens were detected for HPV-DNA using techniques of Gene Array and fluorogenic quantitative polymerase chain reaction （FQ-PCR）. All detections of HPV-DNA were performed in the first admission before the patients underwent any examination or treatment. Results The positive rates of HPV-DNA detection were 100% in cervical intraepithelial neoplasia （CIN） Ⅰ , Ⅱ and cervical carcinoma. Among these, the main subtype was HPV 16. But some of the patients were found to be positive for more than 2 subtypes of HPV. While the commonest HPV subtype was HPV 18 in endometrial cancer. Some of the patients were detected to be positive for more than 2 subtypes of HPV. In 636 female patient with condyloma acuminatum,the infection rates of HPV6, HPV11 accounted for 44.97% and 29.40%, respectively, HPV16 and/or HPV18 infection constituted a small percentage. In a few cases, infection with more than 2 subtypes was detected. Conclusion Cervical carcinoma including pre-cancerous lesion differs from condyloma acuminatum in dominate infection subtype of HPV. The former is mainly associated with HPV16 and HPV18 infections, and the latter mainly associated with HPV6 and HPV11 infections. But in both of the above lesions, a mixed infection with more than 2 types may occur and make the pathological changes and clinical treatment more complicated. The early diagnosis and supervision of HPV infection may be of great value for improvement of prognosis and quality of life.