女性肾移植患者合并下生殖道癌前期病变的临床分析

Lower genital tract neoplasias of female renal transplantation recipients

目的:了解女性肾移植患者发生下生殖道癌前期病变的临床特征。方法:回顾分析阴道镜门诊应用宫颈细胞学、阴道镜与组织病理学,检查评估12例肾移植患者是否合并宫颈、阴道、外阴、肛周等部位的癌前期病变;用凯普核酸分子导流杂交基因芯片技术检测其中8例患者宫颈阴道分泌物中人乳头瘤病毒(HPV)基因分型。结果:(1)宫颈细胞学检测结果异常11例;(2)阴道镜检查宫颈转化区异常10例,同时合并阴道或外阴、肛周多部位病变8例;(3)组织病理学诊断结果:宫颈上皮内瘤变(CIN)2～3级5例,CIN1级及(或)宫颈HPV感染6例;同时合并阴道或外阴、肛周多部位病变8例;(4)HPV基因分型的检测结果:高危型HPV感染5例,低危型HPV感染1例;(5)失访1例。获得随访的11例(6～66个月)均持续存在宫颈细胞学及(或)阴道镜检查结果异常,无1例进展为浸润癌。结论:女性肾移植患者发生高危型HPV感染与下生殖道多部位的癌前期病变相当常见。高等级的CIN、外阴上皮内瘤变(VIN)与肛周上皮内瘤变(AIN)的发生率高且消退缓慢。

Objective ：To evaluate the clinical features of lower genital tract（ cervix, vagina, vulva,anus） neoplasias of female with renal transplantation recipients. Methods： The records of 12 patients of female with renal transplantation recipients were reviewed retrospectively from 2001 to 2006 by ＂three-step＂ technique （ cytology, colposcopy, and pathology）. Twenty-one subtypes of human papillomavirus （HPV） DNA were detected by flow-through hybridization and gene chip （HybriMax） among parts of these patients. Results： （1） Eleven of 12 patients were noted with abnormal cervical cytology. （2） The colposcopy revealed abnormal cervical transformation zone（TZ） in 10 cases. Multiple lesions of the lower genital tract were found in 8 cases by colposcopy. （3） Histopathologic diagnoses showed that 11 of 12 patients had cervical lesions ,including 5 cases with cervical intraepithelial neoplasia （CIN） 2 - 3,6 cases with CIN1 and （or） cervical HPV infection. Multiple lesions of the lower genital tract including CIN, vulvar intraepithelial neoplasia （VIN）, anal intraepithelial neoplasia （AIN）were confirmed in 8 cases by histopathology. （4） Six of 8 patients were found HPV DNA positive by HybriMax,including 5 cases positive for high-risk HPV,and 1 case positive for low-risk HPV. （5） One case was failed to follow up. The other were followed up from 6 to 66 months. They persisted on abnormal in cervical cytology and/or colposcopy ,no patient progressed to malignant tumor of lower genital tract. Condusions：Female with renal transplant recipients have an increased incidence of high-risk subtypes of HPV infection and neoplasms involving multiple sites of the lower genital tract. Highgrade CIN,VIN,AIN are detected frequently. They are more likely to have persistent HPV infection and persistent neoplasms.