喉乳头状瘤临床行为与细胞增殖活性关系的研究

Associations of laryngeal papillomatosis clinical behaviour with human papillomavirus, p_(53) protein and proliferating cells nuclear antigen

利用ISH方法以及免疫病理手段对不同型的LP组织的标本进行PCNA、P53检测，探讨不同型HPV与LP的发生发展的相关机制，以寻求有效的检测方法帮助临床对LP的预后进行评估。标本选自1994年1月～1995年12月间我院收治的LP共36例。ISH法HPV6b／11阳性率为75％，明显高于HPV16和／或HPV18的表达。10例喉鳞癌各有1例HPV16、18阳性，无HPV6b／11阳性。ABC法行P53检测，36例LP标本中仅1例恶变组织阳性表达Ⅱ级（2．8％）；10例喉鳞癌中9例阳性表达（90．0％），其中Ⅱ级以上阳性表达6例（60．0％）。PCNA阳性表达27／36例（75％）；其中JOP组与AOP组阳性率有显著差异（P＜0．05）。本研究表明LP与HPV感染有极为密切的关系，认为HPV分型的检测在判断LP转归中有意义。PCNA阳性表达程度在预测LP肿瘤的活跃程度方面是一个很有意义的指标。P53蛋白表达在喉鳞癌与LP中有显著差异。

Thirty-six patients with previously diagnosed laryngeal papillomatosis and treated in our department between 1994, 1 and 1995, 12 entered the study. The results showed 27/36 (75%) cases were positive for HPV type 6b/11 by using ISH. The positive rate of HPV 6b/11 type expression was remarkably higher than that of HPV 16 or 18 type expression. Of ten laryngeal squamous carcinoma specimens, one contained human papillomavirus 16 and another did 18 type by using ISH. No HPV 6b/11 was detected in any malignant specimen. Overexpression of p53 protein was detected by immunohistochemical methods in one laryngeal papillomatosis case which was identified as malignant transformation. Nine of ten squamous cases were positive for p53 expression. PCNA (proliferating cell nuclear antigen) staining was demonstrated in 27 of 36 LP (laryngeal papillamatosis) cases and the result indicated the statistic significant difference between JOP (juvenile onset papilloma ) diseases and AOP (adult onset papilloma )diseases (P<0. 05).Our finding suggests that laryngeal papillomatosis is significantly correlated with LP lesion HPV 6b/11 type demonstrates ahigher positive rate, whereas HPV type 16 or 18 DNA has a closer association with malignant lesions. The present study also indicates that the different HPV DNA tpye may reflect the clinical behavior of LP so it makes appear as a prognostic factor. PCNA staining expression association with laryngeal papillomatosis activity is another significant prognostic factor but how to decide laryngeal papillomatosis progress by PCNA expression extent needs further study. In addition, the significant difference of the expression of p53 protein between LP and SCC (squamous cell carcinoma) is also observed in our study, which strongly suports that it is worth finding the effect of p53 on the LP recurrent and malignant transforming procedures.