尖锐湿疣患者中HPV亚临床感染的病理形态和病毒型别分析

Pathological characteristics of and human papfllomavirus （HPV） genotype profile in subclinical HPV infection in patients with condyloma acuminatum

目的探讨外阴尖锐湿疣与尖锐湿疣亚临床感染的临床病理形态和HPV—DNA型别。方法未经治疗肛周、外生殖器部位典型CA患者进行醋酸白试验初筛，确定80例醋酸白试验阳性的疑似合并亚临床感染患者，对其进行组织病理及HPV—DNA检测，综合上述结果，确定71例CA合并SPI患者，比较CA和亚临床感染皮损的组织病理和HPV—DNA分型的不同。结果80例尖锐湿疣典型皮损活组织标本经病理学检查，71例（88．75％）表现为典型尖锐湿疣组织病理学改变；9例（11．25％）表现为鳞状上皮非典型增生。80例尖锐湿疣疑似亚临床感染皮损活组织标本经病理学检查：4例（5％）具有典型尖锐湿疣病理改变；71例（88．75％）病理表现为鳞状上皮非典型增生。80例典型尖锐湿疣标本中HPV—DNA阳性者为80例。80例疑似尖锐湿疣SPI标本中HPV—DNA阳性者共75例（93．75％），阴性5例（6．25％）。对确诊的71例尖锐湿疣合并亚临床感染标本的组织病理形态比较，二者存在差异，对二者的空泡细胞数目进行统计学分析，差异有统计学意义（P〈0．05）。对二者的各HPV型别出现频率进行比较，差异无统计学意义（P〉0．05）。结论尖锐湿疣亚临床感染的诊断应以醋酸白试验为基础进行组织病理和分子生物学方法检测HPV的核酸。

Objective To investigate the clinicopathologic characteristics of and HPV subtypes in vulvar condyloma acuminatum （CA） and subclinical HPV infection. Methods Eighty patients with a positive acetowhite test and suspected subclinical HPV infection were selected from 272 patients with typical CA lesions in perianal and external genital region. Tissue specimens were obtained from typical CA and suspected subclinical HPV-infected lesions followed by pathological examination and HPV-DNA detection. Finally, 71 patients were confirmed to suffer from both CA and subclinical HPV infection. A comparative analysis was performed to assess the differences in histopathological manifestation and HPV genotypes between CA and subclinical infection lesions. Results Pathological examination revealed typical histological changes of CA in 71 （88.75%） typical CA specimens and 4 （5%） suspected subclinical infection specimens, as well as squamous dysplasia in 9（11.25%） CA specimens and 71 （88.75%） suspected subclinical infection specimens. HPV-DNA was positive in all （80） of the CA specimens and 93.75% （75） of the suspected subclinical infection specimens, negative in 5 （6.25%） suspected subclinical infection specimens. Obvious differences were observed in pathological manifestation, koilocyte number （P 〈 0.05）, but not in the distribution of HPV subtypes （P 〉 0.05）, between typical CA and concurrent subclinical HPV infection lesions in patients. Conclusion The diagnosis of subclinical HPV infection should be based on the result of acetowhite test, with the results of pathological examination and HPV DNA detection as an adjuvant.