男男性接触者肛周及肛管内尖锐湿疣患者HPV分型与复发的关系

Correlations between human papillomavirus types and recurrence of perianal and anal condyloma acuminatum among men who have sex with men

目的探讨上海男男性接触者肛周及肛管内尖锐湿疣患者人类乳头瘤病毒（HPV）感染基因分型情况及不同基因型别与临床复发的关系。方法导流杂交基因芯片技术对57例MSM尖锐湿疣患者肛周及肛管内皮损进行HPV基因分型研究，并随访高危型组，低危型组经CO2激光治疗后尖锐湿疣的复发率。结果57例MSM尖锐湿疣患者肛周及肛管内皮损检测出56例HPV阳性，占98．2％，共检出11种HPV基因亚型，以HPV11（42例，占75％）和HPV6（30例，占53．6％）为主，检出病例数从高到低依次为HPV11〉HPV6〉HPV16〉HPV18〉HPV33、59、cp8304〉HPV31、35。56例HPV阳性患者中低危型感染36例，占64．3％，均为HPV11和（或）HPV6；高危型感染20例，占35．7％，其中17例为低危型与高危型混合感染，占高危型感染的85％。56例患者经CO2激光治疗后随访6个月，高危型组复发率为95％，低危型组复发率为66．7％，两者差异有统计学意义（P〈0．05）。结论上海男男性接触者尖锐湿疣HPV基因型主要以低危型HPV11、6为主，高危型感染大多合并低危型感染，高危型组复发率明显高于低危型组。

Objective To determine the genotypes of human papillomavirus （HPV） and to estimate their correlations with recurrence of perianal and anal eondyloma aeuminatum （CA） among men who have sex with men （MSM） in Shanghai. Methods Tissue specimens were obtained from the lesions of perianal or anal CA in 57 MSM. Flow-through hybridization and gene chip were used to determine the genotypes of HPV in these specimens. Follow-up was carried out to observe the recun＇ence of CA in these patients after CO2 laser treatment. Results Of the 57 specimens, 56 （98.2%） were positive for HPV, and a total of 11 HPV subtypes were identified. The predominant genotypes were HPV 11 （42 cases, 75%） and HPV 6 （30 cases, 53.6%）, sequentially followed by HPV 16 （8 cases, 14.3%）, HPV 18 （4 cases, 7.1%）, HPV 33 （2 cases, 3.6%）, HPV 59 （2 cases, 3.6%）, HPV cp8304 （2 cases, 3.6%）, HPV 31 （1 case, 1.8%） and HPV 35 （1 case, 1.8%）. Of the HPV-positive specimens, 64.3% （36/56） harbored low risk HPV types （11 and/or 6）, and 35.7 % （20/56） harbored high risk HPV types. Among the 20 specimens positive for high risk HPV, 17 （85%） harbored both low risk- and high risk-HPV genotypes. During the 6-month follow-up after CO2 laser treatment, recurrence was observed in 95% of patients with high risk HPV and 66.7% of patients with low risk HPV （P 〈 0.05）. Conelnsions Among MSM with perianal and anal CA in Shanghai, the predominant genotypes of HPV are low risk types 11 and 6; high risk HPV infection is usually complicated by low risk HPV infection; the recurrence of CA is higher in patients with high risk HPV than in those with low risk HPV.