无呼吸道乳头状瘤儿童上呼吸道乳头状瘤病毒的检测

Detection of human papillomavirus in the upper respiratory tract in children without recurrentrespiratory papillomatosis

目的检测儿童扁桃体和腺样体手术标本中的人乳头状瘤病毒（human papillomavims，HPV）DNA，以了解无复发性呼吸道乳头状瘤（juvenile-onset recurrent respiratory papillomatosis, JORRP）儿童的上呼吸道HPV感染情况。方法前瞻性研究2008年2月至2009年1月因扁桃体肥大或炎症以及腺样体肥大手术的患儿241例，均确诊为无JORRP或其他已知HPV相关疾病。共取得新鲜的扁桃体标本177个和腺样体标本195个。为验证本研究实验方法的可靠性，取同期17例喉乳头状瘤患儿的新鲜乳头状瘤标本作阳性对照。所有标本采用荧光定量聚合酶链反应法检测HPVDNA并分型。结果17例乳头状瘤标本HPV．DNA均阳性，均为HPV6或HPVll感染。241例患儿的372个标本中，仅2例扁桃体阳性，分别为HPV6和HPV感染。再次追问这2例患儿的个人病史和家族史，未发现有HPV感染相关疾病，扁桃体切除样本的病理检查结果均显示淋巴组织增生，无HPV感染的特征病变，也未见恶性肿瘤迹象。本组中上呼吸道HPV感染率为0．8％（2／241）。结论无JORRP儿童的上呼吸道也存在HPV感染，仅有HPV感染可能不足以引发JORRP。

Objective The purpose of this prospective study was to investigate the presence of human papillomavirus （HPV） in tonsillectomy and adenoidectomy specimens from pediatric patients without juvenile-onset recurrent respiratory papillomatosis （JORRP）, so as to understand the effect of HPV infection in the upper respiratory tract in children. Methods Two hundred and forty-one pediatric patients without known JORRP or other HPV-related diseases undergoing tonsillectomy and/or adenoidectomy for hypertrophy or chronic tonsillitis were enrolled in this prospective study. One hundred and seventy-seven fresh samples of tonsillar tissues and 195 samples of adenoid tissues were collected and then examined for the presence of HPV DNA with the polymerase chain reaction （PCR） technique and typing. Laryngeal papilloma specimens from 17 patients obtained during routine debulking procedures were also analyzed and served as positive controls. Results All 17 papilloma specimens were positive for HPV DNA and the type was 6 or 11. This result confirmed that the methods used were valid for detecting HP~ infection. HPV DNA was detected in 2 of the 177 tonsillar specimens and zero of the 195 adenoid specimens. The two positive samples were confirmed with typing. One was positive for HPV6 and the other for HPV11. Review of the medical records of these two cases confirmed that there were no history of HPV-related diseases. Histologic analysis of their specimens showed lymphoid hyperplasia, no specific changes suggesting HPV infection and no signs of malignancy. The HPV infection rate in upper respiratory tract was 0.8% （2/241）. Conclusion There isHPV infection in upper respiratory tract in Chinese children without JORRP, but maybe is not sufficient for the formation of JORRP.