男男性行为者肛门与生殖器人乳头瘤病毒感染的分子流行病学差异表达研究

The genotypes of Human Papillomavirus in anogenital area of men who have sex with men:a molecular epidemiology study

目的了解男男性行为者（MSM）肛门生殖器部位人乳头瘤病毒（Human papilloma virus，HPV）不同基因型别的流行情况及其临床意义。方法采取调查问卷方法收集2013年10月至2015年3月在上海市皮肤病医院性病科门诊就诊的301例男男性行为者的临床资料，同时检测其肛门生殖器HPV感染情况。结果在301患者中，有肛周及肛管内尖锐湿疣（condyloma acuminatum，CA）164例，同时伴有阴茎尖锐湿疣18例。301份肛周及肛管内脱落细胞标本中HPV阳性检出率为78．7％（237／301），其中高危型50．5％（152／301），以HPV16型（14.3％）和HPV52型（14.3％）最常见；低危型69．1％（208／301），其中HPV6型43．9％（132／301）和HPV11型21．6％（65／301）为常见型别。143例阴茎部脱落细胞标本中HPV阳性检出率为44．8％（64／143），高危型为20．3％（29／143），以HPV33型（4．9％）最常见；低危型33．6％（48／143），以HPV11型17．5％（25／143）最常见。高危型HPV16、HPV33、HPV52、HPv53和HPv56在肛周及肛管的感染率比阴茎部位高（P〈0．05）。在16例肛周CA，36例肛管CA、112例肛周肛管CA和22份阴茎部CA标本中，肛周和阴茎部HPV均以单一型感染为主，其中HPV6／11为常见感染型别。肛管CA多重HPV感染为主（88．8％），以HPV16型、HPV52型、HPV56型常见。结论在男男性行为者中，肛周和肛管HPV感染率较高，且肛管CA以混合型HPv感染为主。高危型HPV在肛管感染率比生殖器部位高，筛查MSM肛管HPV感染可为早期防治肛管恶性肿瘤提供依据。

Objective To investigate the prevalence of anogenital Human Papilloma Virus （HPV） genotypes and assess its clinical significance among men who have sex with men （MSM）. Methods A total of 301 MSM cases from Shanghai Skin Disease Hospital during October 2013 to March 2015 were studied. The social-demographic knowledge was enrolled through interviewer-administrated questionnaires. Skin samples were collected from anal genital area of these male patients. Luminex flow cytometry fluorescence technology was used to detect the HPV genotypes. Results Among 301 patients, 164 patients were with Condyloma Acuminatum （CA） of anus and anal canal, and 18 patients with CA of genital. 78.7% （237/301） were HPV infected. The prevalence of high-risk HPV was 50.5% （152/301）, with HPV 16 （14.3%） and HPV 52 （14.3%） being the most common types. 69.1% （208/301） were infected by low-risk HPV with HPV 6 （43.9%） andHPV 11（21.6%） being the most commonly observed. Among 143 exfoliative cell samples of genital, 44.8%（64/143）had HPV detected. The high-risk HPV was found in 20.3%（29/143） samples and HPV33 was the most found （4.9%）. 33.6% （48/143） samples had low-risk HPV found, in which the prevalence of HPV11 （17.5%,25/143） was the highest, followed by HPV6 （14.7%, 21/143） and HPV43 （4.2%, 6/143）. The HPV16, HPV33, HPV52, HPV53 and HPV56 were more frequently （P〈0.05） seen in anal area than in genital. Among 170 cases with CA （16 cases in anus, 36 cases in anal canal, 112 cases in anus and anal canal, 22 cases with genital warts）, the single-type HPV infection （HPV11/6） was predominant for CA in anus （87.5%） and genital warts （100%）. The prevalence of multiple-type HPV infection was 88.8% （33/36） in anal canal warts, and HPV 16, HPV 52 and HPV 56 were the most frequently identified. Conclusion The high prevalence of anus and anal canal HPV infection was observed among MSM in our study. Most participants with CA in anal canal were infected with multiple- type HPVs. The high-risk HPV prevalence was higher in anal than that in genital （P〈0.05）. Therefore, screening and early detection of different type of anal HPV infections might provide the theoretical basis for early prevention of anal cancer among MSM.