肛管内尖锐湿疣的治疗及HPV基因分型检测

Treatment of Anal Condyloma Acuminate and Human Papillomavirus Genotyping

目的:探讨降低肛管内尖锐湿疣复发率的治疗措施。方法:采用导流杂交基因芯片技术检测HPV基因分型。108例肛管内尖锐湿疣患者初次治疗为CO_2激光治疗去除疣体后,给予5-氨基酮戊酸光动力疗法(ALA-PDT),每周1次,共3次。末次治疗后随访6个月,复发患者再次CO_2激光治疗去除疣体后,给予ALA-PDT治疗,每周1次,共10次,结束后外用咪喹莫特乳膏,每周3次,共12周,随访6个月,观察临床疗效和复发率。结果:108例尖锐湿疣患者中HPV阳性者81例,阴性者27例,HPV感染率75.0%。一重HPV感染51例,占47.2%,一重感染中HPV 6型为30例,阳性检出率为27.8%,是主要的感染型别,HPV 11型21例,阳性检出率为19.4%。多重HPV感染30例,阳性检出率27.8%。所有患者经初次治疗后痊愈率为79.6%,有效率为100.0%,复发率为22.1%;对复发患者进行再次治疗后,痊愈率为52.7%,有效率为100.0%,复发率为20.0%,两次治疗之后总的复发率为2.6%(2/77)。结论:肛管内尖锐湿疣组织感染的HPV基因型别主要为HPV6、HPV11及HPV6+HPV11。CO_2激光联合ALA-PPT及外用咪喹莫特软膏治疗肛管内尖锐湿疣,可显著降低肛管内尖锐湿疣的复发率。

Objective： To explore the treatment of anal condyloma acuminata. Methods： Human papillomavirus （HPV） subtypes were detected in 108 patients with anal condyloma acuminata using flow through hybridization and gent chip. All patients with anal condyloma acuminata were treated by CO2 laser and 5-aminolevulinic acid--photodynamic therapy （ALA-PDT）, and the patients with recurrent anal condyloma acuminata were treated by CO2 laser and ALA-PDT and imiquimod. Results： There were 81 positive cases in 108 patients with anal condyloma acuminate, the ratio of total HPV infection was 75.0 %. The ratio of single types was 47.2 % and the rate of multiple types was 27.8 %. The predominant type of single infection was HPV 6 and the ratio was 27.8 %, followed by HPV 11 （19.4 %）. The complete remission was 89 of 108 （79.6 %） after first treatment and 10 of 19 （52.7 %） after second treatment. The recurrence rate was 22.1% and 20.0 % respectively. After two treatments, the recurrence rate was 2 of 77 （2.6 %）. Conclusions： HPV6, HPV11 and HPV6 ＋ HPV11 are the predominant genotypes in the patients with anal condyloma acuminate. ALA-PDT combined with CO2 laser and imiquimod is effective in treatment of anal condyloma acuminate and can reduce the recurrence rate.