痔疮被覆鳞状上皮黏膜HPV感染及其致瘤性研究

HPV infection and its tumorigenicity in the squamous epithelium covering hemorrhoids

目的探讨痔疮被覆鳞状上皮黏膜中人乳头瘤病毒(HPV)感染情况及其致瘤性。方法选取中日友好医院痔疮标本6208例,筛选鳞状上皮黏膜中含有典型及不典型挖空细胞的痔疮样本135例,同期30例未见挖空样细胞的痔疮样本作为对照组。免疫组化检测标本中Ρ16的表达,PCR杂交法检测HPV病毒并分型。结果含挖空细胞病例占总送检痔疮病例的2.17%(135/6208)。实验组病例被覆上皮轻度不典型增生(80例)、中度不典型增生(21例)、重度不典型增生/原位癌(19例)、肛周鳞状细胞癌(15例),四组HPV感染阳性率分别为77.50%(62/80)、71.43%(15/21)、42.11%(8/19)、73.33%(11/15),其中高危型HPV的感染率分别为11.29%(7/62),33.33%(5/15),100%(8/8),90.91%(10/11)。检测出P16阳性率为51.85%(70/135),HPV分子亚型中56例单一低危型感染,23例单一高危型感染及17例混合亚型感染。结论痔疮被覆鳞状上皮中HPV感染较低,组织学中的挖空细胞是重要提示,对于伴有挖空细胞的痔疮应进行HPV分子亚型与免疫组化P16的联合检测。

Objective To investigate the infection and tumorigenicity of human papillomavirus(HPV)in the squamous epithelium of hemorrhoids.Methods From 6208 hemorrhoids samples in China Japan Friendship Hospital,135 hemorrhoids samples containing typical and atypical hollowed cells in squamous epithelium mucosa were selected and 30 hemorrhoids samples without hollowed cells in squamous epithelium mucosa in the same period were randomly selected as the control group.HPV virus was detected and classified by PCR hybridization,and samples were detected by immunohistochemistryΡ16.Results The cases of hemorrhoids with hollohed-out cells in squamous epithelium accounted for 2.17%(135/6208)of all hemorrhoids.The experimental group was divided into mild dysplasia,moderate dysplasia,severe dysplasia/carcinoma in situ,and perianal squamous cell carcinoma.The positive rates of HPV infection in the four groups were 77.50%(62/80),71.43%(15/21),42.11%(8/19),73.33%(11/15),among which the infection rates of high-risk HPV were 11.29%(7/62),33.33%(5/15),100%(8/8),90.91%(10/11),respectively.The positive rate of P16 was 51.85%and 56 cases of single low-risk type,23 cases of single high-risk type and 21 cases of multi-type of HPV were detected.Conclusion The HPV infection in hemorrhoid squamous epithelium is low,and the hollohed-out cells in the histology is an important indicator.Hemorrhoids with hollowed-out cells should be tested by HPV subtype combined with immunohistochemical P16.