人乳头瘤病毒与人类宫颈癌

鉴于人乳头瘤病毒（HPV）与人类宫颈上皮内瘤样病变以至宫颈癌的发病有密切的关系,为此作者复习相关文献,就HPV的结构、女性生殖道HPV感染的流行病学、HPV感染与宫颈癌的关系等方面加以扼要的综述。     

High risk HPV types in southern Iranian patients with cervical cancer

This study was undertaken to assess the rate of HPV infection in cervical carcinoma among southern Iranian patients. 101 archival cervical carcinoma tissue samples of a 10 year period were studied for the presence of HPV DNA in southern Iran by a polymerase chain reaction method. In addition, the presence of high risk HPV-16 and HPV-18 genotypes was investigated. In total, 88 (87.1%) of the samples were HPV DNA positive, of which 83 were squamous cell carcinomas and 5 were adenocarcinomas. HPV-16 genotype was detected in 26.7% of HPV positive cervical carcinomas; however, none of the samples were positive for the existence of HPV-18 genotype. Collectively, these results suggest that HPV-16 and HPV-18 are not the frequent high risk HPV types in our patients and circulating HPV types in southern Iranian population are different from many other populations.     

HPV在宫颈病变中的临床意义

生殖道人乳头瘤病毒(HPV)感染是一种广泛流行的性传播疾病.高危型HPV持续感染被认为是宫颈癌及其癌前病变发生的主要因素.多重HPV感染、HPV病毒负荷与宫颈癌及其癌前病变的病变程度及发展密切相关.目前,对于宫颈HPV感染检测有多种手段,其中PCR和捕获杂交技术(HCⅡ)在临床实验室应用较广泛.在宫颈癌的筛查中联合应用HPV检测和细胞学,可以提高敏感性、减少随诊频率,减少不必要的阴道镜检查.对于细胞学检查为不典型鳞状细胞(ASCUS)者,HPV检测可以帮助进一步区分高危人群.同时,HPV检测有可能作为一种有效的宫颈癌前病变及宫颈癌治疗后随访的预后指标.     

人乳头瘤病毒变异株与宫颈疾病

人乳头瘤病毒(HPV)感染是发生宫颈癌的必要条件。根据病毒基因组核苷酸序列,在亚型的基础上可以进一步将HPV分为不同的变异株。HPV变异株的分布与地理位置关系密切。某些特定的HPV变异株感染可能增加发生宫颈癌的风险,其可能的机制是免疫逃逸、改变病毒癌基因的表达等。     

HPV and cervical cancer: screening or vaccination?

Following the demonstration of the superior validity of human papillomavirus (HPV) tests in screening for cervical cancer and the arrival of highly efficacious HPV 16 and 18 vaccines, cervical cancer prevention enters a time of sustainable introduction in developing countries. Multidisciplinary efforts and novel protocols are being developed, and challenging situations are being faced to make cervical cancer, still the number two cancer in women worldwide, an eradicable condition.     

Human papillomavirus infection: an anonymous prevalence study in South Wales, UK

The objective of this study was to describe human papillomavirus (HPV) prevalence in South Wales in relation to age, cytology and social deprivation. This was an unlinked, prospective, anonymous, population-based study. DNA was purified from 1911 liquid-based cytology samples (mean age 37.7 years, cytology 93.2% negative, social deprivation average score 17.9) using quality assured techniques and the presence of virus determined by PCR-Enzyme Immuno Assay (PCR-EIA). 209 (10.9%) samples contained high-risk (HR) HPV infection of which 36.4% had multiple HR-HPV types. The most frequent HR types were HPV 16 (19.6%), HPV 35 (9.5%), HPV 66 (9.2%), HPV 59 (8.5%) and HPV 56 (7.6%). There was a strong association between HPV infection and cytological abnormality. Significantly more HR-HPV infections were detected in women under the age of 30 years (68.9% of all HR-HPV infections Fisher's exact test P=0.0001) compared to 30 years and above. There was no difference in HPV prevalence between different socioeconomic groups. The data presented suggest a different HPV type distribution in South Wales in comparison to that reported for other populations.     

HPV prevalence, viral load and physical state of HPV-16 in cervical smears of patients with different grades of CIN

Human papillomavirus (HPV) infection is the most important event in malignant transformation of human cervical epithelium. We analysed in cervical smears, HPV genotypes with a focus on single/multiple infections, then characteristics of HPV-16 infections (presence of other genotypes, viral load and physical state) according to the grade of histological lesions. The purpose of this study was to know if these parameters could allow to differentiate histological diagnoses. DNA was extracted from 363 cervical samples corresponding to 24 cases without lesion, 96 CIN1, 92 CIN2, 144 CIN3 and 7 cancers. Our results show that HPV-16 was predominant and its prevalence increased with the severity of lesions (CIN1: 27.1%; CIN3: 65.3%). In addition, we showed that the frequency of single infections, as compared with multiple infections, increased with the severity of the lesion (CIN1: 25.0%; CIN3: 54.8%). Among HPV-16 positive samples (n = 170), we found that viral load, determined on cervical samples by real-time PCR, did not vary significantly according to the different CIN grades. Concerning HPV-16 integration, the mixed and integrated HPV-16 forms, already present in women with normal histology, increased to the benefit of pure episomal forms with the severity of lesions (normal cervix: 28.6%; CIN3: 73.8%). Thus, our data raise the question of the viral load as a valuable clinical parameter to discriminate between lesion grades. Moreover, we emphasize integration as an early event in cervical carcinogenesis, increasing with the severity of lesions. Finally, this study underlines the importance of single versus multiple infections linked to the severity of CIN.     

妇瘤科门诊患者对HPV疫苗知晓及接受情况分析

目的：了解妇瘤科门诊患者对高危型人乳头瘤病毒（HPV）疫苗的知晓情况及接受程度。方法采用问卷调查方式对588例门诊患者进行面对面调查。调查对象包括因宫颈因素就诊的患者（HPV感染、宫颈涂片异常、宫颈上皮内瘤变、宫颈癌等）。结果研究调查了588例门诊患者,因9份问卷不完整,最终共分析579份调查问卷。调查对象平均年龄（36.91±10.1）岁。其中只有108例（18.7%）患者听说过HPV疫苗,然而73.7%（427/579）的被调查者愿意接受HPV疫苗。在进行多因素分析后,年龄小于﹤30岁、教育水平为大专及以上、因宫颈因素就诊为门诊患者对HPV知晓率的独立影响因素。调查中40.7%的患者有关HPV疫苗的信息主要来自网络,54.9%的调查对象希望以后能够通过医生更多地了解HPV疫苗。结论门诊患者对HPV疫苗的知晓程度较低,但仍有73.7%的患者愿意接受HPV疫苗。为了更好地开展HPV疫苗接种计划以及控制宫颈癌的发生,在医师诊疗工作中可以增加HPV疫苗宣教的内容。     

Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervical carcinomas. To determine whether HPR-HPV DNA detection in primary routine screening could represent a sensitive and reliable technique for the detection of high-grade squamous intraepithelial lesions (HGSIL), laboratory analysis using 2 cytologic techniques (conventional and liquid-based), HPV testing with Hybrid Capture II assay (HC-II), followed by colposcopic examination of women with abnormal cervical finding and/or persistent HR-HPV infection, was conducted in 7932 women who had routine cervical examination. The sensitivity of HPV testing for detecting a histologically proven HGSIL was 100%, higher than that of conventional (68.1%) and liquid-based (87.8%) cytology. The low specificities of 85.6% and 87.3% of HPV testing slightly increased to 88.4% and 90.1% if HPV testing was reserved for woman >30 years old. The quantitative approach provided by the HC-II assay for the assessment of the viral load was not reliable for predicting HGSIL in normal smears. HR-HPV testing could be proposed in primary screening in association with cytology. With conventional cytology it significantly improves the detection of HGSIL. With the use of the same cervical scrape for HPV testing and liquid-based cytology, HR-HPV testing would allow to select positive samples treated in a second time for cytology which gives a good specificity.