子宮頸濕疣的病理變化與人乳頭狀瘤病毒的檢測.doc9

單位：100029 北京，中日友好醫院婦產科(袁莉雲，卞美璐)，病理科(羅傑，李挺)，臨床醫學研究所生化室(範慕貞)
關鍵詞：宮頸疾病；尖銳濕疣；乳頭狀瘤病毒；人
　　【摘要】　目的　了解宮頸濕疣病理變化與人乳頭狀瘤病毒(HPV)亞型關係。方法　對計算機輔助細胞檢測(CCT)診斷的71例不典型鱗狀細胞、65例低度鱗狀上皮內病變、17例高度鱗狀上皮內病變及5例鱗狀上皮細胞癌患者，在陰道鏡下行宮頸多點活體組織病理學檢測，同時采用聚合酶鏈反應(PCR)技術對宮頸脫落細胞及分泌物進行HPV6/11、HPV16/18檢測；對經病理檢查證實的宮頸濕疣中的凹空細胞分為Ⅰ型和Ⅱ型。結果　73例宮頸濕疣中，Ⅱ型凹空細胞的HPV16/18感染率為86.0%，明顯高於Ⅰ型凹空細胞的16.7%(P＜0.01)。含有Ⅱ型凹空細胞的低度鱗狀上皮內病變中，HPV16/18感染率及病理性核分裂相發生率均為85.7%，明顯高於Ⅰ型凹空細胞或單純宮頸上皮內瘤變Ⅰ級(P＜0.01)。結論　根據組織病理檢查發現有Ⅱ型凹空細胞，可以推測存在HPV16/18感染。含有Ⅱ型凹空細胞的低度鱗狀上皮內病變與HPV16/18感染密切相關，核異型性顯著，伴病理性核分裂相，在病理診斷上具有重要意義。
Relationship between Histopathologic Observation of Cervical Condyloma and Human Papillomavirus Infection
YUAN Liyun, BIAN Meilu, LUO Jie, et al. China-Japan Friendship Hospital,
　　Beijing 100029
　　【Abstract】　Objective　To study the relationship between histopathologic changes of cervical condyloma and different subtypes human papillomavirus (HPV) infection.Methods　158 women with abnormal Pap smears diagnosed by computer assisted cytologic technique (CCT) including 71 cases with atypical squamous cells of undetermined significance (ASCUS), 65 cases with low-grade squamous intraepithelial lesions (LSIL), 17 cases with high-grade squamous intraepithelial lesions (HSIL) and 5 cases with squamous cancers, underwent directed biopsies under colposcopy and were simultaneously detected for HPV6/11, HPV16/18 DNA by polymerase chain reaction (PCR). Koilocytotisis in 73 cases with pathologically proven cervical condyloma were grouped into type Ⅰ and Ⅱ according to its atypical degree of nuclei.Results　HPV16/18 infection rate among condylomas cases was 86.0%, which was significantly higher than that of type Ⅰ (16.7%) (P＜0.01). In LSIL with type Ⅱ koilocytotisis, HPV16/18 infection rate and abnormal mitotic figures (AMFs) occurrence were 85.7%, significantly higher than those in type Ⅰ koilocytotisis or cervical intraepithelial neoplasia Ⅰ.Conclusions　Type Ⅱ koilocytotisis was correlated with HPV16/18 infection. LSIL with type Ⅱ koilocytotisises, distinct atypical nuclei, also associated with high HPV16/18 rate and AMFs, therefore treatment and follow-up should be more aggressive.
..............................