子宫颈湿疣的病理变化与人乳头状瘤病毒的检测.doc9

单位：100029 北京，中日友好医院妇产科(袁莉云，卞美璐)，病理科(罗杰，李挺)，临床医学研究所生化室(范慕贞)
关键词：宫颈疾病；尖锐湿疣；乳头状瘤病毒；人
　　【摘要】　目的　了解宫颈湿疣病理变化与人乳头状瘤病毒(HPV)亚型关系。方法　对计算机辅助细胞检测(CCT)诊断的71例不典型鳞状细胞、65例低度鳞状上皮内病变、17例高度鳞状上皮内病变及5例鳞状上皮细胞癌患者，在阴道镜下行宫颈多点活体组织病理学检测，同时采用聚合酶链反应(PCR)技术对宫颈脱落细胞及分泌物进行HPV6/11、HPV16/18检测；对经病理检查证实的宫颈湿疣中的凹空细胞分为Ⅰ型和Ⅱ型。结果　73例宫颈湿疣中，Ⅱ型凹空细胞的HPV16/18感染率为86.0%，明显高于Ⅰ型凹空细胞的16.7%(P＜0.01)。含有Ⅱ型凹空细胞的低度鳞状上皮内病变中，HPV16/18感染率及病理性核分裂相发生率均为85.7%，明显高于Ⅰ型凹空细胞或单纯宫颈上皮内瘤变Ⅰ级(P＜0.01)。结论　根据组织病理检查发现有Ⅱ型凹空细胞，可以推测存在HPV16/18感染。含有Ⅱ型凹空细胞的低度鳞状上皮内病变与HPV16/18感染密切相关，核异型性显著，伴病理性核分裂相，在病理诊断上具有重要意义。
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.
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