人类疱疹病毒8型基因型的研究进展

人类疱疹病毒8型广泛存在于各种临床表型的Kaposi肉瘤中,其基因型分布呈现种族与地域特异性.了解Kaposi肉瘤患者中HHV-8基因型特征及分布情况,探讨其与Kaposi肉瘤临床可能的相关性和演变及传播等具有重要意义.并对HHV-8病毒体及其基因组特征,K1和K15基因位点的生物学功能.HHV-8基因型演变呈现地域与种族特异性进行概述.     

艾滋病皮肤并发症的治疗

Kaposi肉瘤目前尚无彻底根除Kaposi肉瘤(KS)的疗法.化学疗法、免疫疗法和放射疗法均有不同程度的疗效.在化疗药物中,长春花硷是最常用的.皮肤病医师的任务是治疗孤立的KS皮损.孤立而又影响功能的损害用切除疗法较好(如足底结     

新疆Kaposi肉瘤组织中人类疱疹病毒8型潜伏期相关核抗原的检测

人类疱疹病毒8型(HHV-8)又称为Kaposi肉瘤相关疱疹病毒,与Kaposi肉瘤相关疾病的发生有密切关系^[1,2].HHV-8潜伏期相关核抗原(LANA)是HHV-8的开放阅读框73(ORF73)编码的一种病毒衣壳蛋白,潜伏感染状态病毒稳定表达LANA,它在病毒基因整合到宿主基因组的过程中起重要作用,而且可以抑制P53蛋白转录活性,因其较好的表达稳定性和特异性常用来检测HHV-8的感染状态.我们用免疫组化方法在43例新疆Kaposi肉瘤石蜡组织中检测了LANA的表达情况,并探讨了在Kaposi肉瘤发病中的作用.     

新疆Kaposi肉瘤组织内人类8型疱疹病毒DNA的检测

目的 了解Kaposi肉瘤组织内人类8型疱疹病毒(HHV-8)在Kaposi肉瘤发病中的作用。方法 应用荧光原位聚合酶链反应(PCR)方法对20例新疆Kaposi肉瘤组织进行HHV-8DNA检测,Kaposi肉瘤组织损害包括结节12份、斑块6份、斑片2份。同时和20份非Kaposi肉瘤组织,包括纤维瘤组织18份,血管瘤组织2份进行对照。结果 20例新疆Kaposi肉瘤组织中有17例检测到HHV-8DNA(阳性率为85%),而20例非Kaposi肉瘤组织HHV-8DNA均为阴性。两组阳性率经校正χ²检验,χ²=26.2,P<0.001.实验中HHV-8DNA片段主要集中于Kaposi肉瘤组织的梭形瘤细胞和血管内皮细胞。除此之外,在Kaposi肉瘤表皮角质形成细胞内也检测到HHV-8DNA片段,但DNA片段的荧光强度明显弱于梭形瘤细胞和血管内皮细胞中的荧光强度。结论 在新疆Kaposi肉瘤的发生中,HHV-8起着一定的作用,可能参与了Kaposi肉瘤的发病,但不是Kaposi肉瘤发生的唯一病因。     

聚合酶链反应检测Kaposi肉瘤组织中类疱疹病毒DNA

近年来,国外许多研究结果认为Kaposi肉瘤与巨细胞病毒、疱疹病毒-6型、乙肝病毒、支原体等感染有关^[1].Chang等^[2]发现Kaposi肉瘤患者皮损有类疱疹病毒(HHV-8),并测定出其碱基排列顺序.为此,我们用一针对HHV-8基因的引物进行扩增,以研究HHV-8感染与Kaposi肉瘤发病的关系.     

PTEN和p-Akt在Kaposi肉瘤组织中的表达

目的 检测PTEN和p-Akt在Kaposi肉瘤组织中的表达,初步探讨PTEN和p-Akt蛋白在Kaposi肉瘤发病中的作用及意义.方法 应用免疫组织化学Envision二步法检测17例Kaposi肉瘤患者肿瘤组织及17例健康人正常皮肤组织内PTEN和p-Akt的表达水平.结果 PTEN、p-Akt蛋白主要表达于胞质.PTEN在Kaposi肉瘤组织中阳性表达率为76.5％(13/17),在正常皮肤组织中为88.2％(15/17),两组表达率差异无统计学意义(x2=2.65,P＞ 0.10).p-Akt在Kaposi肉瘤组织中阳性表达率为100％( 17/17),在正常皮肤组织中均呈阴性表达.结论 p-Akt蛋白的异常表达在Kaposi肉瘤的发展过程中可能发挥了一定作用.     

Kaposi肉瘤组织内人类疱疹病毒8型的K15基因型研究

目的 了解Kaposi肉瘤组织中人类疱疹病毒8型(HHV-8)K15等位基因型分布情况,并初步探讨Kaposi肉瘤不同临床分型及临床表现与不同HHV-8 K15等位基因型的相关性.方法 采用酚-氯仿-异戊醇法对收集的27例Kaposi肉瘤石蜡包埋组织标本进行病毒DNA抽提,并使用巢式PCR扩增K15基因片段,然后测序并确定其等位基因型.结果 27例Kaposi肉瘤中有22例HHV-8感染为阳性,阳性率为81.48%,其中4例艾滋病-Kaposi肉瘤患者HHV-8感染均为阳性,感染率100%;在分析的22例HHV-8病毒株中,20例为P型,2例为M型;4例艾滋病-Kaposi肉瘤患者感染的均为P型HHV-8,2例M型感染者均为经典型Kaposi肉瘤患者.结论 Kaposi肉瘤组织内HHV-8的K15等位基因型主要是P型,也存在部分M型HHV-8感染者.4例艾滋病-Kaposi肉瘤患者感染的HHV-8均为P型.     

累及口腔黏膜的泛发性经典型Kaposi肉瘤一例

Kaposi肉瘤（Kaposi’s Sarcoma, KS）是一种少见的内皮细胞增殖性肿瘤,分为经典型、非洲型、免疫抑制相关型、AIDS相关型临床亚型,其中,经典型KS表现为四肢起病进行性加重的斑片、斑块、结节,病程迁延,早期累及口腔粘膜者罕有。本文介绍一例经典型Kaposi肉瘤,短期内迅速泛发,累及口腔粘膜,最终于我科确诊为Kaposi肉瘤经典型,并拟定干扰素治疗方案。     

肢端皮血管炎:Kaposi肉瘤的一种类似病

肢端皮血管炎常与下肢静脉机能不全有关,它类似于Kaposi肉瘤的某些特点.因与艾滋病有关的Kaposi肉瘤的发病率增高,故人们对Kaposi肉瘤的了解比肢端皮血管炎的了解更多.对此情况,肢端皮血管炎有误诊为Kaposi肉瘤的危险性.临床表现:较新的病例其临床特点为分布于足和足趾背面的为数众多的损害.有些病例的损害从外踝蔓延至近足背三角处并累及足和足趾的伸侧面.最老的损害见于足前段及头3个足趾.损害为为紫蓝色丘疹至结节,有少量鳞屑,邻近组织有水肿及显示郁积性皮炎的其他变化.孤立性丘疹结节性损害可能作为血管肿瘤甚至基底细胞癌而从小腿或踝部被切除.全部病例都有郁积性皮炎.     

Kaposi肉瘤和获得性免疫缺陷综合征——2～4例患者的尸检发现

34%的AIDS患者可患Kaposi肉瘤.AIDS患者所患的Kaposi肉瘤与经典的Kaposi肉瘤相比,损害多发生于身体上部,内脏受侵多见,患者平均存活时间仅为18个月.为了解患有Kaposi肉瘤的AIDS患者的内脏受侵情况及感染情况,作者对24例患Kaposi肉瘤的AIDS患者进行了尸检观察.患者均为男性,死亡时年龄25～61岁,平均37岁.其中白人16例,黑人3例,西班牙人5例,同性恋者     

Immunohistochemical detection of the latent nuclear antigen-1 of the human herpesvirus type 8 to differentiate cutaneous epidemic Kaposi sarcoma and its histological simulators

Kaposi''s sarcoma is the most common neoplasia diagnosed in AIDS patients and the expression of the human herpesvirus-8 (HHV-8) latent nuclear antigen-1 has been useful for its histological diagnosis. The aim of this study is to confirm that immunohistochemistry is a valuable tool for differentiating KS from its simulators in skin biopsies of HIV patients. Immunohistochemical and histological analyses were performed in 49 Kaposi''s sarcoma skin biopsies and 60 of its histological simulators. Positivity was present in the 49 Kaposi''s sarcoma skin biopsies and no staining was observed in the 60 simulators analyzed, resulting in sensibility and specificity of 100%. HHV-8 immunohistochemical detection is an effective tool for diagnosing Kaposi''s sarcoma, especially in early lesions in which neoplastic features are not evident. It also contributes to its histological differential diagnosis.     

The development of Kaposi's sarcoma during immunosuppressive therapy for temporal arteritis

Background The appearance of Kaposi's sarcoma during iatrogenic immnunosuppression for renal transplantation is well known. A growing number of patients undergoing immnunosuppressive therapy for conditions other than organ transplanation have also developed this neoplasm, and temporal arteritis is emerging as one of the more common of those conditions. Case: We report a case of Kaposi's sarcoma complicating corticosteroid therapy for temporal arteritis, summarize the previously reported cases and consider the possible association between these two disorders. Conclusion: Although inconclusive from the available data, patients with temporal arteritis may be predisposed to iatrogenic Kaposi's sarcoma due to a shared antigen specific immune response.     

Kaposi's sarcoma and immunosuppressive therapy: an appraisal

Kaposi's sarcoma can probably be added to the list of tumours (lymphomas and squamous cell epitheliomas) that are especially prone to arise as a result of immunosuppressive therapy. Sixteen examples of this complication have been described in the literature and we report three further instances. These three patients had been on treatment with prolonged steroid therapy, but many of the previosly reported patients had been on aggressive immunosuppressive regimes to prevent rejection of kidney transplants. Kaposi's sarcoma associated with steroid and immunosuppressive therapy may show enhanced incidence in women (7 females as against 12 males) remembering that the spontaneous disease occurs ten times more frequently in men than women. We discuss the implications of these findings against the background of the high incidence of Kaposi's sarcoma in parts of Africa where immunological derangement consequent on malaria may be significant.     

Lymphangiectatic Kaposi's sarcoma in a patient with AIDS

Kaposi''s sarcoma is a malignant disease that originates in the lymphatic endothelium. It has a broad spectrum of clinical manifestations. Its four distinct clinical forms are: classic, endemic, iatrogenic and epidemic Kaposi''s sarcoma. In non-HIV-associated Kaposi''s sarcoma, the disease is typically limited to the lower extremities, but in immunodeficient patients, it is a multifocal systemic disease. The clinical course of the disease differs among patients, ranging from a single or a few indolent lesions to an aggressive diffuse disease. Advanced Kaposi''s sarcoma lesions, typically those on the lower extremities, are often associated with lymphedema. In this paper, we report a case of a patient with a rare form of AIDS-associated Kaposi sarcoma called lymphangiectatic Kaposis''s sarcoma.     

Kaposi's sarcoma associated with immunosuppression for bullous pemphigoid

Kaposi's sarcoma may occur in transplant recipients on immunosuppressive regimens, but is not well recognized in association with treatment for dermatological disease. We report two cases where multifocal Kaposi's sarcoma developed following iatrogenic immunosuppression with prednisolone and azathioprine for bullous pemphigoid. Both patients were HIV negative and, in one case, lesions regressed both clinically and histologically when immunosuppressive therapy was withdrawn.     

Kaposi's sarcoma and rheumatoid arthritis: a possible immunogenic and drug interaction

Background In the literature, Kaposi's sarcoma-rheumatoid arthritis association is reported and it has been suggested that genetic predisposition may play an important role. Numerous studies indicate that immunological deficiency may also have an important role in the pathogenesis of Kaposi's sarcoma, along with a series of others factors. Patients and methods We present two cases of Sardinian women with rheumathoid arthritis and Kaposi's sarcoma where the relationship between the drugs used for the treatment of the former (particularly gold salts) and Kaposi's sarcoma is highlighted. In addition, their genetic background is delineated. Conclusion Our findings suggest that genetic background associated with drugs plays a role in the pathogenesis of Kaposi's sarcoma in rheumatoid arthritis patients.     

The infra-red coagulator in the treatment of AIDS-related Kaposi's sarcoma and a comparison with radiotherapy

Experience with 1 s pulses of the infra-red coagulator is reported for the treatment of 10 cutaneous AIDS-related Kaposi's sarcoma lesions in seven patients. The infra-red coagulator may be a useful addition in the palliative cosmetic treatment of Kaposi's sarcoma, producing an acceptable result in small (less than 2 cm in diameter) Kaposi's sarcoma lesions of the arms and trunk, but not in those situated on the legs.     

Familial Kaposi's sarcoma and Paget's disease of bone

Familial Kaposi's sarcoma and familial Paget's disease of bone have not previously been reported to occur in the one patient or the one family. We report on an 82-year-old female of Lebanese descent who was recently diagnosed with Kaposi's sarcoma and Paget's disease. Of the patient's eight siblings, seven had Paget's disease and two of these also had Kaposi's sarcoma. Histocompatibility leucocyte antigen (HLA) class I and II typing of the patient showed: A2, A3; B35, Bx; Bw6; Cw4; DRβ1*1101 (an HLA-DR5 subtype) DRβ3 and DQβ1*0301. Previous reports have described possible associations of familial Kaposi's sarcoma with HLA-DR5 and Paget's disease with DR2, DRβ1*1104, DPβ1*04and DQw1. Genetic factors and possible viral aetiologies fur each condition are reviewed.     

Pediatric Kaposi's sarcoma associated with immune reconstitution inflammatory syndrome

Immune reconstitution inflammatory syndrome (IRIS) represents paradoxical immune-mediated inflammation in response to an infecting pathogen, occurring after initiation of antiretroviral therapy (ART), concomitantly with immune system recovery. It has also been described in Kaposi's sarcoma (KS). We report a case of a 9-year-old Guinean girl, who developed Kaposi's sarcoma, following introduction of ART. KS associated with immune reconstitution inflammatory syndrome is rare, especially in children, but with the increased use of ART is becoming more prevalent.     

Acute myelocytic leukaemia associated with Kaposi's sarcoma in a patient without serum antibodies to human immunodeficiency virus type 1

We report a 35-year-old man with acute myelocytic leukaemia and Kaposi's sarcoma, whose serum was non-reactive for antibodies to human immunodeficiency virus type-1 by enzyme-linked immunosorbent assay. Western blot and immunofluorescence. Complete remission of both the acute leukaemia and the Kaposi's sarcoma followed treatment with mitoxantrone and cytosine arabinoside. We speculate that the rapid regression of the lesions of Kaposi's sarcoma might be related to mitoxantrone and to the return to normal of his peripheral helper and suppressor T-cell counts.