复发性尖锐湿疣患者HPV感染模式和细胞免疫功能的分析

目的:了解复发性尖锐湿疣(CA)患者的人乳头瘤病毒(HPV)感染亚型和感染模式,以及其外周血T淋巴细胞亚群的表达情况。方法:据纳入标准,选择135例初诊CA患者,将治疗3个月后疣体复发患者81例设为复发组;疣体治疗消失后,随访3个月内未复发患者54例设为治愈组;治疗前对两组患者用聚合酶链式反应(PCR)方法检测HPV亚型;在治疗和随访3个月的截止点采血,应用流式细胞仪检测T淋巴细胞亚群,并与20例健康对照者进行比较。结果:复发组和治愈组HPV感染均以低危亚型HPV6/11为主。复发组单一亚型感染40例(49.38%),混合亚型感染41例(50.62%);治愈组单一亚型感染36例(66.67%),混合亚型感染18例(33.33%),两组HPV感染模式的构成比有统计学差异(2=3.93,P0.05)。复发组外周血T细胞与治愈组比较,CD3+总T细胞(68.13±8.03)%]降低,CD4+T细胞百分率(32.42±4.88)%]降低,CD8+T细胞百分率(38.61±4.19)%]升高,CD4+/CD8+比值降低,差异均有统计学意义(P值均0.01);复发组与正常对照组比较,CD4+T细胞、CD8+T细胞和CD4+/CD8+比值差异均有统计学意义(P值均0.05)。结论:HPV亚型混合感染模式和T淋巴细胞亚群免疫功能异常是促使尖锐湿疣复发的重要因素。

Analysis of HPV Infection Pattern and Cellular Immune Function in Recurrent Condyloma Acuminatum Patients

To study HPV subtypes and pattern of infection, and the expression of peripheral blood T lymphocyte subsets in newly diagnosed patients with and without recurrent geni-tal warts （ condyloma acuminatum, CA） .Methods：Based on the inclusion criteria, 135 newly di-agnosed CA patients were divided into recurrent group （81 cases）：recurrent in three months after multiple treatments, and no recurrent group （54 cases）：no recurrence after treatment in a three-month follow-up.Polymerase Chain Reaction （ PCR） method was used to detect HPV subtypes in warts before treatments.Blood tests were taken at the cutoff point of three months of treatments and follow-up, to analyze the subtypes of lymphocytes with flow cytometry, and the results were com-pared with the normal control group.Results：Nearly half of the cases were infected by low-risk HPV subtype 6/11.In the recurrent group, 40 patients （49.38%） had infection with a single HPV subtype; 41 （ 50.62%） had infections with multiple HPV subtypes.In the no recurrent group, 36 patients had infection （66.67%） with a single HPV subtype, and 18 had infection with multiple HPV subtype （33.33%） .The Difference between frequency of the HPV mixed subtype infection ratio between the recurrent group and the no recurrent group was statistically significant.Compared with the no recurrent group, recurrent group showed a decreased percentage of total CD3 ＋T cells （68.13 ±8.03）%] and CD4 ＋T cells （32.42 ±4.88）%] （both P〈0.05）, an increased percentage of CD8 ＋ cells （ 38.61 ±4.19 ）%] （ P 〈0.05 ） , and a decreased CD4 ＋/CD8 ＋ratio （ P〈0.05） .Compared with the normal control group, CD4 ＋T cells、CD8 ＋T cells and the ratio of CD4 ＋/CD8 ＋of the recurrent group showed statistically significant difference （P〈0.05）.Conclusion：Infection pattern of mixed HPV subtypes and cellular immune dysfunc-tion are important factors contributing to recurrence of condyloma acuminatum.