Brown M R, Noffsinger A, First M R, Penn I, Husseinzadeh N
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, 45267, USA.
Gynecol Oncol. 2000 Nov;79(2):220-4. doi: 10.1006/gyno.2000.5942.
Immunocompromised patients, such as female renal transplant recipients, have an increased incidence of neoplasms involving the lower genital tract (i.e., cervix, vagina, vulva). The relationship between lower genital tract neoplasms and human papillomavirus (HPV) infection has been established and high-risk oncogenic subtypes have been identified (HPV 16, 18, 45, and 56). The purpose of this study is to evaluate HPV subtypes present in lower genital tract neoplasms of post renal transplant women and compare HPV subtypes found in these patients with immunocompetent patients having similar neoplasms and normal immunocompetent controls.
Twenty specimens from lower genital tract neoplasms of 16 renal transplant patients, 13 specimens from 13 immunocompetent patients with similar histology, and 13 patients with normal lower genital tract histology were analyzed for the presence of HPV using polymerase chain reaction. HPV primers including the L1 (late) region consensus primers and primers specific for the HPV E6 (early) region for subtypes 6, 11, 16, and 18 were amplified with DNA from the above patient samples.
Overall, HPV was detected in 21/46 specimens tested. Thirteen of the HPV-positive specimens were from transplant patients, and 8 were from immunocompetent patients (5 immunocompetent with disease and 3 normal patients). This difference in the total number of HPV-positive cases was statistically significant between the transplant and immunocompetent group (P = 0.02). Although no difference in HPV 6 and/or 11 was detected between the two groups, HPV subtypes 16 and/or 18 approached statistical significant difference (P = 0.06).
High-risk oncogenic HPV subtypes 16 and/or 18 were found at a higher rate in transplant patients compared with their immunocompetent counterparts. The combination of immunocompromise and increased HPV 16 and/or 18 positivity may place these patients at increased risk for aggressive lower genital tract neoplastic progression.
免疫功能低下的患者，如女性肾移植受者，下生殖道（即子宫颈、阴道、外阴）肿瘤的发病率增加。下生殖道肿瘤与人乳头瘤病毒（HPV）感染之间的关系已得到证实，并且已鉴定出高危致癌亚型（HPV 16、18、45和56）。本研究的目的是评估肾移植术后女性下生殖道肿瘤中存在的HPV亚型，并将这些患者中发现的HPV亚型与患有相似肿瘤的免疫功能正常患者以及正常免疫功能对照进行比较。
使用聚合酶链反应对16例肾移植患者下生殖道肿瘤的20个标本、13例组织学相似的免疫功能正常患者的13个标本以及13例下生殖道组织学正常的患者进行HPV分析。用上述患者样本的DNA扩增HPV引物，包括L1（晚期）区域共有引物以及针对6、11、16和18亚型的HPV E6（早期）区域的特异性引物。
总体而言，在检测的46个标本中有21个检测到HPV。13个HPV阳性标本来自移植患者，8个来自免疫功能正常患者（5例患病的免疫功能正常患者和3例正常患者）。移植组和免疫功能正常组之间HPV阳性病例总数的差异具有统计学意义（P = 0.02）。尽管两组之间未检测到HPV 6和/或11的差异，但HPV 16和/或18亚型接近统计学显著差异（P = 0.06）。
与免疫功能正常的患者相比，移植患者中高危致癌HPV亚型16和/或18的检出率更高。免疫功能低下与HPV 16和/或18阳性率增加相结合，可能使这些患者发生侵袭性下生殖道肿瘤进展的风险增加。
