课件：HPV与宫颈病变.ppt

宫颈癌防治研究的三大突破 病因的确定 筛查方法的改进 薄层液基细胞学和自动阅片系统 HPV-DNA试验检测 HPV预防性疫苗 谢 谢！ * 宫颈癌是最常见的女性生殖道恶性肿瘤，多年来科学家不断探究其病因 * 1.150年前，发现修女中宫颈癌极罕见，性混乱与婚产情况与宫颈癌有关；2.60年代报道妇女血中抗HSV-2抗体明显增高，有人提出HSV－2可能是宫颈癌的病因，但缺乏分子学支持，在肿瘤组织中也未检测出HSV DNA，所以此概念逐渐改变；3.从较落后的方法到PCR技术；4.世界各国的大量研究使人们的认识日渐统一：HPV感染是宫颈上皮内瘤变＆宫颈癌发生的必要因素，无论是实验室亦或流行病学证据均证实了这一观点。 * HPV是一种环状双链结构的DNA病毒，由8000个碱基对组成，是一种没有包被的病毒颗粒。其基因结构中包含6个早期转录单位E1、E2、E4－E7，2个晚期转录区L1、L2，E6和E7是病毒癌基因，参与宿主细胞的病毒基因表达和复制，并调控这些活动；它们所编码的蛋白可诱导细胞增殖和转化；参与细胞周期调控：E6与P53、E7与PRb结合，导致这两种抑癌基因失活，使细胞无限制生长。L1、L2 编码膜壳蛋白，可诱导机体产生对HPV 的抗体－疫苗预防 * Very briefly, some background virology, to help you understand this complex virus. HPV is a DNA virus. The process of cellular replication is a four-phased cycle whereby DNA is duplicated. HPV functions by disrupting this four-phased cell cycle of duplication of cellular DNA. Usually, chromosomal DNA is replicated during the S phase (DNA sysnthesis). The M or mitosis phase is when the separation of duplicated DNA takes place. These two phases are separated by the gap phases, G1 and G2. Cells that are not dividing exit the cell cycle during the G1 phase and reside in a quiescent state or G0. To replicate, HPV must induce DNA synthesis in host cells that are in this quiescent G0 phase and move them into the activated G1 phase shown on the right side. HPV oncogenes, genes which promote cancer growth, E6 and E7, stimulate cell proliferation by interfering with the functions of the retinoblastoma protein pRB, a central regulatory protein of the cell cycle, and the p53 tumor suppressor protein, which suppresses tumor growth. Cells thereby go into a nonstop proliferation pattern of growth, eventually leading to premalignant change, which can then progress to malignant transformation. * 粘膜型：口咽、食道、结膜、气道（罕见） ； 皮肤型： 疣状病变。 根据HPV与癌瘤的关系，感染肛门生殖器的HPV可分类为高危型和低危型 * The WHO has estimated worldwide prevalence of HPV at 9-13%. Approximately 630 million individuals are infection, with up to 30 million new cases per year. In t