賴嘉希，柯吳堅(jiān)，劉 晗

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人乳頭狀瘤病毒非性行為傳播途徑的研究現(xiàn)狀

賴嘉希，柯吳堅(jiān)，劉 晗

人乳頭狀瘤病毒(HPV)感染是導(dǎo)致宮頸癌和尖銳濕疣的致病病原體。主要對(duì)HPV除性接觸外的其他可能的傳播途徑如經(jīng)手傳播、圍產(chǎn)期傳播、血液傳播、空氣傳播的研究現(xiàn)狀進(jìn)行綜述，指出由于研究的樣本量相對(duì)不大，仍需要進(jìn)一步研究明確這些傳播途徑在HPV感染和發(fā)病中是否具有直接的相關(guān)性。

人乳頭狀瘤病毒；傳播途徑；非性行為傳播；經(jīng)手傳播；圍產(chǎn)期；血液傳播；空氣傳播

人乳頭狀瘤病毒(human papillomaviruses，HPV)是一種小的DNA病毒，其基因組僅有大約8 000個(gè)堿基對(duì)[1-2]。HPV感染宿主，主要通過(guò)上皮組織微擦傷[3-4]使病毒體與HPV受體(如α整合素和層黏連蛋白)結(jié)合，從而使病毒顆粒通過(guò)網(wǎng)格蛋白介導(dǎo)和/或小窩蛋白(根據(jù)不同類型的HPV)介導(dǎo)的胞吞作用進(jìn)入上皮細(xì)胞的基底層[5]。此時(shí)，病毒基因組被輸送到細(xì)胞核并在細(xì)胞中進(jìn)行復(fù)制，從而隨著宿主角質(zhì)形成細(xì)胞的分化形成一個(gè)復(fù)雜的轉(zhuǎn)錄級(jí)聯(lián)，并嚴(yán)格遵循宿主角質(zhì)形成細(xì)胞的分化程序的生命周期[6-8]。已知有120多種HPV類型，其中51個(gè)類型和3個(gè)亞型感染生殖器黏膜[9]，有15種被列為高風(fēng)險(xiǎn)型(HPV16，18，31，33，35，39，45，51，52，56，58，59，68，73，82)，3種被列為可能的高風(fēng)險(xiǎn)型(HPV26，53，66)，12種被列為低風(fēng)險(xiǎn)型(HPV6，11，40，42，43，44，54，61，70，72，81和CP6108)[10]。HPV主要通過(guò)性接觸傳播[11-12]，本研究主要對(duì)除常見(jiàn)HPV感染途徑外其他可能的傳播方式進(jìn)行綜述，現(xiàn)報(bào)道如下。

1 經(jīng)手傳播

多項(xiàng)研究顯示HPV可通過(guò)感染者及其性伴的手傳播[13-14]。Hernandez等[15]對(duì)25對(duì)異性戀且一夫一妻制夫婦的生殖器和優(yōu)勢(shì)手進(jìn)行隨訪，每隔1個(gè)月檢測(cè)HPV 1次，平均隨訪7.5個(gè)月。研究發(fā)現(xiàn)有2對(duì)夫婦中出現(xiàn)男性生殖器高危型HPV傳染到女性的優(yōu)勢(shì)手，2個(gè)妻子優(yōu)勢(shì)手的HPV傳染到丈夫的生殖器，1個(gè)妻子生殖器HPV傳染到丈夫的優(yōu)勢(shì)手，各有2個(gè)丈夫和妻子自己生殖器的HPV傳染到自己的手。因此，該研究認(rèn)為HPV的自身或性伴接種可能在HPV感染過(guò)程中扮演著重要角色。Winslow等[16]研究同樣認(rèn)為男性如果其生殖器感染高危型HPV，則超過(guò)一半的人指尖可檢測(cè)出HPV。Winer等[17]研究顯示性活躍的女性指尖HPV陽(yáng)性率為14%，而無(wú)性接觸的手似乎在HPV傳播中很少發(fā)揮作用[18]。Winer等[17]研究對(duì)14位無(wú)性行為女性的指尖進(jìn)行HPV檢測(cè)，均未檢測(cè)出HPV。另一份報(bào)告同樣顯示，無(wú)任何性行為的女性僅1%(1/76)手指可檢測(cè)出HPV，如果有手與生殖器接觸史但無(wú)陰道插入性行為的女性約10%(7/72)的HPV呈陽(yáng)性[19]。

2 圍產(chǎn)期傳播

雖然母親在分娩中可通過(guò)產(chǎn)道將HPV傳染給新生兒，但是新生兒卻罕見(jiàn)出現(xiàn)HPV相關(guān)臨床癥狀或體征[20]。目前已經(jīng)證實(shí)HPV具有能夠隱藏宿主幾十年而不發(fā)病的特點(diǎn)，因此缺乏顯性的臨床表現(xiàn)并不能排除無(wú)癥狀HPV潛伏感染。HPV6和HVP11型的圍產(chǎn)期傳播可導(dǎo)致幼年發(fā)病性復(fù)發(fā)性呼吸道乳頭瘤病(juvenile-onset recurrent respiratory papillomatosis，JORRP)的發(fā)生[21]。JORRP非常罕見(jiàn)，在美國(guó)每10萬(wàn)名兒童約出現(xiàn)2例JORRP[22]。雖然JORRP發(fā)生率在分娩時(shí)患有尖銳濕疣的女人中相對(duì)較高，但總感染JORRP的風(fēng)險(xiǎn)仍然小于1%[23]。

3 血液傳播

盡管傳統(tǒng)觀念一直認(rèn)為HPV不經(jīng)由血液傳播，因?yàn)樗桓腥酒つw和黏膜組織，但最近的研究卻對(duì)這個(gè)觀念提出質(zhì)疑[24]。由于在宮頸癌病人的血液中可以檢測(cè)到HPV DNA[25]；因此，Bodaghi等[26]為證實(shí)HPV可通過(guò)血液傳播，對(duì)57例經(jīng)母嬰或輸血感染HIV的無(wú)性行為兒童的冷凍血液樣本進(jìn)行HPV研究，發(fā)現(xiàn)14.0%(8/57)的血液中可檢測(cè)出高危型HPV16，由此研究者認(rèn)為HPV有可能經(jīng)輸血傳播。同樣，Chen等[27]對(duì)保存在澳大利亞紅十字會(huì)的180名健康男性血液樣品進(jìn)行HPV檢測(cè)，發(fā)現(xiàn)8.3%(15/180)的血液可檢測(cè)出一種或多種HPV型。然而，值得注意的是從血液中檢測(cè)到HPV DNA的存在與檢測(cè)到病毒本身不同。此外，存留在病人血液中的病毒是否仍然具有傳染性也是未知的。因此，血液中的HPV是否具有傳染性仍有待進(jìn)一步確定。

4 空氣傳播

研究已經(jīng)證實(shí)通過(guò)電灼或激光燒蝕尖銳濕疣產(chǎn)生的含HPV病毒顆粒氣霧具有傳染性[28]。HPV病毒顆?？蓪?dǎo)致醫(yī)務(wù)人員感染，挪威的一位44歲的外科醫(yī)生因采用激光消融治療巨大生殖器尖銳濕疣后，由于吸入含HPV氣霧而出現(xiàn)喉乳頭狀瘤[29-30]；因此，外科醫(yī)生(包括手術(shù)室內(nèi)其他工作人員)在進(jìn)行尖銳濕疣電灼或激光治療過(guò)程中需要做好防護(hù)措施(如配備吸煙機(jī))，避免感染HPV。

5 小結(jié)

HPV感染的主要傳播途徑為性接觸，而非性接觸的HPV傳播途徑(如手、圍產(chǎn)期、血液、空氣等)由于研究的樣本量相對(duì)不大，因此仍需要進(jìn)一步研究明確這些傳播途徑在HPV的感染和發(fā)病中是否具有直接的相關(guān)性，從而有利于指導(dǎo)臨床防控HPV感染。

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(本文編輯李亞琴)

Research status quo of non-sexual transmission of human papillomaviruses

Lai Jiaxi，Ke Wujian，Liu Han

(Guangdong Provincial Dermatology Hospital，Guangdong 510009 China)

賴嘉希，護(hù)師，本科，單位：510009，廣東省皮膚病醫(yī)院；柯吳堅(jiān)、劉晗(通訊作者)單位：510009，廣東省皮膚病醫(yī)院。

信息 賴嘉希，柯吳堅(jiān)，劉晗.人乳頭狀瘤病毒非性行為傳播途徑的研究現(xiàn)狀[J].護(hù)理研究，2017，31(19)：2319-2320.

R473.51

A

10.3969/j.issn.1009-6493.2017.19.006

1009-6493(2017)19-2319-02

2016-05-18；

2017-06-15)