HPV在线视频

Hello again.
大家好

I’m Yun Su,
我是来自

from Shantou University Medical College.
汕头大学医学院的苏芸老师

This time we will discuss
这节课我们来学习

human papillomavirus(HPV).
人乳头瘤病毒（HPV）

Let’s start.
我们开始吧

These are the learning objectives
以下是这节课的

for you:
学习目标

1.Describe the general
1.描述HPV

properties of HPV;
的一般特性

2.Explain the pathogenesis of HPV;
2.解释HPV的致病机制

3.List the appropriate laboratory tests
3.列举HPV的实验室

for diagnosis,
诊断方法

and know how to treat,
并懂得如何

prevent and control HPV infection.
治疗和防控HPV感染

First,
我们

we will show you a case:
先来看一个案例

A 40-year-old woman goes for a routine
一名女性，40岁，到医院

gynecologic exam.
进行常规妇科检查

She is sexually active
她的性生活频繁

and has delivered 3 healthy children.
并且生过3个健康的孩子

She has had 6 sexual partners
她曾有过6个

in her lifetime.
性伴侣

She is also a pack-a-day smoker.
而且有吸烟史，量为每天一包

The report of the Pap (Papanicolaou)
子宫颈抹片检查

smear
（巴氏涂片）

smear
（巴氏涂片）

indicates a pre-cancerous change.
结果显示癌前病变

PCR analysis indicates that cells
PCR分析显示病灶中的

in the lesion
细胞

are infected with human papillomavirus.
被人乳头瘤病毒感染

Now,
现在

here come the questions:
问大家几个问题

1.What is HPV?
1.HPV是什么？

2.How is HPV transmitted?
2.HPV是怎么传播的？

3.How can infection be prevented?
3.怎么预防HPV感染？

The first question:
第一个问题

What is HPV?
HPV是什么？

The human papillomaviruses are small,
人乳头瘤病毒（HPV)）是微小的

non-enveloped viruses
无包膜病毒

with double-stranded
病毒基因组是

circular DNA genomes.
双链环状DNA

At least 100 types
通过DNA同源性测序

have been identified
现已发现

by DNA sequence homology,
100余型的HPV

some of which are potentially
其中一些是致癌的

carcinogenic genotypes.
高危型别

HPV can be distinguished
根据感染组织进一步分类

further as cutaneous
病毒可以分为

or mucosal based on target tissue.
嗜皮肤性和嗜黏膜性HPV

As the picture shows,
HPV结构如图所示

the virus is coated with
病毒衣壳为二十面体

icosahedral capsid.
立体对称

The capsid consists of
衣壳由两种

two structural
结构蛋白

proteins (L1 & L2 proteins)
（L1蛋白和L2蛋白）组成

that form 72 capsomeres.
的72个壳粒构成

Depending on the host cell,
根据感染细胞的不同

these viruses
病毒

are capable of causing lytic,
可导致细胞裂解

chronic,
慢性感染

latent,
潜伏感染

abortive,
顿挫感染

and/or transforming infections.
和/或细胞转化

Let’s get to know the viral genome
我们来进一步了解HPV的

more in detail.
病毒基因组

The HPV genome is circular dsDNA
HPV基因组是环状dsDNA

and has 7.9 kb.
约7.9kb

The HPV DNA contains
病毒DNA分为

7 or 8 early genes (E1 to E8)，
7或8个早期基因（E1到E8）

2 late or structural genes (L1 and L2),
2个晚期或结构基因（L1和L2）

and an upstream regulatory region(URR).
以及上游调节区（URR）

As the table shows,
这个表格展示了

the genes encode different proteins
不同基因编码的

involved in distinct functions.
不同功能的蛋白质

E1 and E2 proteins
E1和E2蛋白

bind DNA and promote replication
与DNA结合并促进复制

and transcription.
和转录

E4 disrupts cytokeratins
E4能破坏细胞角蛋白

to promote viral release.
促进病毒释放

E5 oncoprotein activates
E5肿瘤蛋白激活

the EGF receptor to promote growth.
EGF受体促进病毒生长

E6, E7
E6，E7

bind to growth-suppressor proteins
蛋白与抑癌因子

p53 and p105RB,
p53和p105RB结合

and cause immortalization
导致细胞永生化

and are associated with
这与人类子宫颈癌的

human cervical cancer.
发生密切相关

L1 and L2
L1和L2

are late structural (capsid) proteins.
是晚期结构（衣壳）蛋白

How does HPV replicate
HPV在靶细胞中

in the target cell?
如何复制？

HPV replication
HPV的复制过程

is linked to the life cycle of
与角化细胞

the keratinocyte
及上皮细胞

and epithelial cell.
的生命周期有关

1.HPV infects the basal layer
1.HPV通过皮肤上的

through a very tiny break in the skin.
微小创口感染基底上皮细胞

Then,
然后

L1 protein
L1蛋白

attaches to the receptors
结合到受体上

and initiates the replication.
并启动复制过程

2.HPV genomes
2.HPV的基因组

replicate along with cellular DNA
在未分化的基底上皮细胞中

in undifferentiated basal cells.
伴随着细胞DNA一起复制

3.Upon differentiation,
3.在细胞分化之后，

late gene is expressed and amplified.
晚期基因大量表达

4.E6, E7, E4 and E5
4.E6、E7、E4和E5

contribute to productive replication.
有助于高效复制

5.L1 and L2 promote virion assembly,
5.L1和L2促进病毒颗粒的装配后

resulting in viral release
病毒颗粒

from the uppermost layer
从最表层上皮

of the epithelium.
释放

What are the consequences of HPV
HPV感染和复制

infection and replication?
的后果是什么？

Infection by papillomaviruses
乳头瘤病毒的感染

induces epithelial proliferation.
会诱导上皮增殖

The HPV types are tissue specific,
HPV具有组织特异性

causing different disease presentations:
从而产生不同的疾病

The cutaneous
皮肤

squamous epithelium infection
鳞状上皮感染

can lead to warts
会导致疣

while mucous membranes infection
而黏膜感染

result in genital,
会诱发生殖器

oral,
口腔

and conjunctival papillomas.
和眼结膜乳头瘤

As I mentioned,
如前所述

different HPV types
不同类型的HPV

have affinities for various tissues
对不同组织的亲和力不同

and hence different manifestations.
因此具有不同的感染表现

The table here summarizes the HPV types
这个表格总结了不同类型HPV

and diseases they cause.
及它们所导致的疾病

As you can see,
可以看到

HPV can cause
HPV可以导致

skin lesions (such as warts)
皮肤病变（如疣）

and mucosal diseases
和黏膜性疾病

such as benign head and neck tumors,
如头颈部良性肿瘤

condylomata acuminata
尖锐湿疣

or cervical intraepithelial neoplasia.
或宫颈上皮内瘤样病变

A wart is a proliferation of skin cells
疣由皮肤细胞增殖形成

that regresses with time.
也可随着时间消除

The lesion
这种病变

is usually found on keratinized
通常出现在

surfaces of the hands
手和脚的

and feet.
角质层上

Condylomata acuminata
尖锐湿疣

are found on the external genitalia
通常发生在外生殖器

and perianal areas
和肛周部位

and are common
在滥交的人身上

in promiscuous individuals.
比较常见

Most cases are caused by
（尖锐湿疣）大部分病例由

HPV-6 and HPV-11.
HPV-6和HPV-11导致

The genital tract HPV infection
生殖道HPV感染

is a very common sexually
是一种非常常见的

transmitted disease.
性传播疾病

The infected person
感染者

is usually asymptomatic.
通常无明显症状

Carcinogenic HPV types (HPV-16 & HPV-18)
致癌高危型HPV(HPV-16和HPV-18)

infection of the female genital tract
导致女性生殖道的感染

can initiate the development of
可以诱发

intraepithelial cervical
宫颈上皮内瘤样病变

neoplasia and cancer.
和癌症的发生

These pictures show you the different
以下图片展示了HPV

HPV diseases.
所致的不同疾病

Picture 1
图1

shows a wart on the hands and feet.
展示的是手和脚上的疣

The appearance of the wart
疣的外观

depends on the HPV type
取决于HPV的类型

and the infected site.
以及感染部位

Picture 2
图2

is the condylomata acuminata.
展示的是尖锐湿疣

The lesion may appear as soft,
病灶质软

flesh-colored warts that are raised
肉色，外观为菜花状

and cauliflower shaped.
突起

Picture 3
图3

shows the cervical cancer.
展示的是宫颈癌

Now what is HPV?
对于什么是HPV这个问题

I believe you have got the answer.
我相信大家已经有了答案

Let’s go on to the next question:
下一个问题

how is HPV transmitted?
HPV是如何传播的呢？

HPV is ubiquitous
HPV广泛存在

and resistant to inactivation.
而且抵抗力较强

It can be transmitted from
病毒可以通过

unclean surfaces of
污染的

countertops or furniture,
工作台、家具

bathroom floors,
浴室地板和

and towels.
毛巾传播

The individuals acquire the virus:
个体感染病毒的方式有

1.by direct contact
1.通过皮肤

through very tiny breaks
或黏膜上的小伤口

in the skin or mucosa;
直接接触感染

2.during sexual intercourse;
2.通过性交感染

3.when a newborn is delivered
3.新生儿出生时通过

through the mother’s infected
被感染母亲的子宫颈

cervix & vagina.
和阴道感染

There are some risk factors
HPV的感染有

for HPV infection,
一些危险因素

including
包括

1.Weakened immune system;
1.免疫力下降

2.a breach in the skin;
2.皮肤伤口

3.multiple sexual partners;
3.结交多个性伴侣

4.tobacco use.
4.吸烟

Now then,
现在

the 3rd question,
我们来看第三个问题

how can the infection be diagnosed
HPV感染如何诊断

and prevented?
和预防？

A few approaches are available.
可以采用以下几种办法

1.Cytological changes can be detected.
1. 检测细胞学病变

Histological appearance
组织学特点

consisting of hyperplasia
包括

of the prickle cells
棘细胞增生

and an excess production of keratin
以及过度角化

are characteristic for warts.
都是疣的特点

The presence of
在巴氏涂片中出现

Koilocytotic cells(vacuolated cytoplasm)
空泡细胞（空泡化细胞质）

in Pap smear indicates HPV infection.
提示细胞被HPV感染

2.DNA molecular probe,
2. DNA分子探针

PCR analysis of cervical swabs
宫颈拭子的PCR分析

are usually chosen for the diagnosis
通常可用来进行

and typing of the HPV infection.
HPV感染的诊断和分型

After the diagnosis,
在确诊后

what shall we do next?
我们下一步该做什么

In fact,
事实上

there is no cure for HPV.
HPV感染没有特异性的治愈方法

Most are cleared up by the immune system
大多数患者在未治疗的情况下病毒就

without any treatment.
已经被免疫系统清除

Treatment is used to relieve
因此临床治疗通常用来缓解

or manage the symptoms of the disease.
或控制症状

For example,
例如

warts can be removed by cryotherapy
疣可以通过冷冻疗法来去除

and surgery
而喉乳头瘤

may be necessary for the removal
可能需要

of laryngeal papillomas.
通过外科手术切除

How to prevent HPV infection?
那如何预防HPV感染呢？

There are some effective measures
有效的预防措施

including:
包括

1.Avoid direct
1. 避免直接

contact with infected tissue;
接触受感染的组织

2.Adequate precautions
2.实施有效的措施

to prevent sexual transmission;
防止性传播

3.Routine Pap smear
3.对于性行为活跃的女性

for sexually active women;
要定期进行巴氏涂片检测

4.HPV Vaccination.
4.接种HPV疫苗

Currently,
目前

the vaccines containing the L1
由L1主要衣壳蛋白

major capsid protein
制备而成的

assembled into virus-like particles
HPV病毒样颗粒疫苗

are used for immunization.
可以用于预防接种

A 4-valent,
四价

a 9-valent,
九价

or divalent HPV vaccine
或二价HPV疫苗

is recommended for girls and boys
适用于男孩和女孩

starting at age 11 years—
疫苗可从11岁开始

before sexual activity—
在发生性行为之前接种

to prevent cervical cancer,
可预防子宫颈癌

penile and anogenital warts.
阴茎和生殖器疣的发生

Although the vaccine is effective
虽然疫苗接种能有效预防

for prevention,
一些HPV类型的感染

it does not offer protection against
但却无法对所有的HPV感染

all possible HPV strains.
提供全面保护

Finally,
最后

we go back to the questions of the case.
我们再次回顾这个案例的问题

Trust you can answer them correctly.
我相信大家都已经知道了正确答案

Thank you for joining us!
谢谢大家的参与！

Next time,
下节课

we will share some
我们将会学习

other interesting contents.
其他有趣的内容

Here are the references.
以下是参考资料