Chin J Dent Res 2016;19(1):9–16; doi: 10.3290/j.cjdr.a35692

人類乳頭狀瘤病毒（HPV）與口咽癌：以史為鑒

Human Papilloma Virus and Oropharyngeal Carcinoma – Lessons from History

Alexander Chris VLANTIS

本文由來(lái)自香港中文大學(xué)威爾士王子醫(yī)院的Alexander Chris VLANTIS醫(yī)生為我們介紹了人類乳頭狀瘤病毒（HPV）與口咽癌關(guān)系的歷史經(jīng)驗(yàn)。HPV是一種常見的病毒，世界上10%的人口的上皮組織都受到其感染。除大部分性活躍的人群已被感染外，還有很多健康人群攜帶并用機(jī)體免疫力控制著感染。

HPV在宮頸黏膜的感染比較頑固，與幾乎所有的宮頸癌相關(guān)。幸運(yùn)的是，宮頸癌篩查的敏感性和特異性都很高，可以顯著降低宮頸癌的發(fā)病率。雖然如此，宮頸癌仍是導(dǎo)致癌癥死亡的主要原因之一。越來(lái)越多人的口咽黏膜受到HPV的持續(xù)感染，導(dǎo)致口咽癌的潛在增長(zhǎng)，在有吸煙史的老年男性當(dāng)中尤為明顯。

有研究中心報(bào)道70%的口咽癌與HPV感染相關(guān)，獨(dú)立于飲酒和吸煙這些危險(xiǎn)因素，也有一些中心報(bào)告僅有20%相關(guān)。目前，對(duì)高危患者的教育尚不到位，口咽腔HPV感染的檢出率也僅有40%。未來(lái)在唾液和血漿中檢測(cè)病毒DNA可能是更有效的檢測(cè)手段。HPV疫苗從2006年起就已上市，但在很多國(guó)家都尚未開始常規(guī)使用。HPV陽(yáng)性的口咽癌發(fā)病率目前尚不明確。醫(yī)務(wù)人員需對(duì)此疾病高度重視。

Chin J Dent Res 2016;19(1):9–16; doi: 10.3290/j.cjdr.a35692

Human Papilloma Virus and Oropharyngeal Carcinoma – Lessons from History

Alexander Chris VLANTIS1

The human papilloma virus (HPV) is a common virus that infects epithelium in 10% of the world’s population. While most sexually active people become infected, the majority with a healthy natural immunity control their infection. When the infection becomes persistent in cervical mucosa for instance, it is associated with nearly all cervical cancers. Fortunately cervical cancer screening is both sensitive and specific and when accessed has led to significant reductions of this disease. Despite this, cervical cancer still remains one of the leading causes of death from cancer. Oropharyngeal mucosa is becoming persistently infected with HPV in an increasing number of people leading to a potential epidemic of oropharyngeal carcinoma. While only 10% of new oropharyngeal infections persist, those in elderly men who smoke are more likely to do so. Some centres report more than 70% of oropharyngeal cancers are associated with HPV infection, which is different to cancers caused by alcohol and tobacco. Other centres report only a 20% association. Education against high-risk sexual behaviour has been met with limited success. Screening for oropharyngeal HPV infection has been disappointing with a pickup rate of only 40%. Some hope lies in detecting viral DNA in both the saliva and plasma. A HPV vaccine has been available since 2006 but is not yet routinely given to both sexes in many countries. Its effect on the incidence of HPV-positive oropharyngeal carcinomas is currently unknown. Vigilance by dental and medical colleagues in the meantime is essential.

Key words: cervical carcinoma, human papilloma virus, oropharyngeal carcinoma, screening, vaccination

來(lái)源： 中華口腔醫(yī)學(xué)會(huì)