A Preliminary Study Of The Efficacy Of Photodynamic Therapy On Immune Activity In Patients With Condyloma Acuminatum

Objective1. To observe human papillomavirus (HPV) genotypes in patients with condyloma acuminatum (C A) in Hangzhou.2. To explore the immunity of CA patients and the efficacy of photodynamic therapy on immune activity in patients with CA.Methods1. Detecting HPV genotypes of190patients in different areas including cervix and/or vulva, anus, urethral orifice.2. Detecting T lymphocyte subsets of36patients (23cases tested after treatment again) and24healthy controls and CD4+CD25+Foxp3+T regulatory cells of33patients (23cases tested after treatment again) and26healthy controls in the peripheral blood by using flow cytometry. Using immunohistochemical method to detect CD4, CD8, FOXP3, PD-1, PD-L1, E-cadherin and CCL20expression in the lesions of10patients. SPSS19.0was used for statistical processing.Results 1. HPV genotypes of224specimens in190patients were detected. One hundred and seventy-tree of them were positive (77.23%). There were107for single infection (61.85%),66for multiple infections (38.15%). The positive rate of urethral orifice was lower than other sites (p<0.05), The positive rate of single low-risk HPV in patients with cervical positive was significantly lower than the urethral orifice (P<0.05). All of the120patients who were detected HPV genotypes in cervical had CA lesions in vulva. Only10patients had warts in cervical. HPV genotypes of85(77.27%) in110patients without cervical warts were positive. Positive rate of HPV-6was the highest (61,21.86%), followed by HPV-11(55,19.71%),16(36,12.90%),52(20,7.17%),18(17,6.09%),58(16,5.73%,53) and CP8304(14,5.02%). Other12genotypes were less than10times. HPV-35was not detected. The detection rate of HPV-6in cervical was significantly lower than that in anus. HPV-11in cervical was lower than that in urethral orifice (P<0.05). High-risk genotypes in cervical were higher than in urethral orifice (P<0.05).2. The percentage of CD4+T cells and ratio of CD4/CD8in CA patients was significantly lower as compared to healthy controls (P<0.01). After treatment, CD4/CD8increased significantly than that before (P<0.05). The percentage of CD4+CD25+Foxp3+T regulatory cells in peripheral blood before and after ALA-PDT was significantly higher as compared to healthy controls (P<0.01), while there was no statistically difference between pretherapy and posttreatment (P>0.05). Twenty-five patients with CA after successful ALA-PDT treatment were followed-up. Eight cases recurred, while17cases relieved after3months follow-up. The percentage of CD4+CD25+Foxp3+regulatory T cells in recurrent group was higher than that in non-recurrent group (P<0.05).3. The density of CD4in CA lesions before treatment was higher than that in healthy controls (P<0.05). Though CD8positive expression is higher than that of healthy controls, there was no statistically significant difference (P>0.05). CD4/CD8in CA lesions decreased obviously (P<0.05). Photodynamic therapy made CCL20and CD4/CD8ratio increased as compared to those before treatment (P<0.05). Comparing the expression of Foxp3, PD-1, PD-L1and E-cadherin in the CA lesion before and after treatment, as well as healthy controls, there were no statistical difference (P>0.05).Conclusion1. HPV positive rate in the CA was77.23%in Hangzhou. HPV infections were caused by one or multiple genotypes (genotypes2-6). Single infection was the main type. HPV can cause cross infection in multiple sites such as genital and cervical. Many female patients without cervical clinical lesions also had cervical HPV infection. Though without cervical wart, female C A patients should routinely detect HPV genotypes in cervical and follow-up, if necessary give treatment.2. Before treatment, the percentage of CD4+T cells and CD4/CD8ratio in peripheral blood were lower, while CD4+CD25+Foxp3+T cell was higher than that in healthy controls. The expression of CD4in skin lesion was higher while CD4/CD8was lower as compared to healthy controls. The immune function of CA was abnormal, in a state of imbalance. After photodynamic therapy, CD4/CD8in peripheral blood and CA lesion increased. The expression of CCL20in CA lesion increased. Photodynamic therapy may improve the imbalance of immune status in CA patients and promote the cure of C A lesion.