umdlavuza womlomo wesibeletho
Ngokwezibalo zeWorld Health Organisation ngo-2012, balinganiselwa ku-530,000 266,000 izigameko ezintsha zomdlavuza womlomo wesibeletho emhlabeni wonke unyaka nonyaka, kanti isibalo sabashona minyaka yonke singu-85. Iziguli ezingaphezu kuka-130,000% zigxile emazweni asathuthuka, futhi kunezigameko ezintsha ezingaphezu kuka-XNUMX zomdlavuza womlomo wesibeletho eChina minyaka yonke. Isigameko somdlavuza womlomo wesibeletho sihlobene eduze nokutheleleka. Inani elikhulu lezifundo ze-molecular epidemiological lithole ukuthi ukutheleleka okungapheli nge-high risk human papillomavirus (HPV) kuyimbangela eyinhloko yomdlavuza womlomo wesibeletho futhi kuyisimo esidingekayo. Ngaphansi kwezinye izici ezisizayo (ukuvuvukala kwendlela yokuzala) Banga umdlavuza womlomo wesibeletho futhi kukhuthaze ukukhula kwesimila.
Ucwaningo lwe-Epidemiological lomdlavuza wesibeletho we-HPV ukutheleleka
I-HPV iyigciwane eliyindilinga le-DNA eliyindilinga ephindwe kabili. Njengamanje, angaphezu kwama-180 ama-HPV subtypes atholakalayo, cishe angama-40 awo angama-subtypes wokutheleleka okuzala, kanti izinhlobo eziyi-15 zingadala izicubu ezimbi zokuzala ezaziwa ngokuthi yi-HPV.
Ukutheleleka nge-HPV okuyingozi kakhulu kuyisimo esidingekayo somdlavuza womlomo wesibeletho, kepha hhayi bonke abantu abane-HPV abazoba nomdlavuza womlomo wesibeletho. Ucwaningo lwe-Epidemiological lukhombisile ukuthi izinga lokutheleleka nge-HPV engozini enkulu kubantu cishe liyi-15% kuya ku-20%, abesifazane abangaphezu kwama-50% bane-HPV ngemuva kokuya ocansini lokuqala, kanti abesifazane abangama-80% batheleleke nge-HPV ngesikhathi sokuphila kwabo. . Kodwa-ke, abesifazane abangaphezu kwama-90% bangasuswa amasosha omzimba kungakapheli iminyaka emithathu ngemuva kokutheleleka nge-HPV. Zingu-3% kuphela iziguli ezingaba nokutheleleka okungapheli, futhi i- <10% yeziguli ezinokutheleleka okuqhubekayo zizogcina ziba nomdlavuza womlomo wesibeletho. Phakathi kwabantu abangenelwa yi-immunodeficiency [ikakhulukazi labo abatheleleke nge-human immunodeficiency virus (HIV)], ingozi yomdlavuza womlomo wesibeletho inyuka kakhulu, okuhlobene nokungakwazi komzimba ukususa i-HPV. Ukuvela komdlavuza womlomo wesibeletho kuyinkqubo eyinkimbinkimbi yezigaba eziningi edinga izinqubo ezintathu: ukutheleleka ngegciwane, izilonda ezingaphambi komdlavuza nomdlavuza ohlaselayo. Imvamisa kuthatha iminyaka engaphezu kwengu-1 ukusuka ekuthelelekeni kwe-HPV okuyingozi enkulu kuya kumdlavuza womlomo wesibeletho.
Ukubonakaliswa kwemitholampilo kokutheleleka nge-HPV akucacisiwe
Indlela eyinhloko yokutheleleka nge-HPV ukuxhumana ngokocansi. I-HPV ithelela amaseli we-basal ngesikhumba esonakele nolwelwesi lwamafinyila. Ngoba igciwane le-HPV lifihliwe, ayikho i-viremia ezokwenzeka ngaphandle kokuthintana negazi kanye namasosha omzimba okuqala, ngakho-ke ngeke kube khona ukuvuvukala okusobala emtholampilo. Ngasikhathi sinye, i-HPV ingagwema ukuvunyelwa kwamasosha omzimba ngokulawula phansi indlela ye-interferon noma ukunciphisa ukubonakaliswa kwama-receptors afana neToll.
Ukuphindaphinda kwegciwane le-HPV kuncike ohlelweni lokuphindaphinda kwe-DNA. Njengoba amaseli e-basal ehlukanisa futhi evuthwa abe amaseli angaphezulu, ukuphindaphinda kwegciwane kuyashesha futhi izinhlayiya zegciwane ziyakhululwa njengoba amaseli ethola i-apoptosis yemvelo. Le nqubo ithatha cishe amaviki ama-3. Uma leli gciwane selitholwe amasosha omzimba okuqala futhi atholiwe, umzimba uzoqala uchungechunge lokusabela kokuvuvukala kwamasosha omzimba ukuze usule igciwane, kodwa ukubonakaliswa komtholampilo okuphelele akuqondile.
Njengamanje, alukho umuthi othize wokutheleleka nge-HPV engcupheni enkulu emtholampilo. Into ebaluleke kakhulu ngemuva kokutheleleka nge-HPV ukuhlolwa kwesibeletho somlomo wesibeletho, ukubuyekezwa kwe-HPV minyaka yonke, kanye ne-colposcopy uma kunesidingo ukukhipha umdlavuza womlomo wesibeletho kanye nezilonda zangaphambili. Indlela ye-HPV enobungozi obudala umdlavuza wesibeletho
I-carcinogenesis ye-HPV enobungozi obukhulu yenzeka kakhulu nge-virus ye-E6 ne-E7 oncoproteins, ehlangana namaprotheni womuntu i-P53 neRb athinta ukwanda kwamaseli nokulawulwa komjikelezo wamaseli, okudala ukwanda kwamaseli okungajwayelekile kanye noguquko, kanti ama-oncoprotein e-E6 ne-E7 ane-Synergy ethile. Ucwaningo luphinde lwathola ukuthi i-E5 oncoprotein nayo ibamba iqhaza elibalulekile ekulawuleni amasosha omzimba kanye ne-carcinogenesis.
Ubudlelwano phakathi kwe-HPV carcinogenesis nezinye izifo ezithinta inzalo nokuvuvukala
Ucwaningo luye lwathola izinguquko eziphawulekayo kuma-cytokines wendawo yomlomo wesibeletho [njenge-interferon (IFN), i-interleukin 10 (IL-10), i-IL-1, i-IL6, ne-tumor necrosis factor (TNF), njll.] kumdlavuza womlomo wesibeletho kanye nezilonda eziyingozi, okuphakamisa ukuvuvukala kwendawo Kukhona indima ethile ekuveleni komdlavuza womlomo wesibeletho. Ucwaningo lubonise ukuthi i-HPV's E5, E6, ne-E7 oncoprotein ingaheha i-cyclooxygenase-prostaglandin (COX-PG) axis. Ucwaningo lwangaphambilini luthole ukuthi i-COX2 ibamba iqhaza ekulimaleni kwe-DNA, ukuvimbela i-apoptosis, i-angiogenesis, kanye nokuthuthukiswa kwesimila Indima ebalulekile. Ucwaningo lwe-Epidemiological luye lwathola ukuthi iziguli ezinezifo ze-genital tract ezifana ne-gonococcus, i-chlamydia, nohlobo lwe-herpesvirus 2 zinengozi enkulu kakhulu yomdlavuza womlomo wesibeletho. Indlela yokwandisa ingozi yomdlavuza womlomo wesibeletho ezigulini ezinezifo zasendaweni yangasese kanye nokuvuvukala kwendawo kungase kubangele i-metaplasia yezicubu zendawo. Le epithelia ye-metaplastic ingase ikhulise ithuba lokutheleleka nge-HPV kanye ne-HPV viral load. Ukuhlaziywa kwe-Meta kusikisela ukuthi ukutheleleka kwe-Chlamydia kuyisici esisebenzisanayo somdlavuza womlomo wesibeletho. Ngakho-ke, ukunciphisa izifo ezithweni zangasese kanye nokulawula ukuvuvukala kwendawo kungase futhi kube isici esibalulekile sokunciphisa umdlavuza womlomo wesibeletho.
