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Title: Cervarix KOL Slide Kit


1
???? ????? ???? ???? ???? ???? ????? ???? ???
?????
?? ??? ????, ????? ????? ????? ??? ???? ?????
????? ????
???? ?? ???, ???????? ?- 180 ???? ?????? ????
???? !!!
???? ????? ???? ??? ????? ????? ???? ??? ?????
???? ???? 45 ??????? ?????? ???? ?? ??????.
2
??? ????? ????? ????? ????
???? ????? ???? ???? ??????. ????? ?????? ?????
????? ????
???? ???????? ?????? H P V
????? ????? ?? ??? ??? ??? ???? ????? ?????
????. ???????? ?? ?????? ???? ???? ???? ?????? !
3
?????? ????????????? ?????? ??? ???????
??????
  • ?????? ?????? ???? ?????? ????? ????? ????
  • ??? 2000 ???? 2CIN (HSIL)- ??????? ????? ??
    14/100,000
  • ?-180 ????? ????? ?? ???? ????? ????
    (5.6/100,000)
  • 47 ???? ???? ???? ????? ???? ???????? ??? ????
    1 (stage1)
  • ?-70 ???? ???? ??? ???? ????? ???? ??? ?????
    ?????? ?????? ?????? ??????? ??????? ?????? ??? 
  •  
  • ?????? ?????? ?????? ???? ?????? ????? ????? ????
  • ?? ?-12 ???? ???? ???? 20-70 ?????? ??????
    ?????? ???? ????? ???? ?? ???
  • ?? ??? ??????? ?-12,500 ??????? ?? ?????? ??
    ????? ????? ????
  • ?-1/3 ???? ???? ?????? (LEEP) ??????? ????? ????
    ???? 30 (??? ?? ??? ????? ?????? ?????? ????
    ????? ????)
  • 70-300 ???? ?????? ?????? ????? ?????, ????
    ?????? ????? ??? ???? ?? ????

4
?????? ????????????? ?????? ??? ??????? ??????
  • ??? ???? ????? ????? ????? ( HSIL)
  • 70-300 ???? ?????? ?????? ????? ?????, ????
    ?????? ????? ??? ???? ?? ????
  • ???????? ???????? ?????? ???? ???? ????? ?????
    ????? ( HSIL ??????? ???????? ?????? ???? ????
    ????? ????????? ??????,
  • ?????? ?- CIN3 ???? ?? ?????? ?????? ?????
    ?? ???? ????? ???? ?? ???? ????????? ?? 3-12 ????
    20 ??? ???? ??????

5
?? ???? ????? ?????? ?????? ????? ???????? ??????
  • 8 ???? 10 ???? ?????? ????? ???? ????? ??????.
  • ????? ???? ?? ??? ???????? ???????, ?? ???? ?????
    ?????? ???? ?? ????.
  • ???? ?- 100 ????? ?????? ?? ???? ???????? ??????,
    ?- 15 ??? ?????? ????? ????? ????.
  • ????? 4 ????? ????? ???? (80) ???? ???? ?????
    ????. ????? ???? ????? ??????? ????? ?? HPV
    31,18,16 ?-45.

6
???? ????? ???? ????? ?????
  • ???? ????? ???? ????? ?????? ???? ?????? ?????
    ???? ?? ????, ????? ??????.
  • ????? ????, ?????? ?????? ???? ????? ????? ??????
    ??????? ??????, ???? ?????? ?? ????. ??? ?????
    ?????? ????? ???????? ????? ????.
  • ?????? ???? ????? ???? ?????? ??????.
  • ??? ???????? ???????? ?? ????? ???? ???? ????? ??
    ????? ???? ???? ????? ?????? ?????? ?????? ??
    ????? ???? ????? ???? ????.
  • ????? ?????? ?????? ?? ???? ???? ???? ???? ?????
    ????? ?? ????? ???? ???? . ????? ????? ????? ????
    ???? ??-10?''? ???? ????? ?????? ???? ??????
    ?????.

7
?????? ????? ????
  • ?????? ???? ????? ????
  • ?????? ??????.
  • ????? ?? ????? ???? ???? ????? ?????? ??????
    ?????? ?? ????? ???? ????? ???? ????.
  • ????? ?????? ?????? ?? ???? ???? ???? ???? ?????
    ????? ?? ????? ???? ???? . ????? ????? ????? ????
    ???? ??-10?''? ???? ????? ?????? ???? ??????
    ?????.

8
The HPV Life Cycle A Sophisticated Immune
Evasion Mechanism1-4
Poor exposure to antigen presenting cells
Uses the natural life cycle of epithelial cells
to release new viruses1-4 Does not cause cell
death1-4
Enters basal epithelial cell, integrates DNA in
host cell1-4 Replicates in the cells and remains
entirely intraepithelial1-4
No viremia
1.Stanley M. Vaccine 2006 24 S106-13, 2.Tindle,
Nat Rev Cancer 2002 2, 59, 3.Stanley M. Vaccine
2006 24 S16-22, 4. Stanley M. HPV Today 2007
11 1-16
9
?? ???? ?????? ?????? ???? ?

?????? ???? ?????? ?????????
???? ??????
???? ???????? ?? ??????
?????? ???? ?????? ?? ????? ??????
???? ????
???? ??????
???? ??????
????? ????? ???????




Basement membrane
???? ??????
???? ???????
Frazer IH. Nat Rev Immunol 2004 44654.
10
???? ????? ???? ???? ?? ??? ????
  • ???? ?- 100 ????? ?????? ?? ???? ???????? ??????,
    ?- 15 ??? ?????? ????? ????? ????.
  • ???? 15 ???? ???? ??? ???? 4 ????? ????? ????
    (80) ???? ???? ????? ????. ????? ???? ?????
    ??????? ????? ?? HPV 31,18,16 ?-45.
  • ???? ???????? ??????? ??????? ????? ????? ????
    ??? ??????? ?????? ????? ?????? ?? ???? ??????
    ????? ????? ????.
  • ???????? ?? ???? ????? ???? ??? ???? ??????
    ?????? ???? ??????? ??????? ??????? ????? ?????
    ????.

11
?????? , ?? ?????? - ??? ?????? ????? !!!
?????? ???? ????? ?? ?????
?"???" ??? ????? ???????
????? ?"???"
Cervix
?????? ???? ??? "??????" ???? ???? ???? ??????
?????? ??????? ?? ??????
1. Hayes MMM, et al. Cytopathology 1997
8397408.
12
????? ??????? ???????? ???? ????? ????
??????
????
?????? ????? ????? ???????? ?????? ?????? ?????
32
43
57
????? ?- HPV koilocytosis
????? ????
????? ?????? ?????? ????
CIN II
CIN I
CIN III
?????? ???
CIN Cervical intraepithelial neoplasia
?????
Moscicki et al 2006 Vaccine 24s4 s3/42-51,
Monsonego 2006 Burd EM. Clin Microbiol Rev
200316117., Solomon D et al. JAMA
200228721149.
13
Human papillomavirus
  • HPV is a relatively small virus1 containing
    circular double-stranded DNA within a spherical
    shell (capsid)1
  • HPVs infect epithelial tissue of the skin and
    genital mucosae1

100 nm
1. Burd EM. Clin Microbiol Rev 2003 16117.
14
Active protection via vaccination is mediated by
neutralizing antibodies at the cervix
Neutralizing antibodies
HPV
Cervical canal
Cervical epithelium
Blood vessel
Epithelial tear
Basement membrane
1. Stanley M. Vaccine 2006 24S16S22 2.
Giannini S, et al. Vaccine 2006 2459375949
3. Nardelli-Haefliger D, et al. J Natl Cancer
Inst 2003 9511281137 4. Poncelet S, et al.
IPC 2007(poster).
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