这项横断面研究调查了女性炎性肠病（Inflammatory bowel disease, IBD）患者中高危型人乳头瘤病毒（human papilloma virus, HPV）感染（尤其是16型和18型）和宫颈肿瘤的患病率和危险因素。
This cross-sectional study investigated the prevalence and risk factors of high-risk human papilloma virus (HPV) infection, especially types 16 and 18, and cervical neoplasia in female Inflammatory bowel disease (IBD) patients.
From July 2014 to January 2017, sexually active, female, Chinese IBD patients (21-60 years) and age-matched controls underwent cervical ThinPrep cytology testing (TCT) and high-risk HPV-DNA detection, and completed questionnaires about awareness of cervical cancer and HPV. Cervical dysplasia was categorized as cervical intraepithelial neoplasia (CIN) 1, 2 and 3.
在124名IBD患者（30例溃疡性结肠炎和94例克罗恩病）中，高危型HPV感染者17例（13.7%），其中HPV 16/18型感染者9例（7.3%），病理学证实CIN者4例（3.2%，其中3例CIN3、1例CIN1）。在372名对照组中，高危型HPV感染者33例（8.9%），其中只有1名（0.3%）HPV 16型感染者。对照组中有一例宫颈TCT检测出ASCUS；对照组中没有检测出CIN。IBD患者的HPV 16/18型感染率和CIN发病率显著高于对照组（p值均＜0.001）。HPV感染率在服用甲氨蝶呤的患者[P=0.005，OR值（95% CI）4.76(1.471-15.402)]和服用两种以上免疫抑制剂的患者[P=0.013，OR值（95% CI）3.64(1.255-10.562)]中更高。硫嘌呤、类固醇、英夫利昔单抗以及疾病行为/部位与HPV感染无关。问卷调查结果显示只有29.3%的患者接受过宫颈癌筛查，HPV感染与HPV相关宫颈癌的认知水平不足（28.2%）。
Of 124 IBD patients (30 ulcerative colitis and 94 Crohn's disease), 17 (13.7%) had high-risk HPV among whom 9 (7.3%) had HPV 16/18 infection and 4 (3.2%) had cervical CIN (3 CIN 3, 1 CIN 1) by pathology. Among 372 controls, 33 (8.9%) had high-risk HPV and only 1 (0.3%) had HPV 16 infection. Cervical TCT detected atypical squamous cells of unknown significance in one control; no control had CIN. The HPV 16/18 infection rate and CIN prevalence were significantly higher in IBD patients than controls (both P < 0.001). The HPV-infection rate was higher in patients administered methotrexate [P = 0.005, odds ratio (95% confidence interval) 4.76 (1.471-15.402)] or more than two immunosuppressants [P = 0.013, odds ratio (95% confidence interval) 3.64 (1.255-10.562)]. Thiopurine, steroid, infliximab and disease behavior/location were not associated with HPV infection. Only 29.3% of patients had undergone cervical-cancer screening. Awareness of HPV infection and HPV-related cervical cancer was poor (28.2%).
Female IBD patients are at increased risk of high-risk HPV infection and cervical neoplasia, which may be associated with immunosuppressants. Education and routine follow-up with HPV-DNA testing and TCT are recommended, especially in female Chinese IBD patients.
LI M, YANG Q F, CAO Q, et al. High-risk human papilloma virus infection and cervical neoplasm in female inflammatory bowel disease patients: a cross-sectional study [J]. Gastroenterology report, 2019, 7(5): 338-44.
撰稿及编辑 | 庞智屿
封面图片 | 赵大志
责任编辑 | 刘雨奇
审稿 | 樊碧娆 江路
审核 | 陶霞