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【文献翻译】女性炎性肠病患者中的高危型人乳头瘤病毒感染和宫颈肿瘤:一项横断面研究

目的

1

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.

方法

2

对从2014年7月至2017年1月间的21-60岁性活跃且患有IBD的中国女性以及年龄匹配的对照组进行了液基薄层细胞学(TCT)和高危型HPV DNA检测,并让她们填写了关于宫颈癌和HPV认知情况的问卷。宫颈不典型增生分为宫颈上皮内瘤变(CIN)1、2、3级。

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.

结果

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%).

结论

4

女性IBD患者感染高危型HPV和患宫颈肿瘤的风险增高,这可能与免疫抑制剂的使用相关。建议对患者(尤其是中国女性IBD患者)进行教育并进行HPV DNA检测和TCT的常规随访。

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.

参考文献

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.

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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

声明:该文观点仅代表作者本人,搜狐号系信息发布平台,搜狐仅提供信息存储空间服务。

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