9 246例女性高危型人乳头瘤病毒感染与二价HPV疫苗接种的保护作用
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闫益芬,硕士,妇科,研究方向:妇科肿瘤学

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R181

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Protective effect of bivalent HPV vaccination in 9 246 women with high-risk human papillomavirus infection
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    摘要:

    目的:了解女性高危型人乳头瘤病毒(human papilloma virus,HPV)感染情况,同时,分析二价HPV疫苗对HPV感染的保护作用。方法:采用病例对照研究方法,回顾性调查2018年1月至2018年12月期间在湖北省十堰市人民医院门诊接受高危型HPV感染检查的9246例妇女的HPV感染情况,采用2代杂交捕获法及阴道镜检查进行确诊。采用1:1匹配的方法,将同期进行检查未感染的个体作为对照组组,而确诊的感染组作为病例组,比较两组二价HPV疫苗的接种率差异。同时,将病例组按照接种疫苗及未接种疫苗分为两组并进行随访,事件为24~36个月,统计HPV持续性感染、宫颈上皮内瘤样病变(CIN)和宫颈癌发生情况,了解二价HPV疫苗接种对高危女性人群HPV感染的保护作用。结果:9 246例妇女中共筛查出1632例(17.65%)高危型HPV感染阳性者,卡方结果显示,农村妇女HPV阳性感染率(32.84%)低于城市(67.16%);此外,怀孕次数、婚姻状态对HPV感染也有一定的影响。1632例HPV阳性感染中,接种二价HPV疫苗人数为629例(38.54%),未接种二价HPV疫苗人数为1003例(61.46%)。随访24-36月期间,接种组因不愿配合(18例)、器质性改变无法进行研究(24例)以及出现精神障碍等(3例)最终获得随访数据584例,失访率为7.15%;未接种组因更换居住地(32例)、配合度低(20例)以及心理因素等(2例)最终获得随访数据949例,失访率为5.38%。随访后结果显示,二价HPV接种组持续性HPV感染率、末次随访高危型HPV感染阳性率、随访期间CIN1累积发生率、随访期间CIN2+累积发生率、末次随访CIN1发生率、末次随访CIN2+发生率和宫颈癌发生率分别为3.07%、0.82%、1.84%、1.02%、0.82%、0.20%和0.00%,二价HPV未接种组分别为12.91%、15.52%、7.14%、4.40%、3.02%、1.37%和0.27%。二价HPV接种组女性群体持续性HPV感染率、末次随访高危型HPV感染阳性率、随访期间CIN1累积发生率、随访期间CIN2+累积发生率、末次随访CIN1发生率、末次随访CIN2+发生率均显著低于对照组(P<0.05)。结论:二价HPV疫苗接种对高危型女性的HPV持续感染、宫颈病变和宫颈癌发生有重要的保护作用。

    Abstract:

    Objective To analyse the high-risk human papilloma virus (HPV) infection in women, and to analyze the protective effect of bivalent HPV vaccine on HPV infection. Methods A case-control study method was used to retrospectively investigate the HPV infection status of 9246 women who received high-risk HPV infection examination in the outpatient department of Shiyan people's Hospital of Hubei from January 2018 to December 2018. The second-generation hybrid capture method and colposcopy examination were used to diagnose. Using a 1:1 matching method, the uninfected individuals who were examined during the same period were taken as the control group, and the confirmed infected group was taken as the case group, and the differences in the vaccination rates of the bivalent HPV vaccine between the two groups were compared. At the same time, the case group was divided into two groups according to the vaccinated and unvaccinated groups and followed up. The events ranged from 24 to 36 months. The incidence of persistent HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer were counted to understand Protective effect of bivalent HPV vaccination against HPV infection in a high-risk female population. Results A total of 1 632 cases (17.65%) of 9 246 women were screened positive for high-risk HPV infection. Chi-square results showed that the HPV positive infection rate of rural women (32.84%) was lower than that of urban women (67.16%). , Marital status also has a certain influence on HPV infection. Among the 1632 cases of HPV positive infection, 629 cases (38.54%) were vaccinated with bivalent HPV vaccine, and 1003 cases (61.46%) were not vaccinated with bivalent HPV vaccine. During the follow-up period of 24-36 months, the vaccination group finally obtained follow-up data of 584 cases due to unwillingness to cooperate (18 cases), unable to conduct research due to organic changes (24 cases), and mental disorders (3 cases), with a loss to follow-up rate of 7.15 cases. %; In the unvaccinated group, 949 cases of follow-up data were finally obtained due to change of residence (32 cases), low degree of cooperation (20 cases) and psychological factors (2 cases), and the loss to follow-up rate was 5.38%. The results after follow-up showed that the persistent HPV infection rate in the bivalent HPV vaccination group, the positive rate of high-risk HPV infection at the last follow-up, the cumulative incidence of CIN1 during the follow-up period, the cumulative incidence of CIN2+ during the follow-up period, the incidence of CIN1 at the last follow-up, and the incidence of CIN2+ at the last follow-up. and cervical cancer incidence rates were 3.07%, 0.82%, 1.84%, 1.02%, 0.82%, 0.20%, and 0.00%, respectively, and the bivalent HPV unvaccinated groups were 12.91%, 15.52%, 7.14%, 4.40%, and 3.02%, respectively. , 1.37% and 0.27%. Persistent HPV infection rate, positive rate of high-risk HPV infection at last follow-up, cumulative incidence of CIN1 during follow-up, cumulative incidence of CIN2+ during follow-up, incidence of CIN1 at last follow-up, and incidence of CIN2+ at last follow-up were significantly lower in bivalent HPV vaccination group in the control group (P<0.05). Conclusion Bivalent HPV vaccination has an important protective effect on HPV persistent infection, cervical lesions and cervical cancer in high-risk women.

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  • 收稿日期:2022-06-01
  • 最后修改日期:2022-06-01
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  • 在线发布日期: 2022-07-22
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