中国女性宫颈高危型HPV感染与阴道微生态关系的Meta分析

doi:10.3969/j.issn.1006-7795.2018.06.010

摘要/Abstract

摘要： 目的持续性高危型人乳头瘤病毒（high risk-human papillomavirus，HR-HPV）感染是宫颈癌发生的高危因素，而阴道微生态与宫颈HR-HPV感染相关。本文拟通过文献分析对宫颈HR-HPV感染与阴道微生态的关联做一全面的系统评价。方法检索 CNKI、万方、Pubmed等数据库，利用文献追溯等途径收集国内外公开发表的关于中国女性宫颈HR-HPV感染与阴道微生态的关联研究，收集病例－对照研究的原始文献，并根据文献中的原始资料评价HR-HPV感染与滴虫性阴道炎（trichomonal vaginitis，TV）、细菌性阴道病（bacterial vaginosis，BV）、外阴阴道假丝酵母菌病（vulvovaginal candidiasis，VVC）感染率及乳酸杆菌异常率的关联，采用STATA14.0软件对研究资料进行 Meta分析，利用Egger's test评价发表偏倚。结果总计纳入文献 20篇，共20项病例－对照研究，采用随机效应模型进行计算，结果显示，中国女性中宫颈HR-HPV感染与BV、 VVC和乳酸杆菌异常关联，综合OR值分别为2.23（95%CI：0.99 ~ 2.13）、1.55（95%CI：1.12 ~ 2.12）和3.55（95%CI：2.21 ~ 5.71），差异有统计学意义，且无发表偏倚。HR-HPV感染与TV的关联尚待讨论，综合OR值为1.45（95%CI：0.99 ~ 2.13），但无统计学意义，且存在发表偏倚。结论宫颈HR-HPV感染与阴道微生态存在密切关联，尤其是BV、VVC和乳酸杆菌异常是宫颈HR-HPV感染的高危因素。

关键词: 高危型人乳头瘤病毒感染, 微生态, Meta分析

Abstract: Objective To conduct a comprehensive and systematic review concerning the relationship between cervical high risk-human papillomavirus (HR-HPV) infection and vaginal microecology, as there are inconsistent conclusions about epidemiological studies among Chinese women. Methods CNKI, Wanfang, Pubmed and other databases were retrieved. The correlation between cervical HR-HPV infection and vaginal microecology in Chinese female was collected by literature retrospective method. The original literatures of case-control studies were collected. The infection rates of HR-HPV and trichomonal vaginitis (TV), bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and lactobacillus abnormalities were evaluated according to the original data in the literature. Stata 14.0 software was used to analyze the data, and Egger's test was used to evaluate the publication bias. Results A total of 20 literatures and 20 case-control studies were included. The results showed that cervical HR-HPV infection was associated with BV, VVC and lactobacillus abnormalities in Chinese women. The odds ratios (ORs) were 2.23[95% confidence interval (CI):0.99-2.13], 1.55 (95% CI:1.12-2.12) and 3.55 (95% CI:2.21-5.71), respectively. It is statistically significant and has no publication bias. The association between HR-HPV infection and TV remains to be discussed. The combined OR value was 1.45 (95% CI:0.99-2.13), but there was no statistical significance and had publication bias. Conclusion Cervical HR-HPV infection is closely related to vaginal microecology. BV, VVC and lactobacillus abnormalities are high-risk factors for cervical HR-HPV infection.

Key words: high risk-human papillomavirus infection, microecology, Meta-analysis

中图分类号:

R737.33

张雪芳, 何鑫, 黄文阳, 李卫华, 罗美, 张阳, 王淑珍. 中国女性宫颈高危型HPV感染与阴道微生态关系的Meta分析[J]. 首都医科大学学报, 2018, 39(6): 841-848.

Zhang Xuefang, He Xin, Huang Wenyang, Li Weihua, Luo Mei, Zhang Yang, Wang Shuzhen. A Meta-analysis of the relationship between cervical high-risk HPV infection and vaginal microecology in Chinese women[J]. Journal of Capital Medical University, 2018, 39(6): 841-848.

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