云南省德宏州各民族子宫颈人乳头瘤病毒感染相关因素分析

目的 探讨人乳头瘤病毒（HPV）感染现状及相关影响因素，为制定云南省德宏州相应预防HPV感染策略提供证据支持。方法 选取2021年11月至12月德宏州芒市及梁河地区765例女性（包括阿昌族、傣族、德昂族、汉族、景颇族、傈僳族）进行子宫颈HPV检测，分析HPV感染相关因素，包含年龄、民族、吸烟史、性伴侣数、初次性生活年龄、流产次数、分娩次数、居住地、子宫颈柱状上皮外移情况；对有意义的因素进行多因素logistic回归分析。结果 765例女性HPV总体人群感染率为10.8%（83/765），其中阿昌族感染率为8.7%（8/92），傣族感染率为11.6%（16/138），德昂族感染率为13.9%（20/144），汉族感染率为11.7%（17/145），景颇族感染率为8.7%（15/172），傈僳族感染率为9.5%（7/74）。影响HPV感染的相关因素包括性伴侣数（χ2=5.848,P<0.05）和子宫颈柱状上皮外移（χ2=5.646,P<0.05）；进一步行多因素logistic回归分析提示：性伴侣数（OR=1.943）及子宫颈柱状上皮外移情况（OR=1.723）均为HPV感染的...     

基于人群的宫颈癌及癌前病变危险因素调查

目的研究自然人群宫颈癌相关危险因素。方法在深圳及周边10000名女性宫颈癌筛查基础上进行危险因素调查。结果各项检测结果齐全者8556例,平均年龄38.9岁。高载量HPV感染及HPV-16、58、31、18、33和HPV-52亚型感染患癌风险高;45～59岁年龄段、人工流产≥3次、经阴道分娩≥3次,有家中分娩史者为患CIN2＋的危险因素;而受教育程度高、初潮年龄小、与现在性伴侣性生活时间长、使用避孕套避孕和曾在医院体检为保护性因素。多因素非条件Logistic回归分析,仅HPV感染和曾在医院体检有统计学意义。结论高HPV病毒载量及某些高危亚型具有更强致癌性;定期筛查HPV感染所致宫颈癌前病变及阻断病变的进展是防治宫颈癌的有效手段。     

西藏自治区妇女子宫颈人乳头状瘤病毒感染现状调查及相关因素分析

目的 了解我国西藏自治区妇女宫颈人乳头状瘤病毒(HPV)感染率和亚刑分布及与HPV感染相关的因素.方法 于2007年8月,采用整群抽样的方法对西藏自治区拉萨、日喀则和那曲3个地区的3036例妇女进行流行病学问卷调查和HPV DNA分型检测,并对与HPV感染相关的因素进行单因素及多因素分析.结果 3036例妇女中,HPV感染患者为279例,总感染率为9.19%(279/3036),其中高危型HPV、低危刑HPV和HPV复合感染率分别为7.05%(214/3036)、2.14%(65/3036)和1.32%(40/3036);不同年龄、民族、地区妇女间HPV感染率比较,差异均无统计学意义(P>0.05).HPV感染的亚型中,HPV16(1.52%)最常见,其次为HPV33(1.42%)、58(1.22%)、52(1.15%)和31(1.05%);不同年龄妇女巾,HPV感染的亚型分布也略有不同.单因素分析显示,婚姻状态、初次性生活年龄和妊娠次数为影响HPV感染的危险因素(P<0.05).多凶素分析表明,吸烟(P=0.027)、性伴侣数(P=0.198)和初次性生活年龄(P=0.237)为影响HPV感染的独立危险因素.结论 两藏自治区妇女官颈HPV感染率低于国内外平均水平,其最常见的亚型为HPV16.影响HPV感染的独立危险因素为吸烟、性伴俏数和初次性牛活年龄.     

高危型人乳头瘤病毒感染的危险因素及对阴道微生态环境的影响

目的 探讨高危型人乳头瘤病毒（HR-HPV）感染的危险因素及对阴道微生态环境的影响。方法 回顾性分析2018年12月至2022年12月郑州大学第五附属医院收治的112例HR-HPV感染患者的临床资料,设为HR-HPV组,对感染型别进行分析,另取同期在本院行妇科体检的83例正常女性为对照组。分析HR-HPV感染的型别与危险因素,并探讨HR-HPV感染后阴道微生态环境变化。结果 HR-HPV组中,单一感染70例,多重感染42例;单因素与Logistic回归分析发现初次性生活年龄<18岁、妊娠次数≥5次、性生活频率≥5次/月、流产次数≥2次为HR-HPV感染的独立危险因素,避孕套避孕、性生活后清洗行为是保护因素（P <0.05）。HR-HPV多重感染BV检出率21.43%明显高于单一感染者9.52%(P <0.05)。结论 初次性生活年龄、妊娠次数、性生活频率、流产次数、避孕、性生活后清洗行为情况为HR-HPV感染影响因素,且HR-HPV感染可影响阴道微生态环境。     

文化程度及生育情况对女性围绝经期症状的影响

目的：探讨围绝经期女性文化程度及生育情况与其发生围绝经期症状的关系。方法：选取2013年1月-2017年12月在浙江地区相关医院妇科门诊就诊的2 917例围绝经期女性,采用问卷方式调查其基本情况、改良Kupperman评分法评估女性围绝经期症状。结果：最终纳入的2 479例研究对象中,有721例（29.08%）已自然绝经,绝经年龄为（49.42±3.57）岁。不同文化程度女性在绝经年龄、分娩次数、流产次数、妊娠次数、腰臀比、感觉异常、情绪波动、抑郁疑心和性生活问题方面比较,差异均有统计学意义（均P＜0.05）。不同文化程度、分娩次数和妊娠次数间改良Kupperman评分总分的差异均有统计学意义（均P＜0.05）。结论：文化程度越低,分娩及妊娠次数越多,改良Kupperman评分总分越高,围绝经期症状越严重。不同文化程度及生育情况的围绝经期女性临床处理应个体化。     

妊娠期妇女子宫颈细胞学检查结果异常的相关因素分析

目的 探讨妊娠期妇女宫颈细胞学检查结果异常的相关因素.方法 选择2007年9月至2008年9月在首都医科大学附属北京妇产医院产科定期产前检查的妊娠12～36周的妇女,除外先兆流产、胎膜早破、前置胎盘等并发症共12 112例,于初次产前检查时常规行宫颈液基细胞学检查(TCT),同时记录妊娠期妇女的职业、受教育程度、户口地址、家庭收入、民族、初次性生活年龄、性伴侣个数、避孕方法、孕产史、妇科伴随症状、相关肿瘤家族史、既往妇科病史、吸烟史,并记录当天妇科检查情况,分析TCT结果异常的相关危险因素.结果 资料完整的妊娠期妇女共11 906例,资料满意率为98.30%(11 906/12 112).其中,TCT结果正常10 354例,占86.96%(10 354/11 906)、未明确诊断意义的不典型鳞状上皮细胞(ASCUS)1134例,占9.52%(1134/11 906)、未明确诊断意义的不典型腺上皮细胞(ACUS)112例,占0.94%(112/11 906)、低度鳞状上皮内病变(LSIL)229例,占1.92%(229/11 906)、高度鳞状上皮内病变(HSIL)74例,占0.62%(74/11 906),宫颈鳞癌3例,占0.02%(3/11 906).多因素非条件logistic回归分析结果显示,与ASCUS及AGUS相关的危险因素包括初次性生活年龄(OR_(ASCUS)=2.90、OR_(AGUS)=7.32)、性伴侣个数(OR_(ASCUS)=1.49、OR_(AGUS)=2.02)、流产次数(OR_(ASCUS)=1.68、OR_(AGUS)=3.50);与LSIL、HSIL相关的危险因素包括初次性生活年龄(OR_(LSIL)=6.34、OR_(HSIL)=9.26)、性伴侣个数(OR_(LSIL)=1.69、OR_(HSIL)=1.65)、流产次数(OR_(LSIL)=1.53、OR_(HSIL)=5.33)、吸烟(OR_(LSIL)=1.84、OR_(HSIL)=1.77);与TCT结果异常(包括ASCUS、AGUS、LSIL、HSIL)相关的感染因素包括滴虫性阴道炎(P<0.01)、人乳头状瘤病毒(HPV)感染(P<0.01);柱状上皮异位与TCT结果异常密切相关(χ~2=43.269,P=0.000),但与柱状上皮异位的程度无关.结论 妊娠期妇女宫颈细胞学检查结果异常发生的相关因素与非妊娠期相同.     

人免疫缺陷病毒诱导的免疫抑制:HPV感染的危险因素

人乳头瘤状病毒(HPV)与宫颈癌有关,在HPV感染中免疫状态起着重要作用。有报道在妊娠和免疫抑制的病人在免疫状态改变的情况下HPV感染的危险性增高,认为人免疫缺陷病毒(HIV)感染与HPV感染有关。如果这种情况确立,则对HPV感染和宫颈癌的病人要严密检测是否有HIV感染。在1986年～1989年间对92名患生殖道湿疣的妇女进行HIV检测。其中15名HIV阳性占总数的16.3%,而对照的100名妇女未发现HIV。HIV阳性妇女间HPV流行的相关损伤明显升高。生殖道湿疣HIV阳性妇女其年龄和分娩次数明显低于生殖道     

文化程度及生育情况对女性围绝经期症状的影响

目的:探讨围绝经期女性文化程度及生育情况与其发生围绝经期症状的关系。方法:选取2013年1月—2017年12月在浙江地区相关医院妇科门诊就诊的2 917例围绝经期女性,采用问卷方式调查其基本情况、改良Kupperman评分法评估女性围绝经期症状。结果:最终纳入的2 479例研究对象中,有721例(29.08%)已自然绝经,绝经年龄为(49.42±3.57)岁。不同文化程度女性在绝经年龄、分娩次数、流产次数、妊娠次数、腰臀比、感觉异常、情绪波动、抑郁疑心和性生活问题方面比较,差异均有统计学意义(均P0.05)。不同文化程度、分娩次数和妊娠次数间改良Kupperman评分总分的差异均有统计学意义(均P0.05)。结论:文化程度越低,分娩及妊娠次数越多,改良Kupperman评分总分越高,围绝经期症状越严重。不同文化程度及生育情况的围绝经期女性临床处理应个体化。     

重庆地区29580例女性人乳头瘤病毒感染分布特点分析

目的:研究人乳头瘤病毒(HPV)感染在重庆地区的年龄分布及地理分布等特征,获得重庆地区HPV感染的型别分布特点及优势型别。方法:2010年11月至2015年9月在重庆市40个区县随机抽取有性生活的妇女29580例,进行HPV检测,对感染型别、年龄分布、单一感染及多重感染的情况进行统计。结果:129580例女性中HPV感染率为7.35%,高危型感染位居前6位的依次为HPV16、51、58、68、56、18型。2各年龄段HPV感染率及多重感染构成比呈现"U"形走势。3性伴侣个数及初次性生活年龄与HPV感染率有关(P0.01)。4城区妇女HPV感染率高于郊区(P0.01)。结论:应根据当地HPV感染分布特点,因地制宜制定防控宫颈癌的措施。     

卵巢储备功能下降相关因素的logistic回归分析

目的:探讨导致卵巢储备功能下降(DOR)的相关因素。方法:选取2012年5月~2014年5月在天津市中心妇产科医院生殖医学中心接受常规体外受精(IVF)或卵胞浆内单精子注射(ICSI)治疗的卵巢储备功能下降患者200例和非DOR患者200例(对照组)。采用logistic回归分析方法分析患者年龄、体重指数(BMI)、不孕年限、吸烟史、染色体、痛经史、初潮年龄、月经周期、经期、孕次、初次性生活、初次妊娠年龄、人流次数、药流次数、子宫内膜异位症、手术史、雄激素水平、血型、促排卵次数与DOR的关系。结果:最终进入logistic回归模型参数包括人流次数(OR=2.329)、促排卵次数(OR=9.578)、子宫内膜异位症史(OR=5.836)、初潮年龄(OR=0.318)、手术史(OR=3.409)。结论:人流次数、促排卵次数、子宫内膜异位症病史及手术史均为DOR危险因素,初潮年龄为DOR保护因素。     

Cofactors in human papillomavirus infection and cervical carcinogenesis

Objective

This study aimed to identify the effect of various risk factors as the promoters of HPV infection, and to identify which HPV-positive women may have an increased risk of developing cervical cancer.

Methods

Smear preparations were examined and classified according to the Bethesda system. HPV-DNA detection and genotyping was carried out using polymerase chain reaction combined with reverse hybridization line-probe assays. Age, smoking habit, age at first sexual intercourse, number of sexual partners, number of term births, contraceptive method, progesterone therapy, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were recorded.

Results

642 women (96 women with abnormal cervical cytology and 546 women with normal cytology) provided cervical samples. Smoking habit, number of sexual partners, number of term births, history of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as the promoters of HPV infection. History of sexually transmitted diseases, history or existence of warts and existence of cervical infection were identified as cofactors affecting progression from HPV infection to cervical cancer. Neither of contraceptive methods studied was related to HPV infection or coexistence with malign transformation to cervical cancer.

Conclusion

Information gathered from this study could be used to prioritize limited screening and treatment services to woman who have specific characteristics that may put them at an increased risk of HPV infection. Additionally, by identifying which women have a higher risk of cervical cancer; it may be possible to reduce the number of unnecessary colposcopies.     

Sexual risk history and condom use among people living with HIV/AIDS in Ogun State, Nigeria

IntroductionThe majority of human immunodeficiency virus (HIV) infections are acquired through unprotected sex between partners; only male or female condoms can reduce the chances of infection with HIV during a sexual act.AimThis study was therefore designed to describe sexual risk history and identify factors associated with condom use among people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHAs) in Ogun State, Nigeria.Main Outcome MeasuresMain outcome measures are sexual and HIV risk history, safe sex practices, and condom use.MethodsThis study is an analytical cross‐sectional study. A total sample of all people living with HIV/AIDS attending secondary health facilities in Ogun State were recruited into the study.ResultA total of 637 were interviewed; median age at first sexual intercourse among the study participants was 19 years (mean age = 18.95, standard deviation [SD] = 4.148) with a median of two lifetime sexual partners (mean = 3.22, SD = 3.57). Majority (71.4%) of the respondents had not been diagnosed with a sexually transmitted infection other than HIV. Precisely 47.7% of men and 52.3% of women had two or more sexual partners in the last 6 months. Men were statistically significantly more likely to have multiple sexual partners when compared with women (P = 0.00). Significantly more women (69.8%) than men (30%) had sexual partners whose HIV status they did not know (P = 0.006). Predictors of condom use were individuals who had multiple sexual partners (odds ratio [OR] = 1.41, confidence interval [CI] = 1.05–1.83) and married (OR = 3.13, CI = 1.15–8.51) with higher level of education (OR = 2.78, CI = 1.39–5.79), with knowledge of partner's serostatus (OR = 2.53, CI = 1.50–4.28), and awareness of reinfection (OR = 1.90, CI = 1.22–2.95).ConclusionThe study indicates that the establishment of effective safe sex practices and condom use behavior among PLWHAs in low‐income countries such as the study population requires adequate health education on the transmission of HIV/AIDS and the understanding of the dynamics of family life and gender issues. Amoran O and Ladi‐Akinyemi T. Sexual risk history and condom use among people living with HIV/AIDS in Ogun State, Nigeria. J Sex Med 12;9:997–1004.     

妊娠期和产后妇女宫颈病变筛查研究新进展

近来有研究显示,妊娠期宫颈细胞学异常及人乳头瘤病毒(HPV)感染检出率较高,但分娩后又有一定的自然消退率和进展率。HPV感染易致宫颈细胞学异常,另有研究指出多个性伴侣、初次性生活早、多产次、社会经济地位低下、非白种人、吸烟均是宫颈细胞学异常的高危因素。妊娠期妇女宫颈存在特异性生理改变易导致诊断误差。目前专门针对妊娠期妇女宫颈筛查新方法的研究甚少,仍是使用与非妊娠妇女相同的筛查方法,如液基细胞学、传统巴氏涂片(Pap Smear)、HPV DNA检测。而各项指南对妊娠妇女宫颈病变筛查时机和间隔的选择仍有争论,有待进一步大规模研究。     

Characteristics of women at low risk of STI presenting with pelvic inflammatory disease.

OBJECTIVE: To investigate the background and reproductive history of women who are considered at low risk of sexually transmitted infection (STI) presenting with acute pelvic inflammatory disease (PID). METHODS: Case-control study, investigating 51 women admitted to hospital with a diagnosis of acute PID and 50 healthy women attending for routine gynecological checkup. RESULTS: Women with PID were older (p = 0.003) and more often unemployed (p = 0.008), and had a lower educational level (p = 0.000003). Healthy women reported more regular routine attendance to gynecologists (p = 0.0008) and were less often smokers (p = 0.0009). There was no difference between groups regarding age at first sexual intercourse, number of sex partners during life, duration of current sexual partnership, and frequency of sexual intercourse, total number of deliveries, spontaneous abortions, ectopic pregnancies and outcome of last pregnancy. The number of induced abortions was significantly higher in the PID group (p = 0.0004). There were no differences between the groups with regard to previous episodes of PID. Healthy controls more often reported a history of STI (p = 0.00007). IUD was the most commonly reported current contraceptive method in both groups, and there was no difference in contraceptive practices between groups. CONCLUSION: Women with PID differed from healthy controls only with regard to socio-demographic characteristics and not with regard to common risk factors for PID.     

Risk Factors for Cervical Cancer by Histology

A case-control study in four Latin American countries enabled assessment of risk factors for different histologic types of invasive cervical cancers, with the main analyses focusing on 667 patients with squamous cell cancers and 43 with adenocarcinomas. The epidemiology of the squamous cell tumors resembled that found in other studies, namely a high risk associated with multiple sexual partners (RR = 1.5 for 2 vs 1), early ages at first intercourse (RR = 2.3 for <16 vs 20), history of a sexually transmitted disease (RR = 1.8), multiple births (RR = 2.2 for 7 vs 1-3), absence of prior Pap smear screening (RR = 3.0 vs Pap within 24 months), detection of HPV DNA (RR = 3.6), and limited years of schooling (RR = 1.9 for <4 vs 7). The adenocarcinomas appeared less affected by sexual, reproductive, or socioeconomic factors. There was no relationship with age at first intercourse, history of a sexually transmitted disease or education, and only marginal associations with number of sexual partners or parity. Absence of prior Pap smear screening as well as detection of HPV DNA, however, were associated with relationships equally strong as those for the squamous cell tumors. Oral contraceptive use distinctly affected risk of the adenocarcinomas, increasing risk by approximately two-fold. Analyses of the 18 subjects with adenosquamous cancer suggested some resemblance to the squamous cell tumors, especially with respect to the role of sexual and sociodemographic variables. These findings support the need for detailed studies of etiologic differences between the different histologic types of cervical cancers, with all emphasis on careful pathologic review and precise measurement of HPV.     

High- and Intermediate-Risk Human Papillomavirus Infection in Sexually Active Adolescent Females

STUDY OBJECTIVE: To determine the prevalence of high- and intermediate-risk type human papillomavirus (HPV) infection and cervical dysplasia in an urban Swiss adolescent population attending the local Adolescent Clinic, using a liquid-based Pap test combined with risk type HPV DNA testing. To determine the prevalence of Chlamydia trachomatis in the same study population. DESIGN: Observational study. SETTING: The Adolescent Clinic of the Department of Obstetrics and Gynaecology at the University Clinic, Geneva, Switzerland. PARTICIPANTS: 134 women between 14 and 20 years of age were enrolled in the study. MAIN OUTCOME MEASURES: A standardized patient file on demographic and sexual history information was compiled and completed by physical examination, including a Pap test with adjunct high- and intermediate-risk type HPV DNA detection. RESULTS: Of the 134 specimens analyzed for HPV, 115 patients were negative and 19 (14.2%) were positive for HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, or 68. A significant association between HPV infection and having had more than one lifetime sexual partner was found (P <.05). Six (31.6%) of the HPV-positive and three (2.6%) of the HPV-negative specimens had a low-grade squamous intraepithelial lesion (SIL) by cytology. Abnormal Pap test was related to HPV infection (odds ratio, 46.2; 95% confidence interval, 7.4 to 287.4) and, inversely, to age at first sexual intercourse (odds ratio, 0.98; 95% confidence interval,.97 to 1.0). CONCLUSION: High- and intermediate-risk type HPV infection is a frequent finding in our study group and is linked to having had more than one lifetime sexual partner. No association was found between HPV infection and other potential risk factors such as patient's age, age at first intercourse, frequency of intercourse during the three months prior to the investigation, smoking habits, or alcohol consumption.     

Risk factors for cervical cancer in China: a case-control study

OBJECTIVES: To determine the prevalence of human papillomavirus types and investigate the risk factors for cervical cancer in Hubei, China. METHODS: We conducted a case-control study to investigate risk factors. RESULTS: HPV DNA was detected in 94.55% of patients with cervical carcinoma, and 23.64% of control subjects. The most common HPV type in cervical cancer was HPV type 16 (81.82%), followed by HPV 58 (6.36%). HPV infected patients have a higher risk of developing cervical carcinoma, which is 75.79 times more than non-infected people. The other risks were age at first intercourse (p = 0.017) and number of live births (p = 0.032). A history of previous cytologic screening was associated with a substantial reduction in risk (p = 0.001). CONCLUSIONS: The three principal reasons that Hubei has a high rate of women developing cervical carcinoma are HPV infection, age at first sexual intercourse and number of live births. Cervical cytology screening provides efficacious protection.     

Cervical intraepithelial neoplasia: risk factors for persistence and recurrence in adolescents

One of the most common sexually transmitted infections in adolescents is human papillomavirus. These infections can occur in one or multiple areas of the female genitalia but the vulva is usually the initial site of implantation for HPV. We carried out a long-term follow-up study of adolescents to evaluate the incidence of single or multiple lesions in the lower genital tract, the correlation between sexual behaviour and their localisation and behavioural risk factors for persistence and recurrence of HPV lesions and cervical intraepithelial lesion (CIN). We interviewed 268 women aged 12-21 years who had previously had cytology and/or physical examination suspicious for HPV infection. We asked them information about their lifestyle, sexual behaviour, work, personal or family history of genital warts and school attendance. Those who smoked more than five cigarettes a day were considered "smokers". We have no specific data about oral contraception although we know that none of the patients had used oral contraceptives for more than two years. Two hundred and thirty-four young women between the ages of 12 and 21 years were included in the study. The diagnostic schedule for a complete evaluation included exo- and endocervical cytology, colposcopy and directed biopsy. We found that in 126 out of 234 (53.8%) adolescents using contraceptives, only 85 (36.3%) had used a condom. The sites most frequently affected by lesions were the vulva, perianus and perineum (194/234; 82.9%), and the cervix (125/234; 53.4%). Vaginal lesions were detected in only 29/234 patients (12.3%). In 161 patients, sexual habits, age at first intercourse (p = 0.68), frequency of intercourse (p = 0.49) and number of lifetime partners (p = 0.27) as well as age (p = 0.26) played a role in transmission and incidence of HPV infection but not in the location of the lesions. This could be due to coexistent clinical and subclinical multiple infections as well as transmission via intercourse or from other sources, including tampons. HPV infection is detected by abnormal pap test, but the low correlation with colposcopic and histological findings in this study justify the support of other examinations such as colposcopy and punch biopsy for diagnosis. Moreover more attention should be paid to the psychological aspect of diagnoses and treatment of adolescents compared to older women as there was a high rate of patients lost in our study: 75/234 (32.05%) before LASER surgery and 55/159 (34.59%) during follow-up. Only 12-45% of sexually active adolescent girls had obtained Pap smear screening. In our study we found no correlation between treatment failure and cigarette smoking or between the use of oral contraceptives and persistence/recurrence after LASER surgery.