青少年人乳头瘤病毒感染的研究进展

人乳头瘤病毒分布广泛,且有很强的传染性,感染后引起的尖锐湿疣在性传播疾病中位居第3位.宫颈癌是世界上威胁妇女健康的第2大肿瘤,而99％的宫颈癌患者都存在生殖道人乳头瘤病毒的感染.人乳头瘤病毒感染后无法根治,严重威胁患者的健康甚至是生命,而人乳头瘤病毒疫苗可有效预防尖锐湿疣和宫颈癌的发生.青少年是人乳头瘤病毒的易感人群,重视此类患者人乳头瘤病毒感染的预防有重要意义.     

人乳头瘤病毒疫苗

生殖道人乳头瘤病毒感染被认为是最普遍的性传播疾病.人乳头瘤病毒的状况能够预测鳞状上皮内病变将来的进展,高危型人乳头瘤病毒与肛门及生殖器区域的癌前病变及恶性病变有关.持续人乳头瘤病毒感染是宫颈上皮癌变的重要危险因子.预防性疫苗旨在增强免疫应答,以预防感染和防止临床疾病的发展.治疗性疫苗适用于已经出现人乳头瘤病毒感染的个体.发展中国家通过安全有效的疫苗来预防宫颈癌会得到的巨大受益,儿科给药也许是较好的解决方式.     

宫颈上皮细胞识别及内摄HPV机制的研究进展

宫颈癌是威胁我国妇女健康的主要恶性肿瘤,而人乳头瘤病毒与宫颈癌演变密切相关.人乳头瘤病毒吸附、穿入宫颈上皮细胞(宿主细胞)是一个缓慢而复杂的过程.但其感染的初始机制目前仍众说纷纭,不甚明了.对人乳头瘤病毒进入细胞发挥有效感染机制的深入研究,不仅有助于理解、认识病毒的致病性,更重要的是可为抗宫颈癌药物的开发和疫苗的研制提供理论依据.该文列举相关资料,对近期人乳头瘤病毒识别、粘附宫颈上皮细胞、依赖可能转运途径穿膜入胞相关感染机制的研究进展进行了综述.     

人乳头瘤病毒感染对青少年女性的影响

人乳头瘤病毒是世界范围内最常见的性传播感染因子,其高危型的持续性感染亦是宫颈癌发生的必要因素.青少年女性是肛门、生殖器人乳头瘤病毒感染的最危险人群,对其进行有关人乳头瘤病毒知识的科普宣教并开展深入妇科保健工作十分必要.该文主要针对青少年女性,对该人群的人乳头瘤病毒感染状况及其在生殖器疣、生殖器上皮内瘤样病变和宫颈癌等病变发生发展中的作用作以综述.     

高危人乳头瘤病毒感染与宫颈癌及癌前病变的关系探讨

目的 探讨人乳头瘤病毒(HPV)感染与宫颈癌、癌前病变的关系及不同亚型HPV病毒重叠感染对宫颈癌、癌前病变的影响.方法 以148例宫颈癌及癌前病变患者为观察组并以96例宫颈炎患者为对照组,观察两组研究对象高危HPV病毒感染率、多重感染对宫颈癌、癌前病变的影响及不同病理类型宫颈癌高危HPV感染率.结果 HPV病毒感染率以鳞癌、腺癌居多;高危型HPV病毒感染率、双重感染率、多重感染率在宫颈癌中较高,CINⅢ期、CINⅡ期、CIN Ⅰ期依次降低,均高于宫颈炎中感染率.结论 高危型HPV病毒感染与宫颈癌的发生、发展密切相关,阻断高危型HPV病毒的持续感染可阻断癌前病变的进程,是防治宫颈癌的关键所在.     

岳阳地区妇女宫颈人乳头瘤病毒感染及其亚型分布调查研究

目的 研究岳阳地区妇女人乳头瘤病毒感染及其亚型分布情况.方法 应用基因芯片技术对916例临床疑似人乳头瘤病毒感染患者进行基因分型检测.结果 共有327例人乳头瘤病毒感染病例,感染率为36％;检测出人乳头瘤病毒亚型高危型感染者129例,感染率5％；混合感染者179例,感染率54.74％；感染年龄集中在30～39岁,高峰在35～39岁年龄段(29.35％),与其他年龄段感染率比较,差异具有统计学意义(P＜0.05).结论 岳阳地区妇女宫颈人乳头瘤病毒感染率较高,主要为混合性感染,占54.74％；亚型分布主要为16型、58型,其次为18型、33型等;感染人群高峰年龄在35～39岁.     

昆明女性生殖道人乳头瘤病毒感染状况调查

目的 了解昆明女性生殖道高危型人乳头瘤病毒的感染现状以及子宫颈癌和子宫颈上皮内瘤样病变的发病率.方法 采集昆明市1 499例女性子宫颈脱落细胞进行液基细胞学检查及第2代杂交捕获检测,并用亚能基因芯片技术进行人乳头瘤病毒DNA的分型,对于人乳头瘤病毒阳性和/或液基细胞学检查≥未明确诊断意义不典型鳞状上皮细胞的妇女进行阴道镜下活检,病理结果 作为诊断金标准.结果 第2代杂交捕获检测人群高危型人乳头瘤病毒总检出率为17.21%;高危型人乳头瘤病毒阳性人群中感染最多的型别分别是16、52、58型,各年龄段人乳头瘤病毒感染率经比较差异有统计学意义(χ2=36.524,P<0.05).人乳头瘤病毒感染率随子宫颈病变级别的升高呈趋势性增加(P=0.040),宫颈癌和高度上皮内瘤样病变(≥Ⅱ)的发病率为2.20%.结论 高危型人乳头瘤病毒16、52、58型为昆明地区妇女最常见的3种亚型.昆明地区的人乳头瘤病毒感染较高,宫颈癌和癌前病变的发病率处于中发水平,防癌的重点在于筛查早期癌和上皮内瘤样病变,预防人乳头瘤病毒感染,及时合理治疗上皮内瘤样病变.     

HPV检测在宫颈癌前病变中的意义

流行病学显示,高危型人乳头瘤病毒(HPV)感染是宫颈癌及宫颈癌前病变的主要病因.高危型人乳头瘤病毒的持续感染、多重感染对宫颈癌前病变起到了强烈的预警作用,高危型人乳头瘤病毒检测联合细胞学检查能更加有效地筛查宫颈癌前病变治疗后有无复发或病变残留.该文就高危型人乳头瘤病毒持续感染、多重感染与宫颈癌前病变的关系及高危型人乳头瘤病毒检测在宫颈癌前病变治疗后随访中的意义作以综述.     

接种人乳头瘤病毒疫苗在预防宫颈癌中的作用

目的 对接种人乳头瘤病毒疫苗预防宫颈癌的效果进行评价. 方法 2009年1月-2012年1月随机抽取育龄妇女1 256名作为研究对象,将其分成对照组和观察组,观察组患者接种人乳头瘤病毒疫苗,对照组接种安慰剂,对比分析两组对象的宫颈上皮内瘤样变以及宫颈癌的发生率. 结果 观察组宫颈上皮内瘤样变以及宫颈癌的发生率分别为0.64％和0.32％,显著低于对照组的3.66％和1.91％(P＜0.05). 结论 接种人乳头瘤病毒疫苗能够有效预防宫颈上皮内瘤样变以及宫颈癌的发生,临床应给予关注.     

人乳头瘤病毒疫苗接种意愿及影响因素

宫颈癌与人乳头瘤病毒（human papillomavirus,HPV）感染密切相关，阻断HPV感染是预防宫颈癌及相关疾病的关键。HPV疫苗的推广使用，有效降低了宫颈癌及相关疾病的发生率。本文系统梳理了国内外有关HPV疫苗的接种意愿及影响因素，为提高HPV疫苗的接种率，预防宫颈癌及相关疾病提供参考。     

Human papillomavirus-related content in state and tribal comprehensive cancer control plans

Oncogenic types of the human papillomavirus (HPV) are firmly established as etiological agents for most premalignant and malignant epithelial lesions of the cervical mucosa. Genital infection with HPV is the most common sexually transmitted infection (STI) in the United States. Although most women infected with the virus become HPV negative within 2 years, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer. Since the development of the Papanicolau (Pap) test more than 60 years ago to screen for cervical cancer, technological advances have occurred in cervical cytology screening and HPV vaccine research. For example, in 2001, high-risk HPV DNA testing was recommended for the management of women whose Pap smears (collected by a liquid-based method) reveal atypical squamous cells of undetermined significance. In 2006, the Food and Drug Administration licensed a quadrivalent HPV vaccine for females aged 9-26 years to prevent cervical cancer, precancerous lesions, and genital warts associated with HPV types in the vaccine. New and emerging technologies in cancer diagnosis, management, and prevention are often addressed in comprehensive cancer control (CCC) plans developed by states, tribes, and territories. CCC is a collaborative process through which a community and its partners pool resources to reduce the burden of cancer. To assess whether CCC plans include HPV-related content, particularly regarding cervical cancer screening and prevention, we reviewed the most current plans available between October 2006 and January 2007 on an interactive Internet site for CCC programs (n = 53). This paper describes the contexts in which HPV-related content occurs in the plans.     

修水地区人乳头瘤病毒感染与宫颈癌的研究

目的:调查妇女生殖道高危型人乳头瘤病毒(Human papillomavirus,HPV)感染状况,研究高危型HPV感染与宫颈癌及癌前病变的关系。方法:应用第二代杂交捕获(hybrid capture,HC-Ⅱ)实验对30~49岁的已婚妇女进行高危型HPV DNA检测,采用多因素的非条件Logistic回归模型分析HPV感染与宫颈癌及宫颈上皮内病变(CIN)的关系。结果:调查人群高危型HPV DNA总检出率为18.7%,与正常组相比检出率随病变程度加重呈趋势性增高(χ2=444.04,P<0.001)。各年龄组宫颈HPV DNA的检出率几乎一样,无显著性差异(χ2=10.25,P>0.001)。非条件Logistic回归分析显示,HPV感染与宫颈上皮内高度病变(CINⅡ)及癌症的发生高度相关(OR=121.1)。结论:生殖道高危型HPV感染是当地宫颈癌及宫颈上皮内瘤变流行的主要危险因素,提示宫颈癌的防治重点应放在防止HPV感染、对HPV感染的筛查和密切监测已感染高危型HPV的对象。     

人乳头瘤病毒感染与宫颈癌的关系及其疫苗的研究进展

人乳头瘤病毒(HPV)的持续感染已被证实是诱发宫颈癌的主要原因,其中高危型HPV(HRHPV)-16,-18感染可引起70％以上感染者发生宫颈癌和癌前病变.因此,预防HPV感染是防治宫颈癌的主要途径.而HPV疫苗的成功研制,在预防宫颈癌方面取得巨大突破.目前,全球广泛应用的2种HPV疫苗,分别为4价的Gardasil(R)(抗HPV-6,-11,-16,-18型,默克公司,美国)和2价的cervarixTM(抗HPV-16,-18型;葛兰素史克公司,英国).本研究拟就HPV感染的致癌机制、流行病学现状及预防性HPV疫苗的作用机制及安全性,综述如下.     

我国女性人乳头瘤病毒(HPV)感染的流行病学现状

宫颈癌给我国乃至全世界都造成了沉重的社会经济负担，人乳头瘤病毒（human papilloma virus，HPV）尤其是高危型HPV与宫颈癌前病变和宫颈癌密切相关，HPV疫苗的出现无疑给广大女性带来了福音。目前多个国家已经开展了HPV的疫苗免疫计划，我国大陆虽然刚刚批准了二价的HPV疫苗在国内使用，但仍缺乏系统的HPV感染的流行数据，因而本文就我国女性HPV感染的流行病学状况作一综述，旨在为HPV疫苗的研发和应用及宫颈癌防治工作提供指导。     

清远市中心区域妇女人乳头瘤病毒感染现状调查与分析

目的了解广东清远地区妇女人乳头瘤病毒(HPV)感染基因型的分布情况,为本地区宫颈癌的防治提供科学依据。方法采用核酸分子快速导流杂交基因芯片分型技术对23 983例就诊者进行下生殖道HPV 21种基因亚型的分型检测。对其中部分HPV感染者进行宫颈液基细胞检查和(或)在阴道镜下取组织活检进行病理检查。结果 23 983例标本中,HPV阳性为5 372例,阳性率为22.40%,21种基因亚型均有检出,感染率前五位的HPV基因亚型由高到低依次为HPV-16(6.02%)、52(4.46%)、56(2.68%)、11(2.25%)、66(1.86%)。在5 372例阳性标本中,单一基因亚型感染的3 966例,占73.83%;多重感染的为1 406例,比例为26.17%。HPV感染者高峰年龄段为26⁴5岁。随宫颈疾病及癌前病变程度的加重,高危型HPV感染率均显著上升,CINⅡ、CINⅢ和侵润癌均为100%。结论本地区宫颈炎患者的HPV感染率较高,以16、52、56亚型为主。HPV感染高发于中青年妇女,宫颈病变程度与HPV感染密切相关,长期持续高危型HPV感染可能导致宫颈癌。进行HPV感染者长期的跟踪随访和预后判断,对降低宫颈癌的发病率等有着重要的意义。     

澳门妇女和医师对HPV疫苗的认知态度调查及其推广应用分析

目的了解澳门特别行政区女性和执业医师在人乳头瘤病毒(human papillomavirus,HPV)疫苗纳入免费防疫接种计划之前对其认知、接受度,及疫苗的使用情况,分析影响接种的主要因素,评估HPV疫苗在澳门发展情况,为宫颈癌预防工作提供适当的模式。方法 2008年8~12月采用问卷抽样调查方式对澳门特别行政区1 716名女性及108名执业医师进行问卷调查,利用SPSS 13.5软件进行统计分析。结果受调查妇女中,47.1%的女性曾听过HPV,76.7%的女性听过宫颈癌疫苗,认为HPV感染与宫颈癌有关联性的仅为35.4%。另外,38.4%的女性及其中43.4%的母亲愿意自己或女儿接种疫苗。据多因素logistic回归分析得出年龄、个人收入、职业、个人防护、担心患宫颈癌、担心疫苗来源、认为自己年龄太大或太小是影响接受疫苗的主要因素。澳门医师对HPV及HPV疫苗都有中高度认知。约60%受调查医师对HPV疫苗有信心,而评价疫苗的不足主要是价格太贵。结论澳门宣传有关HPV及HPV疫苗的知识是有效的,HPV疫苗在澳门使用人数逐渐增加。为增加澳门居民对疫苗的接受程度,达到预防宫颈癌的目的,政府仍需采用多种宣传方式加强宣传力度。     

Implementation of an HPV-Vaccination Program

Human papillomavirus (HPV) infection can lead to the development of cervical cancer, the second most common cancer-related cause of death in women in the world. The availability of HPV vaccines provides a new and exciting opportunity for cervical cancer prevention.Currently available phase II and III trial data suggest that HPV vaccines are highly effective in preventing infection with HPV-16 and -18, the two types responsible for approximately 70% of cervical cancers worldwide.In order to determine how best to successfully implement a vaccination program, there are a number of factors that need to be considered in addition to vaccine efficacy. These include the choice of a disease endpoint, the duration of vaccine efficacy, the HPV types included in the vaccine, vaccine costs, vaccine coverage, and how the availability of an effective vaccination program may affect screening for those countries that have a successful screening program in place.For settings in which screening is already in place, there will need to be a careful consideration of new approaches to screening, including screening less frequently and using new screening tests or strategies. For settings that have a high burden of cervical cancer but that have not implemented screening, additional trial and registry data that not only confirm the initial results showing high efficacy but also show significant reductions in pre-cancer, and ultimately cancer, will provide reassurance that a decision to implement an HPV vaccination program is sound.     

Vaccination against human papillomavirus for the prevention of cervical cancer

Persistent infections with high-risk Human papillomavirus (HPV) can lead to cervical cancer. This fact could imply that vaccination against HPV could prevent this disease. Such vaccines could be aimed at the prevention of HPV infections or the treatment of infections, cervical intraepithelial neoplasia (CIN) and cervical cancer. There are two prophylactic candidate vaccines against the high risk HPV types 16 and 18, which appear to be safe and effective in preventing incidental and persistent HPV infections. Phase III studies should reveal whether these vaccines will also have long-term effects by preventing the development of CIN and eventually cervical cancer. The introduction of such an HPV vaccine in the Netherlands, its cost-effectiveness and introduction into the existing national vaccination programmes needs to be studied. The vaccination of girls before they become sexually active seems to be the most effective approach, although older women can also profit from prophylactic vaccination. The current community-based screening, possibly complemented by an HPV test, needs to be continued to identify and treat presently HPV-infected women. In a population with an existing community-based screening program for cervical cancer, a vaccine preventing persisting infection with high-risk HPV will further reduce the incidence of HPV-related cervical cancer.     

A qualitative analysis of South African women's knowledge, attitudes, and beliefs about HPV and cervical cancer prevention, vaccine awareness and acceptance, and maternal-child communication about sexual health

In South Africa, cervical cancer is the second leading cause of death among women. Black South Africa women are disproportionately affected by cervical cancer and have one of the highest mortality rates from this disease. Although the body of literature that examines HPV and cervical cancer prevention is growing in the developing world; there is still a need for a better understanding of women's knowledge and beliefs around HPV and cervical cancer prevention. Therefore, this formative study sought to examine women's attitudes, beliefs and knowledge of HPV and cervical cancer, HPV vaccine acceptance, maternal-child communication about sexuality, and healthcare decision-making and gender roles within an urban community in South Africa.Women ages 18-44 were recruited from an antenatal clinic in a Black township outside of Johannesburg during the fall of 2008. Twenty-four women participated in three focus groups. Findings indicated that the women talked to their children about a variety of sexual health issues; had limited knowledge about HPV, cervical cancer, and the HPV vaccine. Women were interested in learning more about the vaccine although they had reservations about the long-term affect; they reinforced that grandmothers played a key role in a mother's decisions’ about her child's health, and supported the idea that government should provide the HPV vaccine as part of the country's immunization program.Our findings indicate the need to develop primary prevention strategies and materials that will provide women with basic cervical cancer prevention messages, including information about HPV, cervical cancer, the HPV vaccine, screening, and how to talk to their children about these topics. Prevention strategies should also consider the cultural context and the role that grandmothers play in the family unit.     

The HPV Vaccine: A Comparison of Focus Groups Conducted in South Africa and Ohio Appalachia

Worldwide, cervical cancer is one of the leading causes of morbidity and mortality among women. Even though women in developing countries account for approximately 85 % of the cervical cancer cases and deaths, disparities in cervical cancer rates are also documented in developed countries like the United States (U.S.). Recently, formative research conducted in the U.S. and developing countries like South Africa have sought to gain a better understanding of the knowledge, beliefs, and attitudes about cervical cancer prevention, HPV, and the acceptance of the HPV vaccine. This study compares findings from two independent focus group studies. One study was conducted in a segregated township in Johannesburg, South Africa (n = 24) and the other study was conducted in Ohio Appalachia (n = 19). The following seven themes emerged during the discussions from both studies: HPV and cervical cancer; health decision making; parent–child communication; healthy children; HPV vaccine costs; sexual abuse; and HPV vaccine education. Findings from both studies indicate the importance of the role of mothers and grandmothers in the health care decision-making process for children and a lack of awareness of HPV and its association with cervical cancer. While there was interest in the HPV vaccine, participants voiced concern about the vaccine’s cost and side effects. Some participants expressed concern that receipt of the HPV vaccine may initiate adolescent sexual behavior. However, other participants suggested that the HPV vaccine may protect young women who may experience sexual abuse. The importance of developing culturally appropriate educational materials and programs about cervical cancer prevention and the HPV vaccine were expressed by participants in both countries.