Tam Lai-Shan, Chan Alice Y K, Chan Paul K S, Chang Alexander R, Li Edmund K
Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Arthritis Rheum. 2004 Nov;50(11):3619-25. doi: 10.1002/art.20616.
To compare the prevalence of abnormal Pap smears in patients with systemic lupus erythematosus (SLE) with that in a large group of healthy controls, and to determine whether SLE itself is an independent risk factor. The association of human papillomavirus (HPV) infection and the use of immunosuppressive agents with abnormal Pap smears in SLE was also assessed.
Eighty-five SLE patients participated in this cross-sectional study. A sample of cervical cells was collected from each patient for routine cytologic examination. HPV was typed by restriction and sequencing analysis. A structured questionnaire was administered to the subjects to ascertain the possible behavioral and biologic risk factors associated with cervical atypia. Data on 2,080 healthy female subjects were retrieved for comparison.
The mean (+/-SD) age of SLE patients and controls was 42 +/- 9 years and 44 +/- 10 years, respectively. The prevalence of abnormal Pap smears was significantly increased in SLE patients compared with controls (16.5% versus 5.7%). The prevalence of squamous intraepithelial lesions was increased approximately 6-fold in SLE patients (11.8%) compared with controls (2.0%). SLE itself remained an independent risk factor for abnormal Pap smears (odds ratio 3.5, 95% confidence interval 1.8-6.9). The overall prevalence of HPV infection in SLE patients and controls was 11.8% and 7.3%, respectively. However, 10.6% of SLE patients were infected with at least 1 high-risk type of HPV, compared with 4.2% of controls. Multiple infections were also more common in SLE patients than in controls (4.7% versus 1.1%). There were no significant differences in the use of immunosuppressive agents between SLE patients with normal Pap smears and those with abnormal Pap smears.
Abnormal Pap smears were more common among SLE patients than controls, even after adjusting for HPV status. SLE-associated immunosuppression increases susceptibility to high-risk HPV infection and multiple HPV infections. The use of immunosuppressant agents was not associated with abnormal Pap smears.
比较系统性红斑狼疮（SLE）患者与一大组健康对照者宫颈涂片异常的患病率，并确定SLE本身是否为独立危险因素。还评估了人乳头瘤病毒（HPV）感染及免疫抑制剂的使用与SLE患者宫颈涂片异常之间的关联。
85例SLE患者参与了这项横断面研究。从每位患者采集宫颈细胞样本进行常规细胞学检查。通过限制性内切酶和测序分析对HPV进行分型。向受试者发放结构化问卷，以确定与宫颈异型性相关的可能行为和生物学危险因素。检索2080名健康女性受试者的数据用于比较。
SLE患者和对照者的平均（±标准差）年龄分别为42±9岁和44±10岁。与对照者相比，SLE患者宫颈涂片异常的患病率显著升高（16.5%对5.7%）。与对照者（2.0%）相比，SLE患者鳞状上皮内病变的患病率增加了约6倍（11.8%）。SLE本身仍是宫颈涂片异常的独立危险因素（比值比3.5，95%置信区间1.8 - 6.9）。SLE患者和对照者中HPV感染的总体患病率分别为11.8%和7.3%。然而，10.6%的SLE患者感染了至少1种高危型HPV，而对照者为4.2%。SLE患者多重感染也比对照者更常见（4.7%对1.1%）。宫颈涂片正常的SLE患者和异常的SLE患者在免疫抑制剂使用方面无显著差异。
即使在调整HPV状态后，SLE患者宫颈涂片异常仍比对照者更常见。SLE相关的免疫抑制增加了对高危HPV感染和多重HPV感染的易感性。免疫抑制剂的使用与宫颈涂片异常无关。
