Syrjänen Kari, Shabalova Irena, Petrovichev Nicolay, Kozachenko Vladimir, Zakharova Tatjana, Pajanidi Julia, Podistov Jurij, Chemeris Galina, Sozaeva Larisa, Lipova Elena, Tsidaeva Irena, Ivanchenko Olga, Pshepurko Alla, Zakharenko Sergej, Nerovjna Raisa, Kljukina Ludmila, Erokhina Oksana, Branovskaja Marina, Nikitina Maritta, Grunberga Valerija, Grunberg Alexandr, Juschenko Anna, Santopietro Rosa, Cintorino Marcella, Tosi Piero, Syrjänen Stina
Department of Oncology and Radiotherapy, Turku University Hospital, Savitehtaankatu 1, Turku, 20521, Finland.
Eur J Epidemiol. 2007;22(10):723-35. doi: 10.1007/s10654-007-9180-8. Epub 2007 Sep 8.
Recent evidence implicates smoking as a risk factor for cervical cancer (CC), but the confounding from high-risk human papillomavirus (HPV) infections is not clear.
To analyse the role of smoking as an independent predictor of CIN2+ and HR-HPV infections in a population-based prospective (NIS, New Independent States of former Soviet Union) cohort study.
A cohort of 3,187 women was stratified into three groups according to their smoking status: (i) women who never smoked; (ii) those smoking in the past; and (iii) women who are current smokers. These groups were analysed for predictors of (a) HR-HPV; (b) high-grade CIN, and (c) outcome of HR-HPV infections and cytological abnormalities during prospective follow-up (n = 854).
The three groups were significantly different in all major indicators or risk sexual behaviour (or history) implicating strong confounding. There was no increase in HSIL/LSIL/ASC-US cytology or CIN1+/CIN2+/CIN3+ among current smokers. Only few predictors of HR-HPV and CIN2+ were common to all three groups, indicating strong interference of the smoking status. There was no difference in outcomes of cervical disease or HR-HPV infections between the three groups. In multivariate model, being current smoker was one of the five independent predictors of HR-HPV (P = 0.014), with adjusted OR = 1.52 (95%CI 1.09-2.14). In addition to age, HR-HPV was the only independent predictor of CIN2+ in multivariate model (OR = 14.8; 95%CI 1.72-127.31).
These data indicate that cigarette smoking is not an independent risk factor of CIN2+, but the increased risk ascribed to smoking is mediated by acquisition of HR-HPV, of which current smoking was an independent predictor in multivariate model.
近期证据表明吸烟是宫颈癌（CC）的一个风险因素，但高危型人乳头瘤病毒（HPV）感染造成的混杂影响尚不清楚。
在一项基于人群的前瞻性（独联体，前苏联新独立国家）队列研究中，分析吸烟作为CIN2+和高危型HPV感染独立预测因素的作用。
根据吸烟状况，将3187名女性队列分为三组：（i）从不吸烟的女性；（ii）过去吸烟的女性；（iii）当前吸烟者。分析这些组中（a）高危型HPV、（b）高级别CIN以及（c）前瞻性随访期间（n = 854）高危型HPV感染和细胞学异常结果的预测因素。
三组在所有涉及严重混杂的主要性传播行为指标或风险（或病史）方面存在显著差异。当前吸烟者中HSIL/LSIL/ASC-US细胞学或CIN1+/CIN2+/CIN3+并无增加。三组中仅有少数高危型HPV和CIN2+的预测因素相同，表明吸烟状况的强烈干扰。三组之间宫颈疾病或高危型HPV感染的结果并无差异。在多变量模型中，当前吸烟者是高危型HPV的五个独立预测因素之一（P = 0.014），校正后比值比（OR）= 1.52（95%置信区间1.09 - 2.14）。在多变量模型中，除年龄外，高危型HPV是CIN2+的唯一独立预测因素（OR = 14.8；95%置信区间1.72 - 127.31）。
这些数据表明吸烟不是CIN2+的独立风险因素，但归因于吸烟的风险增加是由高危型HPV感染介导的，其中当前吸烟在多变量模型中是一个独立预测因素。
