Okadome Masao, Saito Toshiaki, Tanaka Hideyuki, Nogawa Takayoshi, Furuta Reiko, Watanabe Kayoko, Kita Tsunekazu, Yamamoto Kaichiro, Mikami Mikio, Takizawa Ken
Gynecology Service, National Kyushu Cancer Center, Fukuoka, Japan.
J Obstet Gynaecol Res. 2014 Feb;40(2):561-9. doi: 10.1111/jog.12202. Epub 2013 Oct 22.
Few studies have examined the effect of combined low-risk human papillomavirus (LR-HPV) and high-risk human papillomavirus (HR-HPV) infection on the progression of cervical intraepithelial neoplasia (CIN)2 to CIN3. This multi-institutional prospective cohort study investigated the risk of progression of CIN2 with various combinations of HR-HPV and LR-HPV infection.
Between January 2007 and May 2008, 122 women with CIN2 (aged 20-50 years) from 24 hospitals throughout Japan were enrolled in the study. Ninety-three women were analyzed after a 2-year follow-up with cytology, colposcopy, HR-HPV testing and HPV genotyping. Colposcopy-directed biopsy was performed at entry and the end of this study, or when disease progression was suspected.
Among 93 women with CIN2, 87 (93.5%) had HR-HPV infection. Among these 87 cases, 24 (27.6%) progressed to CIN3 and 49 (56.3%) regressed. None of the six women with CIN2 without HR-HPV infection progressed. The progression rate was significantly lower in women with combined HR-HPV and LR-HPV infection (3/28, 10.7%) than in those with HR-HPV infection only (21/59, 35.6%; P = 0.016). Multivariate analyses showed that CIN2 progression in women with HR-HPV infection was negatively associated with LR-HPV co-infection (hazard ratio = 0.152; 95% confidence interval [CI] = 0.042-0.553). CIN2 regression was positively associated with LR-HPV co-infection (odds ratio = 4.553; 95% CI = 1.378-15.039).
The risk of CIN2 progression is low in women with combined infection of HR-HPV and LR-HPV. The finding may be useful for management of women diagnosed with CIN2.
很少有研究探讨低风险人乳头瘤病毒（LR-HPV）和高风险人乳头瘤病毒（HR-HPV）合并感染对宫颈上皮内瘤变（CIN）2进展为CIN3的影响。这项多机构前瞻性队列研究调查了HR-HPV和LR-HPV感染的不同组合情况下CIN2进展的风险。
2007年1月至2008年5月期间，来自日本各地24家医院的122例CIN2患者（年龄20 - 50岁）纳入本研究。93例女性在经过2年的细胞学、阴道镜检查、HR-HPV检测和HPV基因分型随访后进行分析。在研究开始时、结束时或怀疑疾病进展时进行阴道镜引导下活检。
93例CIN2女性中，87例（93.5%）有HR-HPV感染。在这87例病例中，24例（27.6%）进展为CIN3，49例（56.3%）病情消退。6例无HR-HPV感染的CIN2女性均未进展。HR-HPV和LR-HPV合并感染的女性进展率（3/28，10.7%）显著低于仅HR-HPV感染的女性（21/59，35.6%；P = 0.016）。多因素分析显示，HR-HPV感染女性的CIN2进展与LR-HPV合并感染呈负相关（风险比 = 0.152；95%置信区间[CI] = 0.042 - 0.553）。CIN2消退与LR-HPV合并感染呈正相关（优势比 = 4.553；95% CI = 1.378 - 15.039）。
HR-HPV和LR-HPV合并感染的女性CIN2进展风险较低。这一发现可能有助于对诊断为CIN2的女性进行管理。
