接种加德西疫苗后患者出现的宫颈上皮内瘤变3级
Cervical intraepithelial neoplasia grade 3 in a patient following Gardasil vaccination.
作者信息
McLucas Bruce, Vail Eric, Chua Katherine Jane, Walt Gabriel
机构信息
Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA.
Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
出版信息
BMJ Case Rep. 2019 Aug 10;12(8):e230366. doi: 10.1136/bcr-2019-230366.
Essentially all cervical dysplasia is caused by human papilloma virus (HPV). Three HPV vaccines have been available, with Gardasil-9 being the most recently approved in the USA. Gardasil-9 covers high-risk HPV strains 16, 18, 31, 33, 45, 52 and 58 as well as low-risk strains 6 and 11. A 33-year-old woman (Gravida 2, Para 2) received Gardasil in 2006. Subsequently, her pap smear revealed low grade squamous intraepithelial lesion. Cervical biopsies performed in 2015 and 2016 revealed cervical intraepithelial neoplasia grade 1 (CIN 1). She underwent loop electrosurgical excision procedure for persistent CIN 1, which demonstrated CIN 3. Genotyping revealed HPV type 56 infection. The advancement of Gardasil-9 vaccine only offers 90% protection to patients against HPV-related disease. Lay literature may mislead patients to think they have no risk of HPV infection.
基本上，所有的宫颈发育异常都是由人乳头瘤病毒（HPV）引起的。已有三种HPV疫苗可供使用，其中九价重组人乳头瘤病毒疫苗（佳达修9）是美国最近批准的。佳达修9涵盖高危HPV毒株16、18、31、33、45、52和58以及低危毒株6和11。一名33岁女性（孕2产2）于2006年接种了四价重组人乳头瘤病毒疫苗（佳达修）。随后，她的巴氏涂片显示低度鳞状上皮内病变。2015年和2016年进行的宫颈活检显示为宫颈上皮内瘤变1级（CIN 1）。她因持续性CIN 1接受了环形电外科切除术，术后显示为CIN 3。基因分型显示为HPV 56型感染。九价重组人乳头瘤病毒疫苗（佳达修9）的推广仅为患者提供了90%的针对HPV相关疾病的保护。通俗读物可能会误导患者，让他们认为自己没有感染HPV的风险。
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