人乳头瘤病毒（HPV）疫苗接种对局部手术治疗后HPV感染及HPV相关疾病复发的影响：一项系统评价与Meta分析

Effect of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: A systematic review and meta-analysis.

作者信息

Cao Qinxue, Hou Yantao, Wang Chaoyang, Yin Juntao

机构信息

Department of Obstetrics and Gynecology, Huaihe Hospital, Henan University, Henan, China.

Henan Technical Institute, School of Mechanical and Electrical Engineering, Zhengzhou, China.

出版信息

PLoS One. 2024 Dec 31;19(12):e0312128. doi: 10.1371/journal.pone.0312128. eCollection 2024.

DOI:10.1371/journal.pone.0312128

PMID:39739895

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11687797/

Abstract

BACKGROUND

The prophylactic vaccines available to protect against infections by human papillomavirus (HPV) are well tolerated and highly immunogenic. This systematic review and meta-analysis aimed to explore the efficacy of HPV vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment.

METHODS

A literature search was performed using PubMed/MEDLINE, Embase, the Cochrane Library, Scopus, Web of Science, and bioRxiv/medRxiv from inception to July 15, 2024. Randomized controlled trials (RCTs) reporting the effect of HPV vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment vs no HPV vaccination were included. The primary outcome measure was risk of recurrence cervical high-grade squamous intraepithelial lesion (HSIL) after local surgical treatment, with follow-up as reported by individual studies. Included studies were assessed for risk of bias using the Revised Cochrane risk-of-bias (RoB 2.0 tool). Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated. No restrictions were applied on language, the date of publication, age, sex, and country. All analyses were carried out using the Review Manager 5 software (version 5.4).

RESULTS

Eight RCTs (n = 3068) met the inclusion criteria. The risk of cervical HSIL recurrence was not reduced in individuals who were vaccinated compared with those who were not vaccinated (RR 0.92, 95% CI: 0.66-1.27; I2 = 40%). However, HPV vaccination reduced the risk of recurrence of cervical HSIL related to the HPV types HPV16/18, but uncertainty was large (RR 0.57, 95% CI: 0.18-1.84; I2 = 29%).

CONCLUSIONS

Adjuvant HPV vaccination after surgical excision is not associated with a reduced risk of recurrent HSIL overall or a reduced risk of recurrent lesions caused by the most oncogenic strains (HPV16/18). Therefore, HPV vaccination should not be considered for adjuvant treatment in patients undergoing surgical excision.

摘要

背景

现有的预防人乳头瘤病毒（HPV）感染的预防性疫苗耐受性良好且免疫原性高。本系统评价和荟萃分析旨在探讨HPV疫苗接种对接受局部手术治疗的个体感染HPV风险及与HPV感染相关的复发性疾病的疗效。

方法

使用PubMed/MEDLINE、Embase、Cochrane图书馆、Scopus、Web of Science以及bioRxiv/medRxiv进行文献检索，检索时间从数据库建立至2024年7月15日。纳入报告HPV疫苗接种与未接种HPV疫苗相比，对局部手术治疗后HPV感染及HPV相关疾病复发影响的随机对照试验（RCT）。主要结局指标为局部手术治疗后宫颈高级别鳞状上皮内病变（HSIL）复发风险，随访情况按各研究报告。采用修订的Cochrane偏倚风险（RoB 2.0工具）对纳入研究进行偏倚风险评估。计算合并风险比（RR）和95%置信区间（CI）。对语言、发表日期、年龄、性别和国家不设限制。所有分析均使用Review Manager 5软件（版本5.4）进行。

结果

八项RCT（n = 3068）符合纳入标准。与未接种疫苗的个体相比，接种疫苗的个体宫颈HSIL复发风险未降低（RR 0.92，95% CI：0.66 - 1.27；I² = 40%）。然而，HPV疫苗接种降低了与HPV 16/18型相关的宫颈HSIL复发风险，但不确定性较大（RR 0.57，95% CI：0.18 - 1.84；I² = 29%）。