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宫颈人乳头瘤病毒阳性增加口腔人乳头瘤病毒感染风险:一项荟萃分析的系统评价

Cervical HPV Positivity Elevates the Risk for Oral HPV Infection: A Systematic Review with Meta-Analysis.

作者信息

Mózes A E, Olasz F H, Martineková P, Kiss-Dala S, Bródy A, Végh D, Zsembery Á, Hegyi P, Ács N, Rózsa N K

机构信息

Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.

Department of Pediatric Dentistry and Orthodontics, Semmelweis University, Budapest, Hungary.

出版信息

J Dent Res. 2025 Jun 23:220345251337071. doi: 10.1177/00220345251337071.

Abstract

The human papillomavirus (HPV) is the most common sexually transmitted infection of the 21st century, infecting an estimated 630 million people worldwide and contributing to approximately 4.5% to 5% of all cancers. The incidence of HPV-associated oropharyngeal cancer is increasing. Yet, population screening for oral HPV infection is not recommended by the Food and Drug Administration due to the low prevalence and lack of a universally accepted screening strategy or tool. The study aims to evaluate the link between cervical and oral HPV infection in women and identify high-risk groups. The protocol was registered on PROSPERO (CRD42023477695). The systematic search was performed in 3 databases (PubMed, EMBASE, and CENTRAL) on January 3, 2025. Forty-one analytical observational studies reporting on oral HPV status in women with and without cervical HPV positivity were included. Effect sizes, including proportions and odds ratios with 95% confidence intervals (CIs), were analyzed using a random-effects model. Location, population characteristics, and sampling methods were used to perform the subgroup analyses. The meta-analysis revealed an odds ratio of 2.22 (CI: 1.52-3.25) for oral HPV in women with cervical HPV positivity compared with those without it. The prevalence of oral HPV was significantly higher in cervical HPV-positive women (13%, CI: 8%-20%) than in HPV-negative women (4%, CI: 2%-7%). In addition, the prevalence of oral HPV was even higher in cervical HPV-positive women with positive cytology (17%, CI: 6%-39%). Risk-of-bias assessment indicated low risk among all studies using Quality in Prognosis Studies and moderate to low risk among studies assessed with the Joanna Briggs Institute Prevalence Critical Appraisal Tool. Our findings support the association between cervical HPV positivity and elevated risk for oral HPV infection. Moreover, the highest prevalence of oral HPV carriage was observed in women with positive cytology. As 1 in 8 women with cervical HPV carries oral HPV, screening should be considered for this at-risk population.

摘要

人乳头瘤病毒(HPV)是21世纪最常见的性传播感染,全球估计有6.3亿人感染,约占所有癌症的4.5%至5%。HPV相关口咽癌的发病率正在上升。然而,由于患病率低且缺乏普遍接受的筛查策略或工具,美国食品药品监督管理局不建议对口腔HPV感染进行人群筛查。该研究旨在评估女性宫颈和口腔HPV感染之间的联系,并识别高危人群。该方案已在国际前瞻性系统评价注册库(PROSPERO,注册号CRD42023477695)登记。于2025年1月3日在3个数据库(PubMed、EMBASE和CENTRAL)中进行了系统检索。纳入了41项分析性观察研究,这些研究报告了宫颈HPV阳性和阴性女性的口腔HPV状况。使用随机效应模型分析效应量,包括比例和95%置信区间(CI)的比值比。采用研究地点、人群特征和抽样方法进行亚组分析。荟萃分析显示,宫颈HPV阳性女性的口腔HPV感染比值比为2.22(CI:1.52 - 3.25),而宫颈HPV阴性女性为对照。宫颈HPV阳性女性的口腔HPV患病率(13%,CI:8% - 20%)显著高于HPV阴性女性(4%,CI:2% - 7%)。此外,细胞学检查阳性的宫颈HPV阳性女性的口腔HPV患病率更高(17%,CI:6% - 39%)。偏倚风险评估表明,使用预后研究质量工具评估的所有研究风险较低,而使用乔安娜·布里格斯研究所患病率批判性评价工具评估的研究风险为中度至低度。我们的研究结果支持宫颈HPV阳性与口腔HPV感染风险升高之间的关联。此外,细胞学检查阳性的女性口腔HPV携带率最高。由于每8名宫颈HPV感染女性中就有1名携带口腔HPV,因此应考虑对这一高危人群进行筛查。

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