Becker T M, Wheeler C M, McGough N S, Parmenter C A, Jordan S W, Stidley C A, McPherson R S, Dorin M H
University of New Mexico School of Medicine, Albuquerque 87131-5306.
JAMA. 1994 Apr 20;271(15):1181-8.
To assess risk factors for high-grade cervical dysplasia among southwestern Hispanic and non-Hispanic white women.
Clinic-based case-control study.
University-affiliated gynecology clinics.
Cases were Hispanic and non-Hispanic white women with biopsy-proven high-grade cervical dysplasia (n = 201). Controls were Hispanic and non-Hispanic white women from the same clinics with normal cervical epithelium (n = 337).
Study design included interviews focused on histories of sexually transmitted diseases, sexual behavior, reproductive histories, hygienic practices, contraceptive use, cigarette smoking, and diet. Laboratory studies included bacterial and protozoal cultures of the cervix; hybridization tests to identify human papillomavirus (HPV) genome with commercial (ViraPap and ViraType) and polymerase chain reaction-based assays; and serum antibody tests for herpes simplex virus, Chlamydia trachomatis, syphilis, hepatitis B, and hepatitis C.
For both ethnic groups combined, after adjustment for ethnicity, age, and sexual behavior, the strongest risks for cervical dysplasia were associated with cervical HPV infection as identified by ViraPap (odds ratio [OR], 12.8; 95% confidence interval [CI], 8.2 to 20.0) or with polymerase chain reaction (OR, 20.8; 95% CI, 10.8 to 40.2). Other factors associated with dysplasia included cigarette smoking at the time of diagnosis (OR, 1.8; 95% CI, 1.2 to 2.8); low income (OR, 2.2; 95% CI, 1.2 to 4.0); low educational level (OR, 6.2; 95% CI, 3.4 to 11.1); history of any sexually transmitted disease (OR, 1.9; 95% CI, 1.3 to 2.7); and seroprevalence of antibodies to hepatitis B (OR, 1.8; 95% CI, 0.9 to 3.5). For Hispanic women, HPV 16/18 identified by ViraType was strongly associated with cervical dysplasia (OR, 171.0; 95% CI, 22.8 to 1280.5). Antibodies to herpes simplex virus type 2 were not associated with dysplasia in Hispanic women but were significantly associated with dysplasia among non-Hispanic whites. Risks associated with cigarette smoking also varied by ethnic group.
The strongest risk factor associated with high-grade cervical dysplasia among clinic attendees was HPV infection. Although most of the risk factors we examined showed similar associations for dysplasia for both ethnic groups, our data suggest that several different risk factors may be relevant to the development of cervical dysplasia in Hispanics compared with non-Hispanic whites who attend the same clinics.
评估美国西南部西班牙裔和非西班牙裔白人女性中高级别宫颈发育异常的危险因素。
基于诊所的病例对照研究。
大学附属医院的妇科诊所。
病例为经活检证实为高级别宫颈发育异常的西班牙裔和非西班牙裔白人女性（n = 201）。对照为来自同一诊所宫颈上皮正常的西班牙裔和非西班牙裔白人女性（n = 337）。
研究设计包括针对性传播疾病史、性行为、生殖史、卫生习惯、避孕措施使用、吸烟情况和饮食的访谈。实验室研究包括宫颈的细菌和原虫培养；使用商业检测法（ViraPap和ViraType）和基于聚合酶链反应的检测法进行杂交试验以鉴定人乳头瘤病毒（HPV）基因组；以及针对单纯疱疹病毒、沙眼衣原体、梅毒、乙型肝炎和丙型肝炎的血清抗体检测。
对于两个种族组合而言，在对种族、年龄和性行为进行调整后，宫颈发育异常的最强危险因素与ViraPap检测出的宫颈HPV感染相关（比值比[OR]，12.8；95%置信区间[CI]，8.2至20.0）或与聚合酶链反应相关（OR，20.8；95%CI，10.8至40.2）。与发育异常相关的其他因素包括诊断时吸烟（OR，1.8；95%CI，1.2至2.8）；低收入（OR，2.2；95%CI，1.2至4.0）；低教育水平（OR，6.2；95%CI，3.4至11.1）；任何性传播疾病史（OR，1.9；95%CI，1.3至2.7）；以及乙型肝炎抗体血清阳性率（OR，1.8；95%CI，0.9至3.5）。对于西班牙裔女性，ViraType检测出的HPV 16/18与宫颈发育异常密切相关（OR，171.0；95%CI，22.8至1280.5）。单纯疱疹病毒2型抗体在西班牙裔女性中与发育异常无关，但在非西班牙裔白人中与发育异常显著相关。吸烟相关的危险因素也因种族而异。
在就诊患者中，与高级别宫颈发育异常相关的最强危险因素是HPV感染。尽管我们研究的大多数危险因素在两个种族的发育异常中显示出相似的关联，但我们的数据表明，与就诊于同一诊所的非西班牙裔白人相比，西班牙裔女性宫颈发育异常的发生可能涉及几种不同的危险因素。
