Roteli-Martins C M, Panetta K, Alves V A, Siqueira S A, Syrjänen K J, Derchain S F
Department of Obstetrics and Gynecology, Campinas State University (UNICAMP), Brazil.
Acta Obstet Gynecol Scand. 1998 Jul;77(6):678-82. doi: 10.1034/j.1600-0412.1998.770617.x.
This cross-sectional study was designed to evaluate the role of cigarette smoking and high-risk HPV types as risk factors of CIN 2 and 3 in young, sexually active Brazilian women.
A series of 100 consecutive women with abnormal Pap smears were recruited, subjected to colposcopy, punch biopsy, and questionnaire for their social, sexual and reproductive factors. Of these, 77 women between 20 and 35 years of age (median 26.5 years) with biopsy-confirmed CIN 1 or CIN 2 and 3, were enrolled in this study. Representative samples from the exocervix and endocervix were obtained for HPV testing with the Hybrid Capture HPV-DNA assay, including the probes for the oncogenic HPV types (16, 18, 31, 33, 35, 45, 51, 52 and 56).
The overall rate of CIN 2 and 3 was 23/77 (29.8%). The women with CIN 1, 2 and 3 did not differ from each other with regard to their age, race, schooling, marital status, lifetime number of sexual partners, age at first intercourse, use of oral contraceptives, or parity. However, current cigarette smoking was strongly associated with CIN 2 and 3 (p<0.001), and among smokers, the risk of high-grade CIN increased in parallel with the time of exposure (years of smoking) (p=0.07). HPV-DNA of the oncogenic types was detected in 43 (56%) women, the risk of being HPV DNA-positive was significantly higher in CIN 2 and 3 as compared with CIN 1 (p=0.037). Importantly, the prevalence of high-risk HPV types was significantly higher in cigarette smokers than in non-smokers (p=0.046).
The results indicate that the severity of CIN lesions was clearly related to two fundamental risk factors: 1) high-risk HPV types, and 2) current cigarette smoking. These two risk factors were closely interrelated in that the high-risk HPV types were significantly more frequent in current smokers than in non-smokers, suggesting the possibility of a synergistic action between these two risk factors in cervical carcinogenesis.
本横断面研究旨在评估吸烟和高危型人乳头瘤病毒（HPV）作为巴西年轻性活跃女性中2级和3级宫颈上皮内瘤变（CIN）危险因素的作用。
招募了连续100例巴氏涂片异常的女性，对其进行阴道镜检查、组织活检，并就其社会、性和生殖因素进行问卷调查。其中，77例年龄在20至35岁之间（中位数26.5岁）、活检确诊为1级CIN或2级和3级CIN的女性纳入本研究。采集宫颈外口和宫颈管的代表性样本，采用杂交捕获HPV-DNA检测法进行HPV检测，检测探针包括致癌性HPV类型（16、18、31、33、35、45、51、52和56）。
2级和3级CIN的总体发生率为23/77（29.8%）。1级、2级和3级CIN的女性在年龄、种族、受教育程度、婚姻状况、性伴侣终身数量、初次性交年龄、口服避孕药使用情况或生育状况方面无差异。然而，当前吸烟与2级和3级CIN密切相关（p<0.001），在吸烟者中，高级别CIN的风险随暴露时间（吸烟年限）增加（p=0.07）。43例（56%）女性检测到致癌型HPV-DNA，2级和3级CIN中HPV DNA阳性的风险显著高于1级CIN（p=0.037）。重要的是，吸烟者中高危型HPV类型的患病率显著高于非吸烟者（p=0.046）。
结果表明，CIN病变的严重程度与两个基本危险因素明显相关：1）高危型HPV类型，2）当前吸烟。这两个危险因素密切相关，因为当前吸烟者中高危型HPV类型的频率显著高于非吸烟者，提示这两个危险因素在宫颈癌发生过程中可能存在协同作用。
