Objective To evaluate the diagnostic accuracy of human papillomavirus test for cervical neoplasia. Methods The Cochrane Library (Issue 2, 2010), Cochrane Central Register of Controlled Trials (Issue 2, 2010), and the following databases as CBMdisc, CNKI, MEDLINE, PubMed, and EMbase were all searched from their establishment to June 2010 to get all the randomized control trials (RCTs), and the relevant magazines and the references of the included studies were also searched. The screening, data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently. The software Metadisc 1.4 was used to perform meta-analyses, and the forest plots and SROC curves were drewn with the RevMan 5.0 software. Results A total of 7 RCTs involving 171 604 subjects were included. The meta-analyses showed, the sensitivity of the HPV test for detecting cervical neoplasia (CIN) was higher than that of the conventional cytology test; the difference in sensitivity for detecting CIN in or above second grade was only found between the test of HPV combined with cervical cytology and the test of conventional cytology (Plt;0.00001), but the HPV test obviously lowered its diagnostic specificity. Among the following three tests for diagnosing CIN, such as, the single test of HPV, the combined test of HPV and cervical cytology, and the test of HPV followed by cytology shunting, the statistic differences compared with the conventional cytology test were found (Plt;0.01) except the last test (P=0.41) which had no difference in diagnosing CIN in or above the first grade. Conclusion The current evidence indicates that, compared with the conventional cytology test, the HPV combined with the cytology test can improve the sensitivity for diagnosing CIN in or above the second grade, but the HPV test cannot improve the specificity for cervical neoplasia. The application of human papillomavirus test for detecting cervical neoplasia needs to be further studied.
【摘要】 目的 评价人乳头状瘤病毒(HPV)DNA检测在宫颈癌筛查中的价值。 方法 采用第二代杂交捕获(HCⅡ)技术和液基细胞学测试(LCT)2种方法,对1026例在妇科病中心就诊的受检者进行同步盲法检测,同时进行阴道镜检查。以宫颈活检组织病理学检查结果为诊断标准。评价该方案在宫颈癌筛查中的应用价值。 结果 病理检查结果显示,宫颈上皮内瘤变(CIN)Ⅰ级152例,CINⅡ级108例,CINⅢ级109例,宫颈浸润癌28例。筛查高危型HPV感染366例,阳性率3570%, 在不同宫颈病变中的阳性率分别是:宫颈癌9290%(26/28),CINⅢ900%(99/109),CINⅡ8890%(96/108),CINⅠ8750%(133/152)。高危HPV对宫颈高级别病变的敏感性、特异性、阳性预测值,阴性预测值分别是9860%、8610%、1480%和9980%;HPV与LCT联合检测(平行试验)的以上各指标分别是10000%、8090%、1210%和10000%。 结论 高危型人乳头状瘤病毒检测在宫颈癌前病变的筛查中有较高的敏感度和阴性预测值,联合LCT检测是目前宫颈癌筛查具有诊断价值的方法。【Abstract】 Objective To investigate the value of high risk human papillomavirus(HPV) DNA dectection for cervical cancer screening. Methods Hybrid capture Ⅱ(HCⅡ)human papillomavirus (HPV) test and liquid based cytology test (LCT) were performed in 1026 patients treaed in Xuzhou No.1 hospital from May 2008 to May 2009,and the abnomal cytological or HPV DNA findings were further biopsied under the colposcopeto to appraise the appicational importance of each approach for screening cervical cancer. Results Pathological results showed that cervical intraepithelial neoplasial(CIN)Ⅰin 152 patients,CIN Ⅱ in 108 patients,CIN Ⅲ 109 patients,invasive cervical cancer in 28 patients.HPV infected 366 patients in detection, with 3570% positive rate. The infection rate of HPV in cervical cancer was 929%(26/28),in CIN Ⅲ was 908%(99/109),in CIN Ⅱ was 889%(96/108),and in CIN Ⅰwas 875%(133/152).The pathological results treated as standard,the sensitivity, soecificiy, positive prevalue, negative prevalue of HCⅡ HPV for detecting highgrade cervical lesions were 986%,861%,148% and 998%.The values for HPVLCT parallel test were 1000%,809%,121% and 100%. Conclusion Highrisk HPV DNA test is of high sensitivity and negativepredictive value. The combination of HCⅡ HPV and LCT tests are of great value for screening cervical cancer at present.
ObjectiveTo systematically review the safety and immunogenicity of quadrivalent HPV vaccine among healthy population. MethodsDatabases including PubMed, EMbase, CBM, The Cochrane Library (Issue 9, 2013), CNKI, Web of Science and WanFang Data were searched for randomized controlled trials (RCTs) about safety and immunogenicity of quadrivalent HPV vaccine from inception to October 2013. Meanwhile handwork retrieval was also conducted and references of included literature were retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 9 studies were finally included consisting of 8 RCTs and involving 39 688 patients. The result of meta-analysis showed that:a) for safety, the incidence of injection adverse reaction (swelling and red spots) in vaccine group was higher than that in placebo group (RR=1.22, 95%CI 1.13 to 1.32, P<0.000 01); while the incidences of systemic adverse reaction (RR=1.03, 95%CI 0.99 to 1.07, P=0.1) and serious adverse reaction (RR=1.06, 95%CI 0.75 to 1.50, P=0.74) were alike between the two groups; and b) for immunogenicity, the serum antibody seroconversion rates in the vaccine group (including subtypes of HPV6, HPV11 HPV16 and HPV18) were all higher than those in the placebo group, with significant differences. ConclusionCompared with placebo, quadrivalent HPV vaccine has relatively high incidences of adverse reaction and high-degree immunogenicity, which can be widely used in the prevention of relevant diseases of human papillomavirus infection among adolescents. The main adverse reaction is local dysfunction, which is well tolerated, so the vaccine can be safely used. Due to limited quantity and quality of the included studies, the above conclusion should be verified by further conducting more large-scale, multicentre, high quality RCTs.
Objective To evaluate the cost effectiveness of human papillomavirus vaccine (HPV) for treating cervical cancer. Methods We constructed a Markov model to evaluate the cost-effectiveness of HPV versus Chinese healthy women aged 18 to 25 for treating Cervical Cancer. We calculated the clinical benefits and cost-effectiveness and judged the results based on willing to pay. Sensitivity analysis was made for parameters like cost, discounting rate and vaccine efficacy. Results HPV vaccination was a cost-effective option under the local willing to pay value with the incremental cost utility ratio 43 489 per QALY gained. It proved that vaccination was an economic and effective solution. Conclusion Given the results of Markov model, the cost effectiveness of HPV vaccination of Chinese women aged 18 to 25 is positive. Considering the data sources and model hypothesis, this report has some limitations. Further studies are warranted.
Objective To investigate HPV infection, genotype distribution of HPV infection among 8 944 females of health examination in West China Hospital of Sichuan University. Methods We enrolled 8 944 females of health examination in West China Hospital of Sichuan University from January to September in 2016. HPV genotyping was performed by Luminex fluorescence technique. Excel 2007 and SPSS 17.0 softwares were used to analyze the infection and genotype distribution of HPV. Results The HPV infection rate of 8 944 health examination women was 14.4% (1 291/8 944). Among them, there were 1 025 cases of single infection, the infection rate was 11.5% (1 025/8 944); there were 266 cases of multiple infection, the infection rate was 3.0% (266/8 944). The infection rates of 20 to 25 years and ≥66 years groups in single and multiple infection were higher than other age groups. In the single and multiple infections, the most common genotypes were HPV52, 53, 16 and 58. Infection rate of HPV52 was the highest in single infection, which had two increased age groups including 31 to 35 years and 61 to 65 years old. Infection rate of HPV52 and HPV16 were increased in 20 to 25 years old group of multiple infections. Conclusion In view of the prevalence of HPV infection among health examination females and the genotype distribution, we recommend incorporating HPV52, 53 and 58 into future vaccine screening.
ObjectivesTo systematically review the epidemiology of high-risk human papillomavirus (HPV) infections in western Chinese females.MethodsPubMed, Web of Science, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect epidemiological studies on female genital high-risk HPV infection in western China from January 2000 to July 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using R software.ResultsA total of 35 studies involving 149 037 objects were included. The results of meta-analysis showed that: the total infection rate of high-risk HPV in the northwest was 12.21% (95%CI 10.0% to 16.72%), and that in the southwest was 17.48% (95%CI 13.55% to 21.4%). The infection rate of high-risk HPV among healthy females in the northwest was 10.03% (95%CI 10.0% to 11.67%), while that in the southwest was 14.94% (95%CI 11.51% to 18.38%). CINⅠ, CINⅡ-Ⅲ and cervical cancer patients in the northwest with high-risk HPV infection rate were 70.31% (95%CI 49.0% to 91.61%), 84.29% (95%CI 68.36% to 100.22%) and 89.35% (95%CI 74.15% to 104.55%), respectively. The infection rates of patients with corresponding lesions in the southwest were 59.06% (95%CI 45.87% to 72.25%), 83.79% (95%CI 76.62% to 90.96%), and 81.07% (95%CI 67.77% to 94.37%), respectively.ConclusionsCurrent evidence shows that the epidemiological pattern of female genital high-risk HPV infection in western China is basically consistent with overseas. The high-risk HPV subtypes are subtype 16, 18, 31, 52, 53 and 58. The HPV vaccine used in China has basically covered the prevalent high-risk HPV subtypes in Western China. The wide application of vaccine may reduce the incidence and mortality of cervical precancerous lesions and cervical cancer, which will ensure reproductive health females in Western China. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.