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AIM：虽然是轻微细胞学异常，如果HPV 16/18阳性，有必要进行阴道镜检查

2016-11-15 MedSci MedSci原创

HPV16/18阴道镜宫颈癌
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近期有研究表明，轻微细胞学异常的女性进行高危HPV检测后，使用HPV 16和18型测试作为第二次筛选试验，可以帮助确定是否有必要进行阴道镜检查。 来自布鲁塞尔公共卫生科学机构的Marc Arbyn博士说：“轻微细胞学异常包括无明确意义的非典型鳞状细胞(ASC-US)或低度鳞状上皮内病变(LSIL)，这些情况只会轻度增加宫颈癌风险。由于HPV 16和18型导致了约70%的宫颈癌，如果能将这两个

近期有研究表明，轻微细胞学异常的女性进行高危HPV检测后，使用HPV 16和18型测试作为第二次筛选试验，可以帮助确定是否有必要进行阴道镜检查。

来自布鲁塞尔公共卫生科学机构的Marc Arbyn博士说：“轻微细胞学异常包括无明确意义的非典型鳞状细胞(ASC-US)或低度鳞状上皮内病变(LSIL)，这些情况只会轻度增加宫颈癌风险。由于HPV 16和18型导致了约70%的宫颈癌，如果能将这两个类型的HPV基因分型作为额外的测试工具，那么将有利于更精细化的管理。”

Arbyn及其同事进行了一项系统回顾和荟萃分析，以确定hrHPV测试后，基因型HPV 16/18及轻微细胞学异常（宫颈病变）作为第二次筛选试验的有效性。

检索相关数据库后，研究涉及了ASC-US（n = 8587）和LSIL（n = 5284）女性患者，进行高危HPV和HPV 16/18的分类测试。

他们发现，ASC-US或LSIL女性，基因型HPV 16/18诊断宫颈上皮内瘤变3级（CIN3+）的敏感性为70%。ASC-US和LSIL女性， < 2 CIN的敏感性分别为83% (95% CI, 80-86)和76% (95% CI, 74-79)。此外，HPV 16/18阳性的ASC-US和LSIL女性，CIN3+的平均风险为CIN3+。高危型HPV阳性、HPV 16/18阴性+ASC-US或LSIL女性的CIN3 +平均风险仅为5%。

Arbyn和同事们得出结论：“HPV 16/18阳性的女性有更高的风险，应进行阴道镜检查。”

原始出处：

Arbyn M, et al. Genotyping for Human Papillomavirus Types 16 and 18 in Women With Minor Cervical Lesions: A Systematic Review and Meta-analysis.Ann Intern Med. 2016;doi:10.7326/M15-2735.

Genotyping for HPV 16/18 may better inform colposcopy recommendation.Healio.November 14, 2016

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    2017-03-04 12498da4m32(暂无昵称)

    #阴道镜检查#

    0

  2. 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    2017-08-02 yangcx0915

    #细胞学#

    0

  3. 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    2016-11-19 ylzr123

    HPV16/18阳性的女性有更高的风险，应进行阴道镜检查。受益匪浅，认真学习了，好文值得点赞！

    0

  4. 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level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:30 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155906, encodeId=b315155906fb, content=学习下，不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:19 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155905, encodeId=44d11559051f, content=学习下，好, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-17 虈亣靌

    讲的好学习了

    0

  5. 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objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-17 rebeccajiejie

    #阴道镜#

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-15 1771ae4158m

    有意思，学习下

    0

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level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:30 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155906, encodeId=b315155906fb, content=学习下，不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:19 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155905, encodeId=44d11559051f, content=学习下，好, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-15 1771ae4158m

    学习下，很好

    0

  8. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:51 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155908, encodeId=894b155908a9, content=学习下，很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:43 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155907, encodeId=55de15590ebb, content=学习下，不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:30 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155906, encodeId=b315155906fb, content=学习下，不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:19 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155905, encodeId=44d11559051f, content=学习下，好, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-15 1771ae4158m

    学习下，不错

    0

  9. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:51 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155908, encodeId=894b155908a9, content=学习下，很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:43 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155907, encodeId=55de15590ebb, content=学习下，不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:30 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155906, encodeId=b315155906fb, content=学习下，不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:19 CST 2016, time=2016-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=155905, encodeId=44d11559051f, content=学习下，好, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-15 1771ae4158m

    学习下，不错

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Nov 15 13:29:12 CST 2016, time=2016-11-15, status=1, ipAttribution=)]
    2016-11-15 1771ae4158m

    学习下，好

    0

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近日，葛兰素史克（GSK）公司宣布其针对人乳头状瘤病毒（HPV）16型和18型的二价疫苗希瑞适获得中国食品药品监督管理总局的上市许可，成为国内首个获批的预防宫颈癌的HPV疫苗。 据世界卫生组织官方网站公布的信息显示，宫颈癌已成为发展中国家女性第二大常见癌症，也是致死率最高的癌症之一。因此，希瑞适要进入中国市场的消息一经发布立即引发热议。同时，也使人们对于HPV的关注度直线飙升。

Am J Obstet Gynecol：青少年和年轻妇女HPV、沙眼衣原体共同感染的流行病学调查

背景：人乳头瘤病毒（HPV）、沙眼衣原体（CT）共享相同的性传输路线，并具有相同的危险因素，提示合并感染可能对上皮细胞异常的诱导起协同作用。目的：本研究的目的是确定在青少年和年轻女性中的HPV和CT的患病率，并确定与共同感染的因素。方法：本研究包括276名性活跃参与者，年龄在15-24岁。进行了采访、宫颈标本收集行宫颈涂片和分子试验。对所有宫颈标本测试27个HPV基因型，当然通过PCR也对CT进行

BMJ：HPV究竟多长长时间筛选一次？

由此可见，HPV阴性妇女宫颈癌和CIN3+的长期发生率较低，并支持扩展的宫颈筛查间隔超过五年，尤其是年龄在40岁及以上的女性中。HPV阳性的妇女随后细胞学、HPV16和18型、和/或重复细胞学检查为阴性的妇女比HPV阴性的妇女患CIN3+的风险至少要高出五倍，表明以HPV检测为基础的筛查方案间隔延长（＞五年）应与危险分层一起实施。

CA：美国癌症协会（ACS）更新接种HPV疫苗的建议

人乳头瘤病毒（HPV）与宫颈癌、外阴癌、阴道癌、肛门癌、口咽癌、阴茎癌等众多癌症和癌前病变有关。在美国，每年大约有28500例癌症可以通过接种疫苗进行预防。 如果想获得HPV疫苗的最大效力，ACS推荐：在11-12岁接种HPV疫苗（捆绑其他常规青少年疫苗，如Tdap和MCV4），且在13岁之前完成三剂量HPV疫苗接种。 对于超过最佳年龄段之后，再接种HPV疫苗，可能会没有效果。

Cancer：口腔卫生会影响HPV相关头颈部鳞状细胞癌的患病风险吗？

背景：口腔卫生指标差（包括吸烟），已被证明可以增加的头颈部鳞状细胞癌，特别是口咽部鳞状细胞癌（OPSCC）的风险。但很少有研究探讨该联系是否也与人类乳头瘤病毒（HPV）状态有关。

2016BC指南——女性生殖系统肿瘤：HPV相关肿瘤（宫颈、阴道和外阴）（修订版）发布

2016年7月，不列颠哥伦比亚省临床实践指南中心(BC)发布了女性生殖系统肿瘤：HPV相关肿瘤（宫颈、阴道和外阴）指南2016修订版，指南主要针对年龄≥19岁女性HPV相关肿瘤包括宫颈癌，阴道癌和外阴癌的筛查，诊断以及随访提出推荐意见。全文获取：下载地址：指南下载  (需要扣积分2分, 梅斯医学APP免积分下载)

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