Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females
Risks for incident human papillomavirus infection and low-grade squamous intraepithelial lesion development in young females
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DOI：
10.1001/jama.285.23.2995
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发表时间：
2001-06-20
影响因子：
120.7
通讯作者：
Palefsky, J
中科院分区：
文献类型：
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作者：
Moscicki, AB;Hills, N;Palefsky, J
低度鳞状上皮内病变（LSIL）被描述为人类乳头瘤病毒（HPV）活跃复制的良性细胞学结果。一些研究报告指出，LSIL存在某些行为和生物学风险，这表明仅HPV不足以发展LSIL。然而，由于这些研究大多是横断面的，因此尚不清楚行为和生物风险是否只是HPV感染本身的风险。目的前瞻性地研究HPV阴性女性中HPV感染事件和HPV感染女性中LSIL发生的风险。设计1990-2000年进行的前瞻性队列研究，中位随访时间为50个月。设置和参与者在弗朗西斯科湾区2家计划生育诊所就诊的13至21岁女性; HPV阳性496例，HPV阴性105例。主要指标HPV感染和LSIL的发生发展，通过各种人口统计学分析，行为和临床危险因素。结果54例HPV感染发生在105名女性中，这些女性在进入研究时HPV阴性（HPV阴性者的中位随访时间为26个月）。多变量分析显示，HPV的风险包括性行为（相对危险度[RH]，10.10; 95%置信区间[CI]，3.24-31.50/新伴侣/月）、单纯疱疹病毒史（RH，3.54; 95% CI，1.37-9.10）和外阴疣史（RH，2.73; 95% CI，1.27-5.87）。目前使用口服避孕药具有显著的保护作用（RH，0.49; 95%CI，0.28-0.86）。在基线或随访时HPV阳性的496名患者中，随访期间有109例LSIL事件，从未发生LSIL的患者的中位随访时间为60个月。HPV感染是LSIL发生的最重要的危险因素，多因素模型显示LSIL的危险因素如下：HPV感染时间小于1年（RH，7.40; 95% CI，4.74-11.57）; HPV感染1 - 2年（RH，10.27; 95% CI，5.64-18.69）; HPV感染2 - 3年（RH，6.11; 95% CI，1.86-20.06）和每日吸烟（RH，1.67; 95% CI，1.12-2.48）。此外，在我们的研究中，大多数HPV感染的女性在60个月的中位随访期内没有发生LSIL。这些发现强调了这样的假设：认为与LSIL相关的某些生物学风险实际上是感染HPV的风险。吸烟是LSIL特有的风险，支持烟草在肿瘤发展中的作用。
Context Low-grade squamous intraepithelial lesions (LSILs) have been described as a benign cytological consequence of active human papillomavirus (HPV) replication. Several studies have reported that certain behavioral and biological risks exist for LSIL, suggesting that HPV alone is not sufficient for the development of LSIL. However, because most of these studies have been cross-sectional, it is not known whether behavioral and biological risks are simply risks for HPV infection itself.Objective To prospectively examine risks of incident HPV infection in HPV-negative females and of incident LSIL development in females with HPV infection.Design Prospective cohort study conducted between 1990-2000, with a median follow-up of 50 months.Setting and Participants Females aged 13 to 21 years who attended 2 family planning clinics in the San francisco bay area; 496 had prevalent HPV infection and 105 were HPV-negative.Main Outcome Measure Incident development of HPV infection and LSIL, analyzed by various demographic, behavioral, and clinical risk factors.Results Fifty-four incident HPV infections occurred in the 105 females who were HPV-negative at study entry (median duration of follow-up for those who remained HPV-negative was 26 months). Multivariable analysis showed that risks of HPV included sexual behavior (relative hazard [RH], 10.10; 95% confidence interval [CI], 3.24-31.50 per new partner per month), history of herpes simplex virus (RH, 3.54; 95% CI, 1.37-9.10), and history of vulvar warts (RH, 2.73; 95% CI, 1.27-5.87). Current use of oral contraceptives had a significantly protective effect (RH, 0.49; 95% CI, 0.28-0.86). Among the 496 individuals who were HPV-positive at baseline or in follow-up, there were 109 incident cases of LSIL during the follow-up interval, with a median follow-up time of 60 months for those who never developed LSIL. Human papillomavirus infection was the most significant risk factor for development of LSIL, The multivariable model showed the following risks for LSIL: HPV infection for less than 1 year(RH, 7.40; 95% CI, 4.74-11.57); HPV infection for 1 to 2 years (RH, 10.27; 95% CI, 5.64-18.69); HPV infection for 2 to 3 years (RH, 6.11; 95% CI, 1.86-20.06); and daily cigarette smoking (RH, 1.67; 95% CI, 1.12-2.48).Conclusion Our results indicate distinct risks for HPV and LSIL. In addition, most women with HPV infection in our study did not develop LSIL within a median follow-up period of 60 months. These findings underscore the hypothesis that certain biological risks thought to be associated with LSIL are, in fact, risks for acquisition of HPV. Cigarette smoking was a risk specific to LSIL, supporting the role of tobacco in neoplastic development.