RELATIONSHIP OF CIN III AND HUMAN PAPILLOMA VIRUS

这是一项修订后的提案，将继续进行病例对照研究，以检验 假设感染人乳头瘤病毒(HPV)与 宫颈上皮内瘤变III(CIN)风险增加 III/原位癌)。此外，这项研究还将调查 是否存在或可能牵涉到其他性传播传染病 药物(如单纯疱疹病毒II型、巨细胞病毒和衣原体)和其他暴露(包括 吸烟、避孕用法和营养)。 这项以人群为基础的病例对照研究将继续确定和 采访患有经活检证实的CIN III的妇女，她们是这三家医院的居民 华盛顿州西部的城市县，年龄在45岁或以下，并参加 团体健康合作社(GHC)，美国最大的医疗保健组织之一 各州。相同年龄和居住县的妇女将受到控制 从GHC的招生档案中随机抽取并进行访谈。全 以往的细胞学标本(巴氏涂片)和宫颈活检 和对照将通过以下方式收集和评估HPV类型的存在 聚合酶链式反应(PCR)方法。将采集血液样本 从病例和对照两方面进行分析，以寻找以前接触过 性传播病毒感染。 这项研究最初获得批准，并为为期两年的试验阶段提供资金， 人乳头瘤病毒计划项目赠款(CA 42792)的一部分。这份修订后的提案 解决了评价者对使用聚合酶链式反应方法进行测量的关注 巴氏涂片中HPV的存在。自成立以来，聚合酶链式反应已经成为 被公认为流行病学中最敏感的检测HPV的方法 研究是唯一可用于此类研究的方法，其中 依靠档案标本，如巴氏涂片。

This is a revised proposal to continue a case-control study to test the hypothesis that infection with human papilloma virus (HPV) is related to an increased risk of cervical intraepithelial neoplasia III (CIN III/carcinoma-in-situ). In addition, this study will investigate the presence and possible involvement of other sexually transmitted infectious agents (such as HSV-II, CMV, and chlamydia) and other exposures (including smoking, contraceptive use, and nutrition). This population-based case-control study will continue to identify and interview women with biopsy-proven CIN III who are residents of the three urban counties of western Washington, 45 years old or less, and enrolled in Group Health Cooperative (GHC), one of the largest HMOs in the United States. Control women of the same ages and counties of residence will be randomly selected through enrollment files of GHC and interviewed. All previous cytologic specimens (Pap smears) and cervical biopsies of cases and controls will be collected and evaluated for presence of HPV types by means of Polymerase Chain Reaction (PCR). Blood samples will be collected from both cases and controls and analyzed for evidence of prior exposure to sexually transmitted viral infections. This study was initially approved and funded for a two-year pilot phase as part of a program project grant (CA 42792) on HPV. This revised proposal addresses concerns by reviewers about the use of the PCR method to measure the presence of HPV in Pap smears. Since its inception, the PCR has become recognized as the most sensitive method of measuring HPV in epidemiologic studies and is the ONLY method available for studies such as this which rely on archival specimens, such as Pap smears.