宫颈癌发病与三类危险因素关系的Meta分析

发布时间：2018-04-08 16:16

本文选题：宫颈癌　切入点：危险因素　出处：《广西医科大学》2014年硕士论文

【摘要】：目的：采用Meta分析来综合评价三类危险因素包括：(1)生物学因素：高危型人乳头瘤病毒(High-Risk Human Papilloma Virus, HR-HPV）感染；(2)行为因素：初次性生活过早、多个性伴侣、多次阴道分娩、多次人工流产次、长期使用口服避孕药(Oral Contraceptive, OC)及被动吸烟（SecondHand Smoking, SHS）；（3）遗传因素：妇科恶性肿瘤家族史与宫颈癌（CervicalCancer, CC）发病的关系。方法：宫颈癌的三类危险因素关系通过计算机检索收集从2001年01月到2014年3月国内外包括中文和英文，搜索CNKI、WAN FANG、VIP、Pubmed及Embas数据库。发表的关于宫颈癌发病的三类危险因素的研究文献，由两名研究者进行提取资料，并根据纳入排除标准收集相关病例对照研究(Case-Control Study, CCS)文献，用Meta分析方法进行综合分析，计数资料采用比值比（Odds Ratio,OR）,作为影响因素的效应值，以OR、95%可信区间（Confidence Interval,CI）表示各效应量区间范围。提取有8个因素：①HR-HPV感染;②初次性生活过早；③多个性伴侣；④多次阴道分娩；⑤多次人工流产；⑥长期使用口服避孕药；⑦被动吸烟及⑧妇科恶性肿瘤家族史，可用数据信息纳入研究的试验数据，采用Cochrane协作网提供的Rev Man5.2软件进行统计分析。结果：最终纳入18篇病例对照文献，其中，中文文献4篇，英文文献14篇，研究对象共5187例，其中对照8642例。进行了Meta分析结果对下： 1．生物学因素：HR-HPV感染，合并效应量OR值为128.38,95%CI（75.43,218.51），P＜0.001，其差异具有统计学意义。 2．行为因素：初次性生活过早，合并效应量OR值为1.87,95%C（I1.66,2.11），P＜0.001，其差异具有统计学意义。多个性伴侣，合并效应量OR值为2.30,95%CI（2.03,2.58），P＜0.001，其差异有统计学意义。多次阴道分娩，合并效应量OR值为1.86,95%CI（1.68,2.06），P＜0.001，其差异有统计学意义。多次人工流产，合并效应量OR值为1.42,95%CI（1.17,1.71），，P＜0.001，其差异有统计学意义。长期使用口服避孕药，合并效应量OR值为1.85,95%CI（1.55,2.22），P＜0.001，其差异有统计学意义。被动吸烟，合并效应量OR值为4.03,95%CI（3.20,5.08），P＜0.001，其差异有统计学意义。 3．遗传因素：妇科恶性肿瘤家族史，合并效应量OR值为1.83,95%CI（1.13,2.98），P＜0.05，其差异有统计学意义。结论：本研究对三大类因素进行了Meta分析后结果认为，HR-HPV感染是宫颈癌发病的主要危险因素。初次性生活过早，多个性伴侣，多次阴道分娩，多次人工流产，长期使用口服避孕药，被动吸烟及妇科恶性肿瘤家族史是宫颈癌发病的致病因素。临床上可以应用这些述结论指导妇女健康教育，从而起到宫颈癌的早期预防作用。
[Abstract]:Objective: to evaluate three types of risk factors by Meta analysis: 1) biological factors: high risk Human Papilloma Virus2 (HR-HPV2) behavioral factors: early first sexual life, multiple sexual partners, multiple vaginal births.Multiple induced abortions, long term use of oral contraceptive oral Contractive (OCC) and passive smoking second hand Smoking3) genetic factors: the family history of gynecological malignant tumors and the incidence of Cervical Cancer (CCC).Methods: from January 2001 to March 2014, three types of risk factor relationships of cervical cancer were collected, including Chinese and English, and CNKI WAN fangguang VIPP Pubmed and Embas database were searched.The published literature on the three risk factors of cervical cancer was extracted by two researchers, and the Case-Control study (CCSs) was collected according to the exclusion criteria. The results were analyzed comprehensively by Meta analysis.In the counting data, odds ratio ratio (Odds) was used as the effect value of the influencing factors, and the 95% confidence interval (CI) was used to indicate the range of effect quantities.There were 8 factors: 1 HR-HPV infection and 3 precocious sexual life, 3 multiple sexual partners, 4 vaginal labor, 5 induced abortion and 6 long term use of oral contraceptives, passive smoking and 8 family history of gynecological malignant tumors.The available data information is incorporated into the experimental data, and the Rev Man5.2 software provided by the Cochrane Cooperative Network is used for statistical analysis.Results: 18 case-control articles were included, including 4 in Chinese and 14 in English. 5187 cases were included in the study, of which 8642 were controls.The results of Meta analysis are as follows:1.Biological factor: HR-HPV infection, the OR value of combined effect was 128.38 ~ 95% (P < 0.001).2.Behavioral factors: the first sexual life was premature, the OR value of the combined effect was 1.87 ~ 95%, P < 0.001, the difference was statistically significant.For multiple personality partners, the OR value of the combined effect was 2.30% 95%, 2.03% 2.58% (P < 0.001), and the difference was statistically significant.For multiple vaginal delivery, the OR value of the combined effect was 1.86 ~ 95CII 1.68 ~ 2.06 (P < 0.001), and the difference was statistically significant.For multiple induced abortion, the OR value of combined effect was 1.42% 95% (P < 0.001), and the difference was statistically significant.After long-term use of oral contraceptives, the OR value of combined effect dose was 1.85 卤95CI 1.55 ~ 2.22% (P < 0.001), and the difference was statistically significant.The OR value of the combined effect of passive smoking was 4.03 ~ 95CIQ 3.20 ~ 5.08 (P < 0.001), and the difference was statistically significant.3.Genetic factors: family history of gynecologic malignancy, OR value of combined effect was 1.833.95 CIQ 1.132.98 (P < 0.05), the difference was statistically significant.Conclusion: the results of Meta analysis showed that HR-HPV infection was the main risk factor of cervical cancer.Premature sexual life, multiple sexual partners, multiple vaginal deliveries, multiple induced abortions, long-term use of oral contraceptives, passive smoking and family history of gynecological malignant tumors are the pathogenic factors of cervical cancer.These conclusions can be used in clinic to guide women's health education, so as to play an early role in the prevention of cervical cancer.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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