预防性HPV疫苗预防宫颈癌有效性和安全性Meta分析

发布时间：2018-05-29 01:54

  本文选题：HPV疫苗 + 宫颈癌　； 参考：《中华肿瘤防治杂志》2015年09期

【摘要】：目的系统评价预防性HPV疫苗预防宫颈癌的有效性与安全性。方法计算机全面检索Cochrane Library、PubMed、EMbase、中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)以及万方数据库,并辅以手工检索,检索时间从建库至2014-08,查找关于预防性HPV疫苗预防宫颈癌的随机对照研究(randomized control trials,RCT)。由2名评价员按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果最终共纳入22篇RCT,包括14项原始研究,8项随访研究。Meta分析结果显示,与对照组相比,预防性HPV疫苗对HPV16和HPV18相关的宫颈上皮内瘤样变(cervical intraepithelial neoplasia,CIN)Ⅱ+感染的相对危险度(RR)及其95%可信区间(95%CI),在按照预案规定(PP)人群分析分别为0.03(0.01~0.07)和0.05(0.02~0.13),在意向性分析(ITT)人群分别为0.51(0.41~0.63)和0.15(0.10~0.22)。HPV疫苗对HPV16和HPV18相关的≥6个月持续性感染的RR及其95%CI,在PP人群分析分别为0.06(0.04~0.08)和0.19(0.12~0.32),在ITT人群分析分别为0.14(0.10~0.21)和0.07(0.02~0.26),HPV疫苗对CINⅠ+感染也有相似的有效性。同时,HPV疫苗对于高风险HPV所引起的CINⅡ+、HPV持续性感染和CINⅠ+也有交叉保护效果,其差异有统计学意义。预防性HPV疫苗的主要不良反应较轻微,严重不良反应和死亡率在疫苗组和对照组保持均衡。结论预防性HPV疫苗对预防宫颈癌前病变及HPV持续性感染显示了高效的保护效应和交叉保护效果,是安全有效的。然而现有报道尚不能提供预防宫颈癌的直接证据,有待开展更多高质量RCT并延长随访时间以进一步验证。
[Abstract]:Objective to evaluate the efficacy and safety of prophylactic HPV vaccine in the prevention of cervical cancer. Methods Cochrane Library PubMeden EMbase, Chinese Biomedical Literature Database, Chinese Journal Full-text Database and Wanfang database were searched by computer, supplemented by manual retrieval. The search time was from the construction of the library to 2014-08, and the randomized control trialsof randomized controlled study on the prevention of cervical cancer with prophylactic HPV vaccine was found. According to the criteria of inclusion and exclusion, two evaluators independently carried out literature screening, data extraction and quality evaluation, and Meta analysis was carried out with RevMan 5.2 software. Results A total of 22 RCTs were included, including 14 original studies and 8 follow-up studies. Meta-analysis showed that, compared with the control group, The relative risk of HPV16 and HPV18 associated cervical intraepithelial neoplasia cin 鈪，

本文编号：1949045