全球精选文摘 - 预防性人类乳头瘤病毒L1病毒样颗粒疫苗对2级和3级宫颈上皮内瘤样增生及原位腺癌风险的影响：对4项随机化临床试验的联合分析

Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials

Ault KA, for The Future II Study Group 2009/5/27 10:50:39

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Lancet, 2007,

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Abstract

Background:

Cervical cancer and its obligate precursors, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), and adenocarcinona in situ (AIS), are caused by oncogenic human papillomavirus (HPV). In this combined analysis of four clinical trials we assessed the effect of prophylactic HPV vaccination on these diseases.

Methods:

20 583 women aged 16–26 years were randomised to receive quadrivalent HPV6/11/16/18 vaccine (n=9087), its HPV16 vaccine component (n=1204), or placebo (n=10 292). They underwent periodic Papanicolaou testing, with colposcopy or biopsy for detected abnormalities. The primary composite endpoint was the combined incidence of HPV16/18-related CIN2/3, AIS, or cervical cancer. These trials are registered at ClinicalTrials.gov, numbers NCT00365378, NCT00365716, NCT00092521, and NCT00092534.

Findings:

Mean follow-up was 3·0 years (SD 0·66) after first dose. In women negative for HPV16 or HPV18 infection during the vaccination regimen (n=17 129, per protocol), vaccine efficacy was 99% for the primary endpoint (95% CI 93–100), meeting the statistical criterion for success. In an intention-to-treat analysis of all randomised women (including those who were HPV16/18 naive or HPV16/18-infected at day 1), efficacy was 44% (95% CI 31–55); all but one case in vaccine recipients occurred in women infected with HPV16 or HPV18 before vaccination. In a second intention-to-treat analysis we noted an 18% reduction (95% CI 7–29) in the overall rate of CIN2/3 or AIS due to any HPV type.

Interpretation:

Administration of HPV vaccine to HPV-naive women, and women who are already sexually active, could substantially reduce the incidence of HPV16/18-related cervical precancers and cervical cancer.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

缓慢型心律失常须警惕心肌梗死——四川省人民医院病例

四川省人民医院心内科陈旸陈栖栖苏江刘明江

患者，男，70岁,因“心累、气紧1年余，加重1周”入院。1年前无明显诱因开始出现心累、气紧，不伴心悸、胸痛、胸闷及心前区压榨感，能平卧休息。无夜间阵发性呼吸困难，无双下肢水肿，无气喘，无胸闷胸痛，活动明显，休息后可缓解，多次因受凉复发，抗感染治疗可缓解。1周前患者活动时出现心累、气紧加重，伴乏力、大汗继而出现双眼黑蒙、晕倒，无意识丧失，无大小便失禁，持续约1小时后缓解。3天前受凉后再次发生心累、气紧，不能平卧，双下肢水肿，伴咳嗽,咯白色泡沫痰。当地医院住院治疗无缓解，为进

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