不同价人乳头瘤病毒（HPV）疫苗预防女性持续HPV16/18感染和CIN2+的效果：系统评价和网络荟萃分析

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2025-02-01 DOI:10.1016/j.ijid.2024.107363

Haiyue Wu , Lucia Li , Kun Fu , YuFei Shen , Yingnan Lu , Zexi Liao , Yingzhen Liu , Wenting Zha , Lisha Wu , Yu Zhang

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引用次数: 0

摘要

目的：评价2价、4价和9价HPV疫苗在预防持续HPV感染和宫颈上皮内瘤变2级或以上（CIN2+）病变的基线时不同感染状态的妇女中的疗效。方法：检索PubMed、Web of Science、Cochrane、Embase和ClinicalTrials.gov网站自成立至2024年3月的数据。随机对照试验（rct）和随机对照试验的事后分析报告持续HPV感染和CIN2+接种妇女的风险。计算优势比（ORs）和95%置信区间（CIs）来总结干预效果。结果：纳入18项随机对照试验和1项随机对照试验的事后分析。在按方案（ATP）队列中，4价疫苗对hpv16 /18相关持续感染和CIN2+（6个月持续感染（6mPIs））最有效：OR 0.05, 95% CI [0.02, 0.15]；12个月持续感染（12mPIs）： OR 0.02, 95% CI [0.00, 0.18]；95% ci[0.01, 0.17])。对于总疫苗接种队列（tvc）， 2价疫苗对hpv16 /18相关的12mPIs和CIN2+最有效(12mPIs: OR 0.15, 95% CI [0.04, 0.63]；CIN2+: OR 0.52 95% CI[0.32, 0.87])，而4价疫苗对hpv16 /18相关的6mPIs最有效（OR 0.08, 95% CI[0.02, 0.28]）。结论：无论是否接种HPV疫苗，接种HPV疫苗均可显著降低持续hpv16 /18相关感染和CIN2+的风险。除了4价和9价疫苗外，2价疫苗也可以提供令人满意的保护，防止持续的hpv16 /18相关感染和CIN2+，特别是从长期来看，并且可能成为发展中国家政府主导的疫苗接种计划的替代方案。

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Effects of different-valent vaccines against human papillomavirus (HPV) to prevent persistent HPV16/18 infections and CIN2+ in women: a systematic review and network meta-analysis

Objectives

To evaluate the efficacy of 2-valent, 4-valent and 9-valent HPV vaccination in preventing persistent HPV infections and cervical intraepithelial neoplasia grade 2 or higher (CIN2+) lesions among women with different infection statuses at baseline.

Methods

PubMed, Web of Science, Cochrane, Embase and ClinicalTrials.gov were searched from their inception to March 2024. Randomized controlled trials (RCTs) and post hoc analyses of RCTs reporting the risk of persistent HPV infections and CIN2+ among vaccinated women were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to summarize the intervention effects.

Results

Eighteen RCTs and one post hoc analysis of RCTs were included. In the according-to-protocol (ATP) cohorts, the 4-valent vaccine was the most effective against HPV16/18-related persistent infections and CIN2+ (6-month persistent infections (6mPIs): OR 0.05, 95% CI [0.02, 0.15]; 12-month persistent infections (12mPIs): OR 0.02, 95% CI [0.00, 0.18]; CIN2+: OR 0.03 95% CI [0.01, 0.17]). For the total vaccination cohorts (TVCs), the 2-valent vaccine was most effective against HPV16/18-related 12mPIs and CIN2+ (12mPIs: OR 0.15, 95% CI [0.04, 0.63]; CIN2+: OR 0.52 95% CI [0.32, 0.87]), whereas the 4-valent vaccine was most effective against HPV16/18-related 6mPIs (OR 0.08, 95% CI [0.02, 0.28]).

Conclusions

Vaccination against HPV can significantly reduce the risk of persistent HPV16/18-related infections and CIN2+, regardless of the HPV infection prevaccination. In addition to 4- and 9-valent vaccines, 2-valent vaccines could also provide satisfactory protection against persistent HPV16/18-related infections and CIN2+, especially over the long term, and may constitute an alternative for government-led vaccination programs in developing countries.

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.