男男性行为者肛周及肛管尖锐湿疣复发的危险因素分析

Analysis of risk factors for recurrence of perianal and anal condyloma acuminatum among men who have sex with men

目的探讨男男性行为者(MSM)肛周及肛管内尖锐湿疣复发的危险因素。方法通过问卷调查,采集132例患者的社会人口统计学、行为学资料,使用导流杂交基因芯片技术确定患者感染人类乳头瘤病毒(HPV)的基因分型。采用单因素和多因素Logistic回归分析方法,筛选尖锐湿疣复发的影响因素。单因素分析中P<0.20的变量纳入多因素Logistic回归分析。结果 132例患者首次CO2激光治疗后,复发67例,复发率50.8%。HPV阳性的132例标本中,共检出13种HPV基因型。低危型感染82例(62.1%),高危型感染50例(37.9%)。多因素Logistic回归分析发现,感染HPV基因分型中含有高危型[比值比(OR)=3.501,95%可信区间(CI):1.147~10.682]、皮损的发生部位侵及肛管(OR=5.130,95%CI:1.548~17.006)、首诊时疣体数目>10个或受累面积>2cm^2(OR=7.291,95%CI:2.376~22.374)、患者合并肛门常见疾病(痔疮、肛瘘、肛裂)(OR=6.026,95%CI:1.414~25.686)、合并艾滋病病毒(HIV)感染(OR=15.224,95%CI:1.353~171.241),是尖锐湿疣复发的危险因素。结论高危型HPV感染要加大治疗力度,加强随访,定期复查,关注HIV感染,并采取良好有效的干预机制,以降低尖锐湿疣的复发率。

Objective To explore the risk factors of recurrence of perianal and anal condylorna acuminaturn （CA） among men who have sex with men （MSM） in Shanghai. Methods A questionnaire interview was conducted among 132 MSM to collect social-demographic and behavioral data, and to identify HPV genotyping by the flow-through hybridization and gene chip. Logistic regression analysis was conducted to explore the factors associated with （CA） recurrence. Variables with P valued 0.20 in univariate analysis were included in the multivariate analysis. Results The result from multivariate logistic regression analysis indicated that independent risk factors for recurrence of CA included being infected with high risk type of HPV（OR=3.50, 95 %CI： 1. 147-10. 682）, skin lesions invasion anal （OR=5.13, 95%CI：1.55-17.01）, the number of wart at the first diagnosis〉10, or involvement area〉2cm2 （OR =7.29, 95%0CI：2.38-22.37）, anus common disease such as symptomatic hemorrhoids, anal fistula, anal fissure （OR=6.00, 95%CI：1.41-25.69）, and HIV infection （OR=15.22, 95%CI：1. 35-171. 24）. Conclusion The re- currence rate of CA can be reduced by timely medical treatment, intensive follow ups, regular review, and the effec-tive interventions, especially to HIV positive patients.