HPV四价疫苗对宫颈癌预防效果的meta分析

Efficacy of Quadrivalent Human Papillomavirus Vaccine for Preventing Cervical Cancer:a Meta Analysis

目的:探究四价人乳头瘤病毒疫苗对宫颈癌预防的作用效果。方法:计算机检索Medline、EMBASE、Pubmed、Cochrane library中国生物医学文献数据库系统(CMB)、中国期刊全文数据库(CNKI)、万方数据库、维普数据库等(检索文献年限均为数据库建立-2019年12月),收集各数据库中公开发表的有关四价HPV疫苗在预防宫颈癌中作用的随机对照研究、队列研究的文献,其语种包括中英文。利用RevMan5.3软件进行Meta分析。将CIN1和CIN2+的RR值用作效果指标,并以95%可信区间(95%CI)表示;采用漏斗图检测发表偏倚。结果:最终纳入RCT研究文献13篇,共84038例受试者,其中接种疫苗组42002例,对照组42036例。分析结果显示接种四价疫苗可使宫颈上皮内瘤样变Ⅰ级的发生率降低96%(RR=0.04,95%CI(0.03,0.06),P<0.00001);使CIN2+的发生率降低96%(RR=0.04,95%CI(0.03,0.07),P<0.00001)。结论:接种四价HPV疫苗对预防宫颈癌具有较高的保护性,远期效果良好。

Objective:To explore the preventive effect of quadrivalent vaccine on cervical cancer.Methods:Computer Searched Medline,EMBASE,Pubmed,Cochrane library Chinese Biomedical Literature Database System(CMB),Chinese Journal Full-text Database(CNKI),Wanfang Database,Weipu Database,etc.(The search literature period is all database establishment-December 2019)to collect randomized controlled studies and cohort studies on the role of the tetravalent HPV vaccine in cervical cancer prevention published in various databases,including Chinese and English.Meta analysis was performed by RevMan5.3 software.The RR values of CIN1 and CIN2+were used as efficacy indicators and expressed as 95%confidence intervals(95%CI).Funnel plot was used to detect publication bias.Results:a total of 13 RCTS experiment including 84038 subjects were included,including 42002 subjects in the vaccination group and 42036 subjects in the control group.Analysis results show that tetravalent vaccine can make the cervical intraepithelial neoplasia sampleⅠlevel had a 96%lower incidence(RR=0.04,95%CI(0.03,0.06),P<0.00001);The incidence of CIN2+was reduced by 96%(RR=0.04,95%CI(0.03,0.07),P<0.00001).Conclusion:The tetravalent HPV vaccine has a high protective effect on cervical cancer and has a good long-term effect.