膳食水溶性维生素对低度宫颈上皮内瘤变转归影响的前瞻性队列研究

Effect of dietary water-soluble vitamins on the poor prognosis of low-grade cervical intraepithelial neoplasia-a prospective cohort study

目的探讨膳食水溶性维生素对低度宫颈上皮内瘤变(CINⅠ)转归的影响。方法采用以社区为基础的前瞻性队列研究方法,从课题组于2014年建立的已婚女性队列中,选择经病理学确诊的564名CINⅠ患者为研究对象,在收集一般基线资料的同时,应用导流杂交技术检测HPV分型,采用食物频数问卷调查膳食水溶性维生素的摄入情况,确定暴露水平,进而对研究对象进行12个月的随访观察。随访结束时再次取活检组织行病理学检查,判定CINⅠ患者的逆转、持续和进展情况。采用SPSS 22.0软件进行相关资料的分析。结果膳食水溶性维生素低水平可促进CINⅠ患者的持续或进展,且CINⅠ不良转归的风险随维生素摄入水平的降低而升高,尤其是叶酸、维生素B1、维生素B2、维生素B6、烟酸、生物素和维生素C(RR值分别为15.22、1.86、1.92、2.11、2.98、2.14和2.19)低水平对CINⅠ的持续/进展起到重要促进作用。结合HR-HPV感染状况进行分析后显示,HR-HPV阳性时,叶酸、烟酸和生物素低水平可促进CINⅠ持续和进展。结论膳食水溶性维生素低水平是CINⅠ持续和进展的重要促进因素,对于HR-HPV阳性女性,叶酸、烟酸和生物素的作用更为明显。

Objective To explore the effect of dietary water-soluble vitamins on the poor prognosis of low-grade cervical intraepithelial neoplasia(CINⅠ).Methods A total of 564 participants with CINⅠwere selected from a community-based married women cohort established in 2014.The general baseline information was collected,and HPV genotyping was detected.A food frequency questionnaire was used to investigate dietary water-soluble vitamins'consumption and determine their exposure levels.The follow-up program was carried out for 12 months,and the regression,persistence,and progression of CINⅠwas determined according to histopathological results at 12-month.Results The low-levels of dietary water-soluble vitamins could promote CINⅠ's persistence and progression,showing the increasing tendency of CINⅠpoor prognosis with the decrease of water-soluble vitamin levels.Especially folate,VB1,VB2,VB6,niacin,biotin,and VC(RR values were 15.22,1.86,1.92,2.11,2.98,2.14,2.19,respectively)played an important role.Considering the status of high-risk human papillomavirus(HR-HPV)infection,our results showed that the low levels of folate,niacin,biotin could promote the poor prognosis of CINⅠ.Conclusions The low-level of dietary water-soluble vitamins could facilitate the poor prognosis of CINⅠ.In addition,folate,niacin,biotin were more effective on HR-HPV positive women.