摘要
目的探讨包皮环切对男性生殖器部位人乳头瘤病毒(HPV)感染率的影响。方法通过计算机检索Medline、EMBASE、Cochrane、CBM、万方数据库,收集国内外公开发表的关于包皮环切与男性(15～70岁)HPV感染率关系的随机对照研究(RCT)、队列研究、病例对照研究、横断面研究的文献。应用Revman 5.1统计软件进行数据分析,采用倒漏斗图对发表偏倚进行直观检测。结果共15篇文献纳入分析,包括8 042名受试者。其中13篇文献研究包皮环切术与HPV感染的相关性,因存在明显异质性,采用亚组分析,将仅局限于包皮覆盖区取材的2篇文献和非局限于包皮覆盖区取材的11篇文献分为2个亚组,分别进行Meta分析。Meta分析结果显示:当仅局限于包皮覆盖区取材时,包皮环切术与HPV感染存在负相关[比值比(OR)=0.28,95%可信区间(CI):0.20～0.41];当取材范围非局限于包皮覆盖区时,包皮环切术与HPV感染无明显相关性(OR=0.78,95%CI:0.54～1.14)。包皮环切组高危型HPV感染率低于对照组,差异有统计学意义[相对危险度(RR)=0.62,95%CI:0.51～0.75)]。结论包皮环切可降低男性包皮覆盖区HPV感染率,特别是高危型HPV感染率。
Objective To analyze the effects of circumcision on HPV prevalence in genitals among males. Methods Through searching Medline, EMBASE, Cochrane, CBM, and Wanfang data base, published research papers regarding the relation between circumcision and HPV prevalence in genitals among males aged 18--70 were collected, which involved randomly controlled trials, cohort trials, case-control studies and cross-sectional studies. Data were extracted from literatures and analyzed by using Revman 5.1. The funnel plot was used to test the publication bias. Results Fifteen papers involving a total of 8 042 subjects were included, and of them 13 papers analyzed the effect of circumcision on any genotype HPV prevalence in genitals. Since distinct heterogeneity existed in the studies, the 13 papers were divided into two subgroups. The first subgroup included two trials which only sampled urethra meatus, glans, coronal sulcus and foreskin. The second subgroup included the other eleven trials which not on- ly sampled the upper part, but also the penile shaft, scrotum and perianal region. The meta-analysis was respectively performed to these two subgroups. The analysis showed that in the first subgroup circumcision could reduce the prevalence of HPV[odds ratio （OR） =0.28,95% confidence interval （CI） ：0. 20-0.41], while in the second subgroup, no obvious relation was found between circumcision and HPV prevalence （OR= 0. 78,95 ;CI：0. 54-1.14）. In the group with circumcision high-risk HPV prevalence in the male genitals was lower than in the control, and the difference had statistical significance （RR=0. 62,95;CI：0. 51--0. 75）. Conclusion Circumcision can reduce the prevalence of any genotype HPV, especially high-risk HPV in the sub-foreskin.
出处
《中国艾滋病性病》
CAS
2013年第4期292-296,共5页
Chinese Journal of Aids & STD
基金
国家重大科技专项江苏省传染病综合防治示范区项目(2009ZX10004-904)~~
作者简介
张东妍（1985-），女，山东省阳谷县人，博士在读，方向：皮肤性病流行病学。
通信作者：陈祥生，Email：chenxs@ncstdlc．org
