不同价型人乳头瘤病毒（HPV）疫苗预防女性持续性HPV16/18感染及CIN2+的效果：一项系统评价与网状Meta分析

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.

作者信息

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

机构信息

Department of Gynecology, Xiangya Hospital, Central South University, Changsha, China; Gynecological Oncology Research and Engineering Center of Hunan Province, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.

Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China.

出版信息

Int J Infect Dis. 2025 Feb;151:107363. doi: 10.1016/j.ijid.2024.107363. Epub 2024 Dec 19.

DOI:10.1016/j.ijid.2024.107363

PMID:39709117

Abstract

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.

摘要

目的

评估二价、四价和九价人乳头瘤病毒（HPV）疫苗在预防基线时处于不同感染状态的女性持续性HPV感染及2级或更高级别宫颈上皮内瘤变（CIN2+）病变方面的疗效。

方法

检索了PubMed、科学网、Cochrane、Embase和ClinicalTrials.gov自创建至2024年3月的数据。纳入了报告接种疫苗女性中持续性HPV感染和CIN2+风险的随机对照试验（RCT）及RCT的事后分析。计算了具有95%置信区间（CI）的比值比（OR）以总结干预效果。

结果

纳入了18项RCT和1项RCT的事后分析。在符合方案（ATP）队列中，四价疫苗对HPV16/18相关的持续性感染和CIN2+最有效（6个月持续性感染（6mPIs）：OR 0.05，95%CI[0.02，0.15]；12个月持续性感染（12mPIs）：OR 0.02，95%CI[0.00，0.18]；CIN2+：OR 0.03，95%CI[0.01，0.17]）。对于总接种队列（TVC），二价疫苗对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]），而四价疫苗对HPV16/18相关的6mPIs最有效（OR 0.08，95%CI[0.02，0.28]）。