背景:评价不同阴道给药方式对高度鳞状上皮内病变(HSIL)切除治疗后宫颈持续性高危型人乳头瘤病毒(HR-HPV)感染的临床疗效。
方法:六个数据库(PubMed,Embase,CochraneCentral,中国知网数据库,中国生物医学文献服务,和万方数据库)进行搜索,以收集各种类型的阴道给药的随机对照试验(RCTs),与HSIL切除治疗后持续的HR-HPV感染相比,采用贝叶斯网状Meta分析综合分析不同药物对HR-HPV的清除率.
结果:该研究分析了八种干预措施的疗效,包括干扰素,宝福康,Paiteling,白及三黄粉,乳杆菌阴道胶囊,福宁+干扰素,干扰素+乳杆菌阴道胶囊,干扰素+保妇康,通过汇集和分析52个随机对照试验的数据,了解切除治疗后HR-HPV的清除情况。研究结果表明,干扰素乳杆菌阴道胶囊[OR16.0(95%CI=8.1-32.0)],干扰素+福宁[OR16.0(95%CI=1.1-52.0)],与未治疗相比,干扰素+保妇康[OR14.0(95%CI=6.8-28.0)]均可显著提高术后HR-HPV清除率.此外,当高风险偏倚的研究被排除在外时,干扰素+乳杆菌阴道胶囊[OR8.6(95%CI=4.7-19.0)]和干扰素+保妇康[OR22.0(95%CI=8.7-59.0)]仍与术后HR-HPV清除率增加呈正相关。此外,这项研究的结果还表明,干扰素+保妇康能有效提高术后HR-HPV清除率,主要是当研究被限制在至少12个月的随访期时[OR9.6(95%CI=2.9-34.0)].然而,值得注意的是,大多数试验(52个中的29个,51.6%)被评为中度到高度偏倚风险,证据的确定性是中等到非常低。
结论:各种形式的阴道给药的应用,除了单独使用乳杆菌阴道胶囊,对于宫颈持续性HR-HPV感染患者,切除治疗后比不治疗更有效。然而,对HR-HPV清除效率变化的效应大小的所有估计均不确定.我们对疗效估计和治疗排名的信心很低,需要更大的,更严格,和更长时间的随访RCT来解决。
To evaluate the clinical efficacy of different vaginal administration on cervical persistent high-risk human papillomavirus (HR-HPV) infection after excisional treatment for high-grade squamous intraepithelial lesions (HSIL).
Six databases (PubMed, EmBase, Cochrane Central, China Knowledge Network database, China Biomedical Literature Service, and WanFang database) were searched to collect randomized controlled trials (RCTs) of various types of vaginal administration compared to no treatment on persistent HR-HPV infection after HSIL excisional treatment, and comprehensive analysis of the clearance of different drugs on HR-HPV was performed using Bayesian reticulation meta-analysis.
The study analyzed the efficacy of eight interventions, including Interferon, Baofukang, Paiteling, Bletilla striata Sanhuang Powder, Lactobacilli vaginal capsules, Fuanning + Interferon, Interferon + Lactobacilli vaginal capsules, and Interferon + Baofukang, on the clearance of HR-HPV after excisional treatment through pooling and analyzing data from 52 RCTs. The results of the study demonstrated that Interferon + Lactobacilli vaginal capsules [OR 16.0 (95% CIs 8.1-32.0)], Interferon + Fuanning [OR 16.0 (95% CIs 1.1-52.0)], and Interferon + Baofukang [OR 14.0 (95% CIs 6.8-28.0)] were all found to significantly improve postoperative HR-HPV clearance rates when compared to no treatment. Furthermore, when studies with high-risk bias were excluded, Interferon + Lactobacilli vaginal capsules [OR 8.6 (95% CIs 4.7-19.0)] and Interferon + Baofukang [OR 22.0 (95% CIs 8.7-59.0)] were still found to be positively associated with increased postoperative HR-HPV clearance rate. Additionally, the study´s results also indicate that Interferon + Baofukang was effective in enhancing the postoperative HR-HPV clearance rates, mainly when the studies were restricted to a follow-up period of at least 12 months [OR 9.6 (95% CIs 2.9-34.0)]. However, it is important to note that the majority of the trials (29 out of 52, 51.6%) were rated as moderate to high risk of bias, and the certainty of the evidence was moderate to very low.
The application of various forms of vaginal administration, except for individual use of Lactobacilli vaginal capsules, is more efficacious than no treatment in patients with cervical persistent HR-HPV infection after excisional treatment. However, all of the estimates of the effect size for change in the efficiency of HR-HPV clearance are uncertain. Our confidence in effect estimates and ranking of treatments is low, which needs larger, more rigorous, and longer follow-up RCTs to resolve.