本文選題：宮頸癌　切入點(diǎn)：危險(xiǎn)因素　出處：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：采用Meta分析來綜合評(píng)價(jià)三類危險(xiǎn)因素包括：(1)生物學(xué)因素：高危型人乳頭瘤病毒(High-Risk Human Papilloma Virus, HR-HPV）感染；(2)行為因素：初次性生活過早、多個(gè)性伴侶、多次陰道分娩、多次人工流產(chǎn)次、長期使用口服避孕藥(Oral Contraceptive, OC)及被動(dòng)吸煙（SecondHand Smoking, SHS）；（3）遺傳因素：婦科惡性腫瘤家族史與宮頸癌（CervicalCancer, CC）發(fā)病的關(guān)系。 方法：宮頸癌的三類危險(xiǎn)因素關(guān)系通過計(jì)算機(jī)檢索收集從2001年01月到2014年3月國內(nèi)外包括中文和英文，搜索CNKI、WAN FANG、VIP、Pubmed及Embas數(shù)據(jù)庫。發(fā)表的關(guān)于宮頸癌發(fā)病的三類危險(xiǎn)因素的研究文獻(xiàn)，由兩名研究者進(jìn)行提取資料，并根據(jù)納入排除標(biāo)準(zhǔn)收集相關(guān)病例對(duì)照研究(Case-Control Study, CCS)文獻(xiàn)，用Meta分析方法進(jìn)行綜合分析，計(jì)數(shù)資料采用比值比（Odds Ratio,OR）,作為影響因素的效應(yīng)值，以O(shè)R、95%可信區(qū)間（Confidence Interval,CI）表示各效應(yīng)量區(qū)間范圍。提取有8個(gè)因素：①HR-HPV感染;②初次性生活過早；③多個(gè)性伴侶；④多次陰道分娩；⑤多次人工流產(chǎn)；⑥長期使用口服避孕藥；⑦被動(dòng)吸煙及⑧婦科惡性腫瘤家族史，可用數(shù)據(jù)信息納入研究的試驗(yàn)數(shù)據(jù)，采用Cochrane協(xié)作網(wǎng)提供的Rev Man5.2軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：最終納入18篇病例對(duì)照文獻(xiàn)，其中，中文文獻(xiàn)4篇，英文文獻(xiàn)14篇，研究對(duì)象共5187例，其中對(duì)照8642例。進(jìn)行了Meta分析結(jié)果對(duì)下： 1．生物學(xué)因素：HR-HPV感染，合并效應(yīng)量OR值為128.38,95%CI（75.43,218.51），P＜0.001，其差異具有統(tǒng)計(jì)學(xué)意義。 2．行為因素：初次性生活過早，合并效應(yīng)量OR值為1.87,95%C（I1.66,2.11），P＜0.001，其差異具有統(tǒng)計(jì)學(xué)意義。多個(gè)性伴侶，合并效應(yīng)量OR值為2.30,95%CI（2.03,2.58），P＜0.001，其差異有統(tǒng)計(jì)學(xué)意義。多次陰道分娩，合并效應(yīng)量OR值為1.86,95%CI（1.68,2.06），P＜0.001，其差異有統(tǒng)計(jì)學(xué)意義。多次人工流產(chǎn)，合并效應(yīng)量OR值為1.42,95%CI（1.17,1.71），，P＜0.001，其差異有統(tǒng)計(jì)學(xué)意義。長期使用口服避孕藥，合并效應(yīng)量OR值為1.85,95%CI（1.55,2.22），P＜0.001，其差異有統(tǒng)計(jì)學(xué)意義。被動(dòng)吸煙，合并效應(yīng)量OR值為4.03,95%CI（3.20,5.08），P＜0.001，其差異有統(tǒng)計(jì)學(xué)意義。 3．遺傳因素：婦科惡性腫瘤家族史，合并效應(yīng)量OR值為1.83,95%CI（1.13,2.98），P＜0.05，其差異有統(tǒng)計(jì)學(xué)意義。 結(jié)論：本研究對(duì)三大類因素進(jìn)行了Meta分析后結(jié)果認(rèn)為，HR-HPV感染是宮頸癌發(fā)病的主要危險(xiǎn)因素。初次性生活過早，多個(gè)性伴侶，多次陰道分娩，多次人工流產(chǎn)，長期使用口服避孕藥，被動(dòng)吸煙及婦科惡性腫瘤家族史是宮頸癌發(fā)病的致病因素。臨床上可以應(yīng)用這些述結(jié)論指導(dǎo)婦女健康教育，從而起到宮頸癌的早期預(yù)防作用。
[Abstract]:Objective: to evaluate three types of risk factors by Meta analysis: 1) biological factors: high risk Human Papilloma Virus2 (HR-HPV2) behavioral factors: early first sexual life, multiple sexual partners, multiple vaginal births.Multiple induced abortions, long term use of oral contraceptive oral Contractive (OCC) and passive smoking second hand Smoking3) genetic factors: the family history of gynecological malignant tumors and the incidence of Cervical Cancer (CCC).Methods: from January 2001 to March 2014, three types of risk factor relationships of cervical cancer were collected, including Chinese and English, and CNKI WAN fangguang VIPP Pubmed and Embas database were searched.The published literature on the three risk factors of cervical cancer was extracted by two researchers, and the Case-Control study (CCSs) was collected according to the exclusion criteria. The results were analyzed comprehensively by Meta analysis.In the counting data, odds ratio ratio (Odds) was used as the effect value of the influencing factors, and the 95% confidence interval (CI) was used to indicate the range of effect quantities.There were 8 factors: 1 HR-HPV infection and 3 precocious sexual life, 3 multiple sexual partners, 4 vaginal labor, 5 induced abortion and 6 long term use of oral contraceptives, passive smoking and 8 family history of gynecological malignant tumors.The available data information is incorporated into the experimental data, and the Rev Man5.2 software provided by the Cochrane Cooperative Network is used for statistical analysis.Results: 18 case-control articles were included, including 4 in Chinese and 14 in English. 5187 cases were included in the study, of which 8642 were controls.The results of Meta analysis are as follows:1.Biological factor: HR-HPV infection, the OR value of combined effect was 128.38 ~ 95% (P < 0.001).2.Behavioral factors: the first sexual life was premature, the OR value of the combined effect was 1.87 ~ 95%, P < 0.001, the difference was statistically significant.For multiple personality partners, the OR value of the combined effect was 2.30% 95%, 2.03% 2.58% (P < 0.001), and the difference was statistically significant.For multiple vaginal delivery, the OR value of the combined effect was 1.86 ~ 95CII 1.68 ~ 2.06 (P < 0.001), and the difference was statistically significant.For multiple induced abortion, the OR value of combined effect was 1.42% 95% (P < 0.001), and the difference was statistically significant.After long-term use of oral contraceptives, the OR value of combined effect dose was 1.85 鹵95CI 1.55 ~ 2.22% (P < 0.001), and the difference was statistically significant.The OR value of the combined effect of passive smoking was 4.03 ~ 95CIQ 3.20 ~ 5.08 (P < 0.001), and the difference was statistically significant.3.Genetic factors: family history of gynecologic malignancy, OR value of combined effect was 1.833.95 CIQ 1.132.98 (P < 0.05), the difference was statistically significant.Conclusion: the results of Meta analysis showed that HR-HPV infection was the main risk factor of cervical cancer.Premature sexual life, multiple sexual partners, multiple vaginal deliveries, multiple induced abortions, long-term use of oral contraceptives, passive smoking and family history of gynecological malignant tumors are the pathogenic factors of cervical cancer.These conclusions can be used in clinic to guide women's health education, so as to play an early role in the prevention of cervical cancer.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

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