红细胞叶酸与低度宫颈上皮内瘤变转归关联的巢式病例对照研究  

A nested case-control study on the relationship between red blood cell folate and the prognosis of low-grade cervical intraepithelial neoplasia

作　　者：朱京京 王金桃 巩璐 冉朝霞 郭翀宇 宋丽 吕元婧 丁玲 Zhu Jingjing;Wang Jintao;Gong Lu;Ran Zhaoxia;Guo Chongyu;Song Li;Lyu Yuanjing;Ding Ling(Department of Epidemiology,School of Public Health,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学公共卫生学院流行病学教研室,太原030001

出　　处：《中华预防医学杂志》2022年第4期453-458,共6页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金(81703313,81872705);国家卫生和计划生育委员会公益性行业科研专项(201402010)。

摘　　要：目的探讨红细胞叶酸与低度宫颈上皮内瘤变(CIN 1)转归的关联。方法以课题组2014年建立的已婚女性队列中经病理学确诊的564例CIN 1女性为研究对象,收集患者的人口学特征和宫颈上皮内瘤变相关因素,采用分子导流杂交法检测人乳头瘤病毒感染状况、化学发光免疫法测定红细胞叶酸水平。随访24个月后经病理学判定CIN 1女性的转归结局,以逆转者为对照组,CIN 1持续和进展者分别为病例组,采用logistic回归模型分析红细胞叶酸与CIN 1转归的关系。结果453例女性完成随访,年龄为(49.72±6.84)岁,CIN 1发生逆转342例,持续58例,进展53例,其红细胞叶酸水平M(Q1,Q3)分别为399.01(307.10,538.97)ng/ml、316.98(184.74,428.49)ng/ml和247.14(170.54,348.97)ng/ml。随红细胞叶酸的降低,CIN 1持续和进展发生的风险均呈升高趋势(均P<0.001),而CIN 1逆转发生的风险呈降低的趋势(P<0.001)。结合高危人乳头瘤病毒(HR-HPV)感染状况分析,无论是否感染HR-HPV,红细胞叶酸低均能增加CIN 1进展的风险(HR-HPV感染者:OR=21.34,95%CI:3.98~114.54;HR-HPV未感染者:OR=11.15,95%CI:2.34~53.13)。结论无论HR-HPV感染与否,红细胞叶酸低均可增加CIN 1持续和进展的风险。Objective To evaluate the relationship between red blood cell folate(RBC folate)and the prognosis of low-grade cervical intraepithelial neoplasia(CIN 1).Methods In the married women cohort established in 2014,564 women with CIN 1 diagnosed by pathology were recruited.The demographic characteristics and factors of cervical intraepithelial neoplasia were collected.Meanwhile,the infection status of human papillomavirus(HPV)was detected by molecular diversion hybridization,and the level of RBC folate was measured by chemical photoimmunoassay.After 24 months of follow-up,pathological examination was performed again to observe the prognosis of participants.The women with reversal were taken as the control group,and those with continuous and progressive CIN 1 were taken as the case group respectively.The relationship between RBC folate and CIN 1 outcome was evaluated by logistic regression model.Results 453 women completed the follow-up,aged(49.72±6.84)years old.CIN 1 was reversed in 342 women,continued in 58 cases and progressed in 53 cases.The RBC folate level M(Q1,Q3)were 399.01(307.10,538.97)ng/ml,316.98(184.74,428.49)ng/ml and 247.14(170.54,348.97)ng/ml,respectively.With the decrease of RBC folate,the risk of continuous and progressive CIN 1 increased(all P<0.001),while the risk of reversal CIN 1 decreased gradually(P<0.001).Combined with high-risk human papillomavirus(HR-HPV)infection status,low level of RBC folate could increase the risk of CIN 1 progression regardless of HR-HPV infection(HR-HPV infection:OR=21.34,95%CI:3.98-114.54;HR-HPV uninfection:OR=11.15,95%CI:2.34-53.13).Conclusion Low level of RBC folate could increase the risk of CIN 1 persistence and progression regardless of HR-HPV infection.

关 键 词：红细胞叶酸 低度宫颈上皮内瘤变 转归 巢式病例对照研究 

分 类 号：R737.33[医药卫生—肿瘤]