Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
1
admin
1683-1764
1735-7322
10.18869/acadpub.tumj
000
000
000
fa
jalali
1404
5
1
gregorian
2025
8
1
83
5
online
1
fulltext
other
بررسی خطر مطلق ویروس زگیل تناسلی پر خطر در ضایعات پیش بدخیم و بدخیم دهانه رحم
The absolute risk of genital warts in cervical lesions
مقاله اصیل
Original Article
<span style="font-family:yekanYW;"><span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">زمینه و هدف: </span></span></i></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">از بین علل مرتبط با سرطان دهانه رحم، ویروس پاپیلومای انسانی </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">(Human Papilloma Virus, HPV)</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> عامل اصلی ایجاد ضایعات داخل اپیتلیالی دهانه رحم </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">(CIN)</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> و سرطان سرویکس است. هدف از انجام این مطالعه، بررسی میزان </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> های پرخطر، (</span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV16</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> و </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV18</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">) و تعیین خطر مطلق فوری </span></span><sup><span lang="FA" style="font-size:8.0pt"><span style="line-height:102%">+</span></span></sup><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">CIN2</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، در افرادی دارای آزمایش مثبت </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> بود.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">روش بررسی:</span></span></i></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">این مطالعه یک مطالعه مقطعی، شامل نمونه</span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">‎</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">گیری در دسترس، از بیمارانی است که با آزمایش </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> مثبت، از مهر 1401 تا اسفند 1403 به کلینیک انکولوژی زنان در بیمارستان یاس دانشگاه علوم پزشکی تهران مراجعه کرده بودند. خطر مطلق فوری </span></span><sup><span lang="FA" style="font-size:8.0pt"><span style="line-height:102%">+</span></span></sup><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">CIN2</span></span> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">در بیماران </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> مثبت، که دارای ژنوتیپهای </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV16</span></span><span style="font-size:10.0pt"><span style="line-height:102%"> یا </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV18</span></span><span style="font-size:10.0pt"><span style="line-height:102%"> یا همزمان </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">(Multi. HPV</span></span><sup><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">+</span></span></sup><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">) HPV16/18</span></span><span style="font-size:10.0pt"><span style="line-height:102%"> بودند همراه با درجات مختلف سیتولوژیک، از </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">NILM</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> تا </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">SCC</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> مورد بررسی قرار گرفت.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">یافتهها:</span></span></i></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> به طور کلی، 727 بیمار در مطالعه شرکت کردند. میانگین و انحراف معیار سن شرکتکنندگان به ترتیب، 99/35 و 48/8 سال بود. از بین تمام مراجعین، تعداد زنانی که فقط </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV16</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> مثبت داشتند، 170 نفر (23%) بود و ۲۴ نفر (3/3%) فقط برای </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV18</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> مثبت بودند. خطر مطلق فوری محاسبه شده </span></span><span lang="FA" style="font-size:8.0pt"><span style="line-height:102%">≥</span></span> <sup><span lang="FA" style="font-size:8.0pt"><span style="line-height:102%">+</span></span></sup><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">CIN2</span></span><span style="font-size:10.0pt"><span style="line-height:102%"> در افراد </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV16<sup>+</sup></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، برای </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">NILM</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، 14% و برای موارد </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">ASCUS</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، 6/8% بود و در افراد </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV18<sup>+</sup></span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، برای </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">NILM</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، 3/8% بود.</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"><span style="font-family:"B Lotus""></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">نتیجهگیری:</span></span></i></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> تریاژ سیتولوژیک همراه آزمایش تعیین ژنوتایپ </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">، در گام اول بهعنوان یک رویکرد برای شناسایی ناهنجاریهای سلولی در افراد آلوده به </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">HPV</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> و در گام بعدی، بهعنوان یک رویکرد مناسب برای کاهش ارجاعات کولپوسکوپی میتواند به کار گرفته شود.</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"><span style="font-family:"B Lotus""></span></span></span></span></span></span></span></span><br>
<div><span style="font-size:12pt"><span style="font-family:"Times New Roman","serif""><b><i>Background:</i></b> One of the most common cancers in women is cervical cancer, which is the most preventable cancer leading to death among women worldwide. Among the causes related to cervical cancer, the human papillomavirus (HPV) is the main factor responsible for causing cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of this study was to investigate the prevalence of high-risk HPVs (HPV16 and HPV18) and to determine the immediate absolute risk of CIN2+ in individuals with a positive HPV test.</span></span><br>
<span style="font-size:12pt"><span style="font-family:"Times New Roman","serif""><b><i>Methods:</i></b> This cross-sectional study included women who tested positive for HPV and visited the Gynecologic Oncology Clinic at Tehran University of Medical Sciences from October 2022 to March 2025. Individuals with a positive high-risk HPV result were referred for colposcopy and biopsy. The immediate absolute risk of CIN2+ in HPV-positive patients with HPV16, HPV18, or concurrent HPV16/18 genotypes (Multi. HPV+) was evaluated across different cytologic grades, ranging from NILM (Negative for Intraepithelial Lesion or Malignancy) to SCC (Squamous Cell Carcinoma).</span></span><br>
<span style="font-size:12pt"><span style="font-family:"Times New Roman","serif""><b><i>Results:</i></b> A total of 727 patients participated in the study. The mean age and standard deviation of the participants were 35.99 and 8.48 years, respectively. Among all referrals, the number of women who were positive only for HPV 16 was 170 (23%), and 24 (3.3%) were positive only for HPV 18. The highest number of positive cases for HPV16 and HPV18 were in the age range of 30 to 39 years (45%). In the Multi. HPV+ group, the highest number was observed in individuals under 29 years old (50%). The calculated immediate absolute risk of CIN2+ in HPV16+ individuals was 14% for NILM and 8.6% for ASCUS, while in HPV18+ individuals, it was 8.3% for NILM.</span></span><br>
<span style="font-size:12pt"><span style="font-family:"Times New Roman","serif""><b><i>Conclusion:</i></b> Cytologic triage combined with HPV genotyping testing can be utilized firstly as an approach to identify cellular abnormalities in HPV-infected individuals and subsequently as an appropriate method to reduce referrals for colposcopy.</span></span></div>
خطر مطلق فوری, ژنوتیپهای همزمان HPV16/18, زگیل تناسلی, ژنوتایپینگ, HPV پرخطر.
absolute risk, concurrent HPV16/18 genotypes, genital warts, genotyping, high-risk HPV.
350
357
http://tumj.tums.ac.ir/browse.php?a_code=A-10-3666-935&slc_lang=other&sid=1
Fatemeh
Mollarahimi-Maleki
فاطمه
ملارحیمی ملکی