协和医学杂志

2020, v.11(03) 252-257

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系统性红斑狼疮与人乳头瘤病毒感染及相关疫苗
Systemic Lupus Erythematosus,Human Papilloma Virus Infection and Vaccine

徐东;张奉春;
XU Dong;ZHANG Feng-chun;Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

人乳头瘤病毒(human papilloma virus,HPV)能引起宫颈良性病变(如尖锐湿疣)、癌前病变以及宫颈癌,尤其是血清型16和18,与宫颈癌的发生密切相关。系统性红斑狼疮(systemic lupus erythematosus,SLE)患者HPV感染较普通人群概率更高且多种HPV亚型感染常见,同时异常巴氏涂片、高度宫颈上皮内病变的风险亦显著增加,因此在SLE患者中预防HPV感染非常必要。疫苗是预防感染性疾病最有效的工具之一。已有3种HPV疫苗获批上市,分别为2价(针对HPV 16、18型)、4价(针对HPV 6、11、16、18型)和9价(针对HPV 6、11、16、18、31、33、45、52、58型),用以阻止宫颈癌前病变和宫颈癌,4价和9价疫苗同时也可阻止HPV引起的良性疾病,比如尖锐湿疣。目前多项前瞻性研究显示,HPV疫苗在SLE患者中安全有效,可产生保护性应答。2019年欧洲抗风湿病联盟发表了成人自身炎症性风湿性疾病(autoimmune inflammatory rheumatic diseases,AIIRD)患者疫苗应用的更新建议,推荐AIIRD患者,特别是SLE患者,应按照一般人群的建议接种HPV疫苗。此外,特别值得注意的是,HPV疫苗接种并不能替代常规宫颈不典型增生筛查,亦不能治疗HPV感染,SLE患者即使接种了HPV疫苗,也应定期进行筛查。
Human papilloma virus(HPV)can cause pre-malignant cervical abnormalities and cervical cancer as well as benign conditions such as anogenital warts, especially serotype 16 and 18,which were closely associated with cervical cancer. The prevalence of HPV infection and multiple HPV infections in patients with systemic lupus erythematosus(SLE) is higher than general population, and the risk of abnormal Pap smears and cervical high grade intraepithelial lesions are significantly increased. It is very important to prevent HPV infection in patients with SLE. Vaccine is one of the most effective tools to prevent the infectious diseases. Three non-live protein subunit vaccines for HPV were approved in the last decade: bivalent(HPV 16,18), quadri-valent(HPV 6,11,16,18), and 9 valent(HPV 6,11,16,18,31,33,45,52,58) vaccines. These vaccines were developed to prevent pre-malignant cervical and cervical cancer. qHPV and 9 valent vaccines also prevent benign conditions caused by HPV, such as anogenital warts. Multiple prospective studies showed HPV vaccines were safe and efficacious in patients with SLE, and protective immune response could be produced. In 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases(AIIRD), it is recommended that patients with AIIRD, in particular patients with SLE, should receive vaccinations against HPV in accordance with recommendations for the general population.

关键词(KeyWords): 系统性红斑狼疮;人乳头瘤病毒;疫苗
systemic lupus erythematosus;human papilloma virus;vaccine

Abstract:

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基金项目(Foundation): 中国医学科学院医学与健康科技创新工程(2019-I2M-2-008)

作者(Author): 徐东;张奉春;
XU Dong;ZHANG Feng-chun;Department of Rheumatology and Clinical Immunology, National Clinical Research Center for Dermatologic and Immunologic Diseases,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College;

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