文章：

HPV疫苗如何影响子宫颈癌？

How will HPV vaccines affect cervical cancer?

原文发布日期：2006-10-01

DOI: 10.1038/nrc1973

类型: Review Article

开放获取: 否

要点：

1. Cervical cancer is the second largest cause of cancer deaths in women worldwide. Persistent infection with human papillomavirus (HPV) is necessary but not sufficient to cause cervical cancer, and preventing HPV infection can prevent the disease.
2. Cervical cancer is currently prevented by Pap smears and/or HPV testing and ablation of high-grade squamous intraepithelial lesions (HSILs). However, the US Food and Drug Administration approved a preventive HPV vaccine on 8 June 2006 for the immunization of women between 9–26 years of age.
3. HPV virus-like particle (VLP) vaccines based on the major capsid antigen L1 show very high protective efficacy and good safety profiles so far, and therefore have the potential to globally affect cervical cancer. However, guidelines on when to vaccinate and whether a boost is necessary depend on the duration of protection, which remains to be determined.
4. Protection with the L1 VLP vaccine shows strong HPV type restriction, therefore highly valent vaccines are required for broad protection. Minor capsid antigen L2-based vaccines might have potential for broad coverage with a monovalent vaccine.
5. There is little evidence that HPV VLP vaccines have therapeutic activity in patients, and the continued development of therapeutic vaccines is warranted.
6. The influence of herd immunity through the vaccination of men is likely to be beneficial, but it will have a relatively modest effect on cervical cancer rates compared with the broad vaccination of women. However, trials to evaluate the HPV vaccine in men are ongoing, as men do contract genital warts and HPV-related cancers at other sites in addition to transmitting HPV to women.
7. Societal response is developing and will have an effect on the introduction of HPV vaccines.
8. Cervical cancer normally occurs in developing countries that lack the resources for screening. The development of alternative HPV vaccines that are low cost and heat stable will be important for the worldwide introduction of the vaccine. Approaches to needle-free vaccination are also being tested.
9. Immunodeficient patients suffer more severe HPV disease and have greater susceptibility to HPV-related cancer. It is important to determine whether these patients will respond less well to HPV vaccines.

要点翻译：

1. 宫颈癌是全球女性癌症死亡的第二大原因。持续感染人乳头瘤病毒（HPV）是引发宫颈癌的必要但不充分条件，因此预防HPV感染可有效预防该疾病。
2. 目前通过巴氏涂片和/或HPV检测结合高级别鳞状上皮内病变（HSIL）消融术来预防宫颈癌。美国食品药品监督管理局于2006年6月8日批准了一种预防性HPV疫苗，用于9至26岁女性的免疫接种。
3. 基于主要衣壳抗原L1的HPV病毒样颗粒（VLP）疫苗迄今显示出极高的保护效力和良好的安全性，因此有望对全球宫颈癌防治产生深远影响。但疫苗接种时机和加强接种必要性的指导原则取决于保护持续时间，这仍有待进一步确定。
4. L1 VLP疫苗的保护作用呈现严格的HPV型别限制，因此需要多价疫苗以实现广泛保护。基于次要衣壳抗原L2的疫苗则有望通过单价形式实现广谱保护。
5. 目前几乎没有证据表明HPV VLP疫苗对患者具有治疗作用，因此治疗性疫苗的持续研发至关重要。
6. 通过男性接种疫苗产生的群体免疫可能带来益处，但与广泛接种女性相比，其对宫颈癌发病率的影响相对有限。不过针对男性HPV疫苗的评估试验仍在进行中，因为男性不仅会感染生殖器疣和其他部位的HPV相关癌症，还会将HPV传播给女性。
7. 社会反响正在形成，并将对HPV疫苗的推广产生影响。
8. 宫颈癌通常发生在缺乏筛查资源的发展中国家。开发低成本、耐热的新型HPV疫苗对全球疫苗推广至关重要。无针接种方案也正在试验中。
9. 免疫缺陷患者会遭受更严重的HPV疾病，且对HPV相关癌症的易感性更高。确定这些患者对HPV疫苗的反应是否会较弱具有重要意义。

英文摘要：

Cancer of the uterine cervix is the second largest cause of cancer deaths in women, and its toll is greatest in populations that lack screening programmes to detect precursor lesions. Persistent infection with 'high risk' genotypes of human papillomavirus (HPV) is necessary, although not sufficient, to cause cervical carcinoma. Therefore, HPV vaccination provides an opportunity to profoundly affect cervical cancer incidence worldwide. A recently licensed HPV subunit vaccine protects women from a high proportion of precursor lesions of cervical carcinoma and most genital warts. Here we examine the ramifications and remaining questions that surround preventive HPV vaccines.

摘要翻译： 

宫颈癌是女性癌症死亡的第二大原因，在未建立筛查以发现癌前病变的人群中危害最为严重。持续感染“高危”型人乳头瘤病毒（HPV）是发生宫颈癌的必要条件，但并非充分条件。因此，接种HPV疫苗有望在全球范围内显著降低宫颈癌的发病率。近期获批的一种HPV亚单位疫苗可预防大部分宫颈癌前病变和大多数生殖器疣。本文探讨了预防性HPV疫苗的影响及仍待解决的问题。

原文链接：

How will HPV vaccines affect cervical cancer?