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目的探讨男男性行为者(MSM)肛周及肛管内尖锐湿疣复发的危险因素。方法通过问卷调查,采集132例患者的社会人口统计学、行为学资料,使用导流杂交基因芯片技术确定患者感染人类乳头瘤病毒(HPV)的基因分型。采用单因素和多因素Logistic回归分析方法,筛选尖锐湿疣复发的影响因素。单因素分析中P<0.20的变量纳入多因素Logistic回归分析。结果 132例患者首次CO2激光治疗后,复发67例,复发率50.8%。HPV阳性的132例标本中,共检出13种HPV基因型。低危型感染82例(62.1%),高危型感染50例(37.9%)。多因素Logistic回归分析发现,感染HPV基因分型中含有高危型[比值比(OR)=3.501,95%可信区间(CI):1.147~10.682]、皮损的发生部位侵及肛管(OR=5.130,95%CI:1.548~17.006)、首诊时疣体数目>10个或受累面积>2cm~2(OR=7.291,95%CI:2.376~22.374)、患者合并肛门常见疾病(痔疮、肛瘘、肛裂)(OR=6.026,95%CI:1.414~25.686)、合并艾滋病病毒(HIV)感染(OR=15.224,95%CI:1.353~171.241),是尖锐湿疣复发的危险因素。结论高危型HPV感染要加大治疗力度,加强随访,定期复查,关注HIV感染,并采取良好有效的干预机制,以降低尖锐湿疣的复发率。
Objective To investigate the risk factors of recurrence of condyloma acuminatum in perianal and anal canal in men who have sex with men (MSM). METHODS: A total of 132 patients were enrolled in this study. The demographic and behavioral data were collected and the genotypes of human papillomavirus (HPV) were determined by flow-through hybridization. Univariate and multivariate logistic regression analysis were used to screen the influencing factors of recurrence of condyloma acuminatum. Univariate analysis of P <0.20 variables into multivariate Logistic regression analysis. Results 132 patients after the first CO2 laser treatment, 67 cases of recurrence, the recurrence rate was 50.8%. Of 132 HPV-positive specimens, 13 HPV genotypes were detected. 82 cases (62.1%) were infected with low-risk type and 50 cases (37.9%) with high-risk type infection. Multivariate logistic regression analysis showed that genotypes of HPV infection included high-risk type (odds ratio (OR) = 3.501, 95% confidence interval (CI): 1.147-10.682]. The location of the lesion affected the anal canal = 5.130, 95% CI: 1.548-17.006). The number of warts> 10 or affected area> 2cm ~ 2 at the first visit (OR = 7.291,95% CI: 2.376 ~ 22.374), patients with common anal diseases (hemorrhoids, (OR = 6.026, 95% CI: 1.414 ~ 25.686), and HIV infection (OR = 15.224, 95% CI: 1.353-171.241) were the risk factors for the recurrence of condyloma acuminatum. Conclusion The treatment of high-risk HPV infection should be intensified, follow-up, regular review, attention to HIV infection, and good and effective intervention mechanism to reduce the recurrence rate of genital warts.