口腔不健康是致癌性HPV感染的危险因素

一项针对全国代表性样本的大规模分析结果显示，口腔健康状况不佳是口腔人乳头状瘤病毒(HPV)感染的一个独立危险因素，与吸烟和经口性行为无关。这项研究发表在《癌症预防研究》在线版上(Cancer Prev. Res. 2013 Aug. 21 [doi:10.1158/1940-6207.CAPR-13-008])。



德克萨斯大学医学部的Thanh Cong Bui博士报告称，根据对3,439例年龄30~69岁的受试者的随访结果，随访口腔健康状况不佳与口腔HPV感染风险增加56%有关。牙龈和牙齿有问题的患者，HPV感染率分别增加51%和28%。男性的口腔HPV感染率高于女性(12% vs. 3%)。使用大麻也与感染率增高有关：不使用者的感染率为5%，曾经使用者为8%，目前使用者为14%。

Bui博士及其同事是根据2009~2010年全国健康与营养调查(NHANES)得出上述结果的，这项调查是由美国疾病预防控制中心(CDC)实施的。调查者采集了受试者自我评估的总体口腔健康水平、牙龈疾病患病率、7天内使用漱口水处理牙齿问题的情况，以及牙齿丢失数量。

“好消息是，这一危险因素是可干预的——通过维持良好的口腔卫生与健康，人们可以预防HPV感染和随之而来的HPV相关性癌症。”

既往研究已显示经口性行为、性伴侣数量和每日吸烟数量与高危口腔HPV感染有关。由于经口性行为与吸烟已显示出相似的预测价值，Bui博士等人分析了NHANES中有关低危和高危HPV亚型的数据。利用多变量logistic回归模型，研究者发现，口腔HPV感染与自评总体口腔健康状况差有显著关联，独立于吸烟和经口性行为。

研究者承认，这项研究存在一些局限性，包括无法根据横断面数据确定变量之间的暂时性关联。不过，由于口腔HPV感染通常是无症状的，“它不太可能影响自报告的口腔健康状况”。尽管如此，研究者仍指出可能存在回忆偏倚或未报告的情况。

研究者总结道：“或许应采取针对口腔卫生和健康的公共卫生干预措施，作为HPV相关性口腔癌症的补充预防手段。”

这项研究获得了德克萨斯大学癌症预防研究健康创新项目的拨款支持。作者报告称无相关利益冲突。

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By: WHITNEY MCKNIGHT, Ob.Gyn. News Digital Network

Poor oral health is an independent risk factor of oral human papillomavirus infection regardless of smoking and oral sex practices, analysis of a large, nationally representative sample showed.

Poor oral health was associated with a 56% higher prevalence of oral HPV infection in 3,439 study participants aged 30-69 years, Thanh Cong Bui, Dr.P.H., of the University of Texas Health Sciences Center, Houston, and his colleagues wrote in Cancer Prevention Research.

For those with gum disease and dental problems, prevalence of oral HPV infection was 51% and 28% higher, respectively. More men (12%) than women (3%) were infected with oral HPV (Cancer Prev. Res. 2013 Aug. 21 [doi:10.1158/1940-6207.CAPR-13-008]).
 
Marijuana use also was linked to higher rates of infection: 5% in nonusers, 8% in former users, and 14% in current users.

The findings were derived from the 2009-2010 National Health and Nutrition Examination Survey (NHANES), a nationally representative sampling conducted by the Centers for Disease Control and Prevention. Oral health data were taken from participants’ self-assessments of overall oral health, presence of gum disease, use of mouthwash to treat dental problems within past 7 days of the survey, and number of teeth lost.

"The good news is, this risk factor is modifiable – by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers," Dr. Bui said in a statement.

Previous studies have linked oral sex, number of sex partners, and cigarettes smoked per day with infection with high-risk oral HPV. Because oral sex and smoking previously had been found to have similar predictive value, Dr. Bui and colleagues examined NHANES data for both low-risk and high-risk HPV type. Using multivariable logistic regression models, they determined oral HPV infection was significantly linked with self-rated overall poor oral health, independent of tobacco use and oral sex.

According to the researchers, the study was limited because the temporal relationship between variables could not be established because of the cross-sectional nature of the data; however, because oral HPV infection normally is asymptomatic, "it is unlikely to affect self-reported oral health." Still, they noted that the data, based on self-report, could be subject to recall bias or under-reporting.

"Public health interventions may aim to promote oral hygiene and oral health as additional preventative measures for HPV-related oral cancers," Dr. Bui and his colleagues said.

The study was supported by a grant from the University of Texas Health Innovation for Cancer Prevention Research. The authors reported no conflicts of interest.