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目的探讨包皮环切对男性生殖器部位人乳头瘤病毒(HPV)感染率的影响。方法通过计算机检索Medline、EMBASE、Cochrane、CBM、万方数据库,收集国内外公开发表的关于包皮环切与男性(15～70岁)HPV感染率关系的随机对照研究(RCT)、队列研究、病例对照研究、横断面研究的文献。应用Revman 5.1统计软件进行数据分析,采用倒漏斗图对发表偏倚进行直观检测。结果共15篇文献纳入分析,包括8 042名受试者。其中13篇文献研究包皮环切术与HPV感染的相关性,因存在明显异质性,采用亚组分析,将仅局限于包皮覆盖区取材的2篇文献和非局限于包皮覆盖区取材的11篇文献分为2个亚组,分别进行Meta分析。Meta分析结果显示:当仅局限于包皮覆盖区取材时,包皮环切术与HPV感染存在负相关[比值比(OR)=0.28,95%可信区间(CI):0.20～0.41];当取材范围非局限于包皮覆盖区时,包皮环切术与HPV感染无明显相关性(OR=0.78,95%CI:0.54～1.14)。包皮环切组高危型HPV感染率低于对照组,差异有统计学意义[相对危险度(RR)=0.62,95%CI:0.51～0.75)]。结论包皮环切可降低男性包皮覆盖区HPV感染率,特别是高危型HPV感染率。
Objective To investigate the effect of circumcision on the infection rate of human papillomavirus (HPV) in male genital area. METHODS: Medline, EMBASE, Cochrane, CBM and Wanfang databases were searched by computer. Randomly controlled studies (RCTs) published at home and abroad about the relationship between circumcision and HPV infection in men (15-70 years old), cohort studies, and cases Controlled study, cross-sectional study of the literature. The Revman 5.1 statistical software was used for data analysis and the inverted funnel chart was used for visual inspection of publication bias. Results A total of 15 articles were included in the analysis, including 8 042 subjects. Thirteen of these studies examined the association between circumcision and HPV infection because of significant heterogeneity. Subgroup analyzes were used to identify two articles that were confined to the foreskin-covered area and those that were not localized to the foreskin-covered area The articles are divided into two subgroups and are respectively analyzed by Meta-analysis. Meta-analysis showed that there was a negative correlation between circumcision and HPV infection when confined to the foreskin-covered area only [OR = 0.28, 95% confidence interval (CI): 0.20 to 0.41] There was no significant correlation between circumcision and HPV infection (OR = 0.78, 95% CI: 0.54 to 1.14) when the extent was not limited to the foreskin-covered area. The risk of HPV infection in the circumcision group was lower than that in the control group, with significant difference (RR = 0.62, 95% CI: 0.51-0.75)]. Conclusion Circumcision can reduce the incidence of HPV infection in male circumcision area, especially in high-risk HPV infection.