目的 本文旨在对全流程的生物安全管理问题进行梳理,为未来出现的大规模核酸筛查提供参考。方法 我们参考技术规范及其他医疗机构的实践总结,结合自身实际经验,梳理了核酸采集场所、个人防护、标本采集转运检测流程共3个方面的生物安全管理需注意的问题及解决措施。严格要求采样队伍按标准要求执行,以达到保质保量完成筛查任务的目的。结果 新冠核酸筛查期间我院共外派采集标本361 841人次。标本零污染零丢失,未发生一例生物安全事件,圆满完成采样任务。结论 大规模新冠核酸筛查是查清疫情源头、抑制疫情蔓延的重要手段。为了保证全流程的生物安全,应做好充足准备,严格落实各项生物安全措施。

Objective This article aims to sort out the problems in the whole process of biosafety management and provide reference for large-scale nucleic acid screening in the future. Methods We refer to the technical guidelines and the practice of other medical institutions, combined with our practical experience, summarized the problems and solutions needing attention in biosafety management in three aspects: nucleic acid sampling place, personal protection and the process from sample collection to detection. The sampling team was strictly required to implement the standard requirements, so as to complete the screening task with quality and quantity. Results A total of 361 841 samples were collected during SARS-CoV-2 nucleic acid screening. No samples were contaminated or lost, and no biosafety accident occurred. The sampling task were successfully completed. Conclusion Large-scale SARS-CoV-2 nucleic acid screening is an important method to find out the source of the epidemic and curb the spread of the SARS-CoV-2 pandemic. In order to ensure the biosafety of the whole process, sufficient preparations should be made and biosafety measures should be strictly implemented.

目的 探讨广州地区儿童2019新型冠状病毒(2019 novel coronavirus, 2019-nCoV)感染筛查/疑似病例的流行病学特点、发病特点、可能的原因及防控建议。方法 回顾性分析2020年1月20日—2020年2月29日广州市唯一一家儿童2019-nCoV感染隔离定点医疗单位隔离病房收治住院的符合儿童2019-nCoV感染筛查/疑似病例129例,对其流行病学、发病特点、临床特征、实验室检查及转归、随访等进行总结分析。 结果 男 79例,女 50例,最小1个月,最大13岁,中位数2岁,51例(39.5%)有武汉疫区旅游或居住史,20例(15.5%)有与来自疫区有呼吸道症状人员接触史,17例(13.1%)周边或社区有确诊病例,3例(2.3%)有确诊病人接触史(其中2例为家庭确诊病例密切接触史),38例(29.5%)为临床符合或聚集性发病;临床症状:发热121例(93.8%),咳嗽92例(71.3%),流涕50例(38.8%),32例伴有腹泻、呕吐/腹痛(24.8%),102例(79.0%)白细胞降低或正常,C反应蛋白(C-reactive protein,CRP)＜20 mg/L有103例(79.8%),57例(44.2%)胸片或CT示肺部斑片状影或实变;病原学检查:2019-nCoV实时荧光定量反转录PCR检测结果:所有患儿及陪同家属都有行咽拭子检查,只有21例患儿(16.3%)有行肛拭子检查,仅有1例(0.78%)家庭确诊病例密切接触者肛拭子阳性,但连续多次咽拭子结果阴性,余患者肛拭子和咽拭子及陪同家属咽拭子结果均阴性。其他病原学检查结果61例(47.3%),包括14例RSV阳性,9例流感病毒A,8例人偏肺病毒,6例肠道病毒,6例流感病毒B,6例肺炎支原体,4例副流感病毒1型,1例副流感病毒3型,2例人博卡病毒,3例腺病毒,1例肺炎克雷伯菌,1例人型葡萄球菌,其中1例合并副流感病毒1型及人博卡病毒。跟踪唯一1例确诊患者咽拭子多次检查均阴性,肛拭子持续19天后才转阴,一直无任何症状。其余患者好转出院后第3天、7天及14天进行随访,无异常发现。结论 儿童2019-nCoV感染筛查/疑似病例临床多表现为呼吸道或消化道症状,确诊主要依靠核酸检测,新冠病毒感染确诊率极低,而其将近50%病例能找到除新冠病毒外的其它相关病原体;高危患者为密切接触者,但存在漏诊的可能,肛拭子阳性率或高于咽拭子。

Objective To explore the epidemiological characteristics, onset characteristics, pathogenic mechanism of 2019-nCoV infection in children, and its control and prevention in Guangzhou. Methods From January 20, 2020 to February 29, 2020, a retrospective analysis was carried out on 129 suspected cases of 2019-nCoV infection admitted to the isolation ward of the only medical unit designated for children in Guangzhou. The epidemiology, disease characteristics, clinical characteristics, laboratory examination, outcome and follow-up were summarized and analyzed. Results There were 79 males and 50 females, with a minimum age of 1 month and a maximum age of 13 years. Anong them, 51 cases (39.5%) had a history of tourism or residence in the epidemic area of Wuhan, 20 cases (15.5%) had a history of contact with people with respiratory symptoms from the epidemic area, 17 cases (13.1%) with a confirmed case in the surrounding area or community, 3 cases (2.3%) had a history of contact with a confirmed patient (2 of them were family clustering cases), 38 cases (29.5%) were clinically suspected cases. Clinical symptoms: 121 cases with fever (93.8%), 92 cases with coughing (71.3%), 50 cases with runny nose (38.8%), 32 cases with diarrhea, vomiting or abdominal pain (24.8%). In 102 cases (79.0%), white blood cells were decreased or normal, 103 cases (79.8%) with CRP＜20 mg/L, and 57 cases (44.2%) showed focal infection on chest X-ray or CT scan. Etiological examination: only one case (0.78%) of the family confirmed cases had positive anal swab result, but the throat swab results were negative all the time. The anal swab and throat swab results of other patients and the throat swab results of their accompanying family members were negative. Other pathogens were detected in 61 cases (47.3%), including 14 RSV positive cases, 9 influenza A positive cases, 8 human metapneumovirus positive cases, 6 enterovirus positive cases, 6 influenza B positive cases, 6 Mycoplasma pneumoniae positive cases, 4 parainfluenza virus type 1 positive cases, 1 parainfluenza virus type 3 positive cases, 2 human bocavirus positive cases, 3 adenovirus positive cases, 1 Klebsiella pneumoniae positive cases, 1 Human Staphylococcus positive case, and 1 case with parainfluenza virus type 1 and human bocavirus. The only confirmed patient was followed up while multiple pharyngeal swab results were negative, and the positive anal swab results lasted for 19 days before turning negative and remained asymptomatic. Other patients were followed up on the 3rd, 7th and 14th day after discharge, and no abnormal findings were found. Conclusion Screening/suspected cases of 2019-nCoV infection in children were mostly clinically manifested as respiratory or gastrointestinal symptoms. The diagnosis rate of nucleic acids was extremely low, and there was a possibility of missed diagnosis. Nearly 50% of cases could find other relevant pathogens excluding the 2019-nCoV. The positive rate of anal swab results was higher than that of pharyngeal swab.

目的 探究乙型病毒性肝炎不同状态合并2型糖尿病患者的临床特点。方法 对62例乙型肝炎病毒携带合并2型糖尿病(组1)、129例乙型病毒性肝炎合并2型糖尿病(组2)和83例乙型病毒性肝炎肝硬化合并2型糖尿病(组3)患者的临床资料进行回顾性分析。结果 各组间在性别和年龄上差异有统计学意义(χ²=11.133、P=0.004,F=7.640、P=0.001)。3组研究对象糖化血红蛋白(HbA1c)、总胆固醇(Tch)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)和总胆汁酸(TBA)水平差异有统计学意义(F=4.028、P=0.019,F=4.140、P=0.017,F=3.172、P=0.044,F=6.701、P=0.002,F=53.156、P<0.001,F=4.920、P=0.008,F=4.173、P=0.017,F=7.181、P=0.001,F=9.170、P<0.001)。进一步两两比较,肝炎肝硬化组HbA1c、Tch 、LDL-C、ALB水平降低,但TBIL、IBIL、TBA增高,分别与另2组比较差异有统计学意义(P<0.05);组2空腹血糖(FBG)、HDL-C水平最高,前者高于组1,后者高于组3。各组糖尿病并发症居前三的都是周围神经病变、糖尿病肾病和糖尿病视网膜病变。结论 乙型病毒性肝炎合并2型糖尿病时其不同状态间具有不同的疾病特点,主要体现在携带状态Tch、TG、LDL-C高水平,肝炎状态FBG高水平,肝炎肝硬化状态HbAlc、ALB低水平但胆红素、胆汁酸水平高,在糖尿病并发症方面均以周围神经病变、糖尿病肾病和糖尿病视网膜病变为主。

Objective To study the clinical feature of different viral hepatitis B status with type 2 diabetes. Methods A retrospective analysis was carried out on 62 hepatitis B virus carriers with type 2 diabetes (group 1),129 viral hepatitis B patients with type 2 diabetes (group 2) and 83 viral hepatitis B cirrhosis patients with type 2 diabetes (group 3). Results The differences in gender and age among the three groups were significantly different (χ²=11.133, P=0.004 and F=7.640,P=0.001). The levels of HbA1c, total cholesterol (Tch), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum albumin (ALB), total bilirubin(TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL)and total bile acid (TBA)in three groups were significantly different (F=4.028, P=0.019.F=4.140, P=0.017.F=3.172, P=0.044.F=6.701, P=0.002.F=53.156, P<0.001.F=4.920, P=0.008.F=4.173, P=0.017.F=7.181, P=0.001.F=9.170, P<0.001). In further pairwise comparison, the levels of HbA1c, Tch, LDL-C and ALB of group 3 decreased significantly compared with other two groups, but the levels of TBIL, IBIL and TBA increased, with significant differences.The levels of fasting blood glucose(FBG) and HDL-C in group 2 were the highest,and the FBG was significantly higher than that in group 1, while the HDL-C was significantly higher than that in group 3.In the three groups, the top three diabetic complications were peripheral neuropathy, diabetic nephropathy and diabetic retinopathy. Conclusion Different statuses of viral hepatitis B with type 2 diabetes had different disease characteristics, mainly reflected in the high levels of Tch, TG and LDL-C in the hepatitis B virus carriers, high FBG level in the viral hepatitis B patients, low levels of HbAlc and ALB but high levels of bilirubin and bile acid in the cirrhosis patients.Peripheral neuropathy, diabetic nephropathy and diabetic retinopathy were the main complications of diabetes.

目的 使用金标免疫层析法检测儿童腹泻粪便标本,将其轮状病毒的结果进行分析汇总。方法 选取本院2020年1月—2021年1月收治的86例儿童腹泻者,根据金标免疫层析法的检测方式,将检测结果为阳性者的轮状病毒粪便标本进行回顾性分析。将86例阳性者的轮状病毒粪便标本送往我市疾控中心,采用逆转录-聚合酶链式反应(RT-PCR)进行检测,分析对比检测情况。结果 86例儿童腹泻感染经金标免疫检测为阳性者80例,阳性率为93.02%,同时将86例粪便标本送往本市疾控中心采用RT-PCR检测验证70例阳性,轮状病毒阳性率为81.39%,两种检测方法相比,金标免疫检测结果其准确度更高;80例阳性者中,1岁以下的婴幼儿为31例,占38.75%,较为多见,其次为1岁、2岁的儿童,各占23.75%、25.00%。季节性以秋季和冬季为轮状病毒的高发期,11-12月份36例,占45.00%,1-2月、9-10月18例、16例,占22.50%、20.00%;男女性别比中2组阳性率比较,经统计学分析无明显差异性(χ²=2.500,P＞0.05)。结论 轮状病毒多以5岁以下的婴幼儿为主,秋冬季节较为常见,采取金标免疫层析法的检测方式,来检测儿童的粪便标本,其操作简单,可快速准确地检测出轮状病毒,且该方法具有一定的临床诊断价值,值得推广应用。

目的 分析人类疱疹病毒(EBV)致传染性单核细胞增多症(IM)患儿病毒量与临床特征的关系。方法 选取我院2016年1月—2021年1月收治的EBV定量阳性的IM患儿128例,按照患儿EBV含量分为低病毒量组(n=64)和高病毒量组(n=64)。比较不同病毒含量组患儿的症状体征、实验室检查及临床特征,并分析具有统计学差异的指标与病毒量之间的相关性。结果 高EBV含量组患儿丙氨酸氨基转移酶、乳酸脱氢酶、血沉、外周血白细胞计数指标水平均高于低EBV含量组(P<0.05)。患儿的退热时间、淋巴结缩小时间、肝脾肿大消退时间及住院时间均随着EBV含量的增加而延长(P<0.05)。EBV含量与退热时间、淋巴结缩小时间、肝脾肿大消退时间及住院时间成正相关(r=0.453,0.458,0.402,0.415,P<0.05)。结论 EBV含量越高,IM患儿住院时间及临床指标恢复时间越长,因此临床治疗IM患儿时可以根据EBV含量的高低进行病情评估。

Objective To analyze the relationship between viral load and clinical characteristics in children with infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV). Methods A total of 128 children with IM who tested positive for EBV and admitted to our hospital from January 2016 to January 2021 were selected and divided into low virus group (n=64) and high virus group (n=64) according to their EBV level. The symptoms and signs, laboratory examinations and clinical characteristics of two groups were compared, and the correlation between the statistically different indicators and the amount of virus were analyzed. Results In children with high EBV level, the levels of alanine aminotransferase, lactate dehydrogenase, erythrocyte sedimentation rate, and peripheral blood white blood cell count were higher than low EBV level group (P<0.05). The time of fever, lymph node shrinkage, hepatosplenomegaly to subside, and hospitalization time of the children were all prolonged with the increase of EBV level (P<0.05). The level of EBV was positively correlated with the time to allay fever, the time to shrink the lymph nodes, the time to improve hepatosplenomegaly, and the length of hospital stay (r=0.453, 0.458, 0.402, 0.415,P<0.05). Conclusions The higher EBV level, the longer hospitalization time and recovery time of clinical indicators in children with IM. Therefore, the disease assessment of children with IM can be based on EBV level.

目的 探讨肠道病毒相关性脑炎患儿的临床特点;以期能为临床医师对该病的认识提供一定的帮助。方法 回顾性分析2018年1月—2019年12月广州市妇女儿童医疗中心感染科收治的37例肠道病毒相关性脑炎患儿的临床相关资料。结果 37例患儿男28例,女9例,男女比例3.11:1。主要临床症状体征发热(97.30%)、口腔疱疹和(或)皮疹(54.05%);常见神经系统症状呕吐(56.76%)、头痛(56.76%)、惊厥(29.72%),其中惊厥及呕吐头痛症状≤1岁组与其他年龄组差异有统计学意义;脑脊液检查白细胞升高为主;所有患儿均康复出院且无神经系统后遗症。结论 儿童肠道病毒相关性脑炎近一半患儿临床无咽部疱疹或皮疹表现,1岁以内患儿主要以发热及惊厥为主要表现,大于1岁尤其学龄前期及学龄期患者以发热呕吐伴头疼为主要表现;早期诊治预后良好。

Objective To explore the clinical characteristics of children with enterovirus associated encephalitis, in order to provide some help for clinicians to understand the disease. Methods The clinical data of 37 children with enterovirus related encephalitis treated in the infection department of Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were analyzed retrospectively. Results There were 28 males and 9 females, with a male to female ratio of 3.11:1. The main clinical symptoms and signs were fever (97.30%), oral herpes and/or rash (54.05%); the common nervous system symptoms were vomiting (56.76%), headache (56.76%) and convulsion (29.72%). There were significant differences in convulsion, vomiting and headache symptoms between ≤ 1 year old group and other age groups. The leukocytes level in cerebrospinal fluid was elevated. All children recovered and discharged without neurological sequelae. Conclusions Nearly half of children with enterovirus associated encephalitis had no clinical manifestations of pharyngeal herpes or rash. The main manifestations of children under 1 year old were fever and convulsion. The main manifestations of children over 1 year old, especially preschool and school-age patients, were fever and vomiting with headache. Early diagnosis and treatment had good prognosis.

目的 分析探讨健康驿站新冠病毒肺炎病例感染来源,评估驿站站内感染风险,规范驿站管理,降低感染风险。方法 对驿站2022年2月21日—3月9日全部14例新冠肺炎病例自入境到报告进行全链条风险分析。结果 14例病例为7批次不同时间入住,其中病例1、2、3、4、5、6、7、8、9、10、12、13共12例病例入境后即确诊,病例11入住5天(其共同入境、同住人员病例10,入境后即确诊)确诊、病例14入住10天发病确诊,其余病例均未呈现感染发病时间特异性,未呈现入境后交叉感染时间特异性,未见入住后空间、通风系统、排污系统交集,未见交叉感染情况。结论 该驿站目前报告新冠肺炎病例均有相关旅居史,主要在香港本土感染。13名病例大概率均在香港感染,入境隔离时发病确诊,其中病例1、2、3、4,病例6、7、8,病例10、11是3起呈现家庭聚集性感染发病,病例5、9是独立个案,病例14需要进一步排除,驿站未规范管理会导致误报及进一步扩大站内感染风险。

Objective To investigate and analyze the source of infection of COVID-19 cases in health station, assess the risk of infection, standardize the management and reduce the risk of infection. Methods From February 21 to March 9, 2022, the whole chain risk analysis of all 14 COVID-19 cases from entry to reporting was carried out. Results Fourteen cases were admitted in 7 batches at different times. Except for case 11 who diagnosed at the 5th day (the case of co-entry and co-resident case 10 was diagnosed after entry), and case 14 who diagnosed at the 10th day, the rest of the cases were diagnosed after entry, which did not show infection-onset time specificity, no time specificity of cross-infection after entry, no intersection of space, ventilation system and sewage system after entry, and no cross-infection. Conclusions The COVID-19 cases reported by the station were mainly infected in Hong Kong. Those 13 cases were highly likely infected in Hong Kong, all were diagnosed at the time of entry quarantine, while cases 1~4, cases 6~8, and cases 10~11 were 3 cases of family cluster infection, case 5 and 9 were an independent case, and case 14 needed to be further investigation. Failure to standardize the management of the station will lead to false alarms and further increase the risk of infection in the station.

目的 报道1例新生儿单纯疱疹病毒中枢神经系统感染病例,并通过文献回顾和复习,提高临床上对此类少见病的认识,减少该病的误诊、漏诊。方法 回顾性分析1例新生儿单纯疱疹病毒中枢神经系统感染患儿的发病、诊断和治疗过程,结合以往的文献报道,总结该病的临床表现和诊治要点。结果 回顾文献显示:新生儿单纯疱疹病毒中枢神经系统感染非常少见。病死率高,存活者大多存在神经系统不良结局。本例为14天大新生儿,因发热入院,原因未明,入院即予阿昔洛韦抗病毒治疗取得良好疗效,随访至今(3月大),未见神经系统异常表现。提示及早有效的抗病毒治疗是影响预后的关键因素。结论 新生儿单纯疱疹病毒中枢神经系统感染临床无特异性表现,此病少见。尽早、足程的抗病毒治疗,可明显改善患儿的预后。对于不明原因发热的新生儿(特别是社区获得者),早期经验性予以阿昔洛韦抗病毒治疗,利大于弊。

Objective To report a case of herpes simplex virus central nervous system infection in a neonate and to review literatures about this disease, and to improve clinical understanding of this rare disease and reduce misdiagnosis and missed diagnosis. Methods The clinical manifestation,diagnosis and treatment of the patient with herpes simplex virus central nervous system infection were analyzed.The epidemiology,clinical manifestation and key points of diagnosis were summarized from literature review. Results Literature review showed that: neonatal herpes simplex virus central nervous system infection is very rare. The mortality rate is high, and most of the survivors have adverse neurological outcomes. This case is a fourteen days newborn who was admitted to the hospital due to fever for unknown reasons. He was given acyclovir antiviral therapy immediately after admission and achieved good results. Follow-up of 3 months showed no neurological abnormalities. It suggested that early and effective antiviral therapy is a key factor affecting the prognosis. Conclusion Neonatal herpes simplex virus central nervous system infection has no specific clinical manifestations, and this disease is rare. Early, full-course of antiviral therapy can greatly improve the prognosis of children. For newborns with unexplained fever (especially those obtained in the community), early empirical antiviral treatment with acyclovir is more beneficial than harmful.

目的 调查临床护士对新型冠状病毒肺炎的知信行现状,为制定相关培训策略提供依据。方法 采用便利抽样法,2020年3月选取我院的1 007名临床护士作为研究对象,采用一般资料及临床护士对新型冠状病毒肺炎知信行问卷对其进行调查。结果 1 007名临床护士对新型冠状病毒肺炎的知识、态度、行为得分分别为(28.82±9.22)分、(52.04±5.52)分、(55.38±7.93)分,新型冠状病毒肺炎知信行总分为(136.24±14.52)分。不同年龄、职称、职务、工作年限、何时参加过穿脱防护服操作培训及考核新型冠状病毒肺炎知识得分比较,差异均有统计学意义(P<0.05);工作年限、何时参加过穿脱防护服操作培训及考核,其新型冠状病毒肺炎态度得分比较,差异均有统计学意义(P<0.05);是否参加过穿脱防护服操作的培训及考核、何时参加过穿脱防护服操作培训及考核、是否参加过咽拭子采集的培训及考核的新型冠状病毒肺炎行为得分比较,差异均有统计学意义(P<0.05)。结论 临床护士对新型冠状病毒肺炎的知识得分处于较低水平,态度和行为得分较好,建议护理管理者需加强临床护士对新型冠状病毒肺炎的知识学习及相关培训,以提高护士知识及技能水平。

Objective To investigate the current status of nurses' knowledge, attitude and behavior to new coronavirus pneumonia, to provide the basis for formulating relevant training strategies. Methods In March 2020, 1 007 clinical nurses in our hospital were selected as the research object. The general information and questionnaire about the new coronavirus pneumonia were investigated in these nurses. Results Scores of 1 007 nurses answered the knowledge, attitude and behavior to new coronavirus pneumonia were(28.82±9.22),(52.04±5.52), and(55.38±7.93), respectively. The total score of knowledge, attitude, and behavior to the new coronavirus pneumonia was(136.24±14.52). The differences of scores of knowledge about new coronavirus pneumonia between different ages, job titles, duties, working years, and when they participated in the training and evaluation of wearing and taking off protective clothing were statistically significant (P<0.05). There was a statistically significant difference in the attitude scores of the new coronavirus pneumonia between different working years and when they participated in training and evaluation of wearing protective clothing (P<0.05). There were statistically significant differences in the behavior scores to new coronavirus pneumonia between whether and when they have participated in the training and evaluation of wearing and taking off protective clothing, and whether they had participated in the training and evaluation of pharyngeal swab collection (P<0.05). Conclusion Nurses' knowledge scores for new coronavirus pneumonia are at a low level, but their attitude and behavior scores are higher. It is recommended that new coronavirus pneumonia knowledge and related training should be strengthened for nurses to improve nurses' knowledge and skills.

目的 评价口服核苷类似物富马酸丙酚替诺福韦治疗宫颈持续性高危型人乳头瘤感染患者的疗效。方法 本回顾性研究中,将同一亚型高危型人乳头瘤病毒感染超过1年患者随机分为两组,治疗组给予口服富马酸丙酚替诺福韦,25 mg,每天一次,连续3个月;对照组给予宣教说明,无特殊处理。于入组后第3个及第6个月随诊。检测患者宫颈人乳头瘤病毒感染的变化,同时观察宫颈细胞学、阴道镜Reid评分及宫颈组织病理学变化。结果 宫颈持续性高危型人乳头瘤病毒感染者共82例,分为两组:治疗组42例,对照组40例。均完成随访。在治疗结束时、治疗结束后3个月,治疗组清除人乳头瘤病毒的有效率分别为 52.38% 和 61.90%,优于对照组20.00%(P＜0.05)和30.00% (P＜0.05);治疗结束时、治疗结束后3个月,治疗组细胞学异常的缓解率分别为66.67%和77.78%,优于对照组22.22%(P＜0.05)和33.33%(P＜0.05);治疗组中Reid评分3分及其以上者例数较对照组少(2 vs 10,P＜0.05),且Reid评分较基线明显下降(P＜0.05),对照组Reid评分无显著变化(P＞0.05)。6个月时治疗组中宫颈上皮内瘤变I级者组织学缓解率优于对照组(72.72% vs 35.00%,P＜0.05)。随访期间无严重不良反应。结论 口服富马酸丙酚替诺福韦可有效清除宫颈持续性高危型人乳头瘤病毒感染,且安全、临床可行。

Objective To investigate the clinical efficacy of nucleoside analogues Tenofovir Alafenamide (TAF) therapy for cervical high-risk HPV (HR-HPV) infection. Methods In this prospective study, a total of 82 patients with persistent cervical HR-HPV infection were randomly divided into two groups. The treatment group (42 patients) administered orally TAF (25mg, once daily, 3 months). The control group (40 patients) received no treatment. All patients were followed up for 6 months. HPV testing, ThinPrep cytology test (TCT), and Reid colposcopic index (RCI) grading were performed for both groups. Results HR-HPV remission rates were 52.38% and 61.9% in the treatment group at the 3-and 6-month follow-up, respectively, whereas 20% and 30% in the control group at the 3-and 6-month follow-up visits. Conversion rates of abnormal TCT results were 66.67% and 77.78% in the treatment group at two follow-up visits. In contrast, the control group showed remission rates at 22.2% and 33.3%, respectively. There were 2 and 10 patients with grade of 3-4 or higher at the treatment group and the control group at the 6-month visit, respectively. RCI scoring was declining obviously at 6 months in the treatment group (P<0.05), whereas the control group showed no significantly difference. 16 of 22 (72.72%) patients with CINⅠin the treatment group were alleviated at 6-month visit compared to 35% in the control group(P<0.05). No serious adverse events happened during the treatment and follow up. Conclusion Tenofovir alafenamide is an effective, safe and accessible treatment for cervical HR-HPV infection.