Passive smoking is an independent risk factor for

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•
Sitakan Natphopsuk, et al.
π‘æπ∏åµâπ©∫—∫ • Original Article
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1
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40002 ª√–‡∑»‰∑¬
Passive Smoking is an Independent Risk Factor for Cervical
Cancer in Northeast Thai Women
Sitakan Natphopsuk1, Wannapa Settheetham-Ishida1*, Supat Sinawat1, Chamsai Pientong2, Pissamai Yuenyao3
1
Department of Physiology, 2Microbiology, 3Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen
University, Khon Kaen, 40002, Thailand
Backgrounds and Objectives: Cancer of the cervix is
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¡“∑”°“√µ√«®À“¥’ ‡ ÕÁ π ‡Õ¢Õ߇™◊È Õ ‰«√— ‡Õ™æ’ «’ (human
papillomavirus) ¥â«¬«‘∏’ GP5+/6+ PCR °“√»÷°…“π’ȉ¥â√—∫
°“√√—∫√Õß®√‘¬∏√√¡°“√«‘®¬— „π¡πÿ…¬å®“°¡À“«‘∑¬“≈—¬¢Õπ·°àπ
‡≈¢∑’Ë HE 450333
the most common cancer in Thai women with an estimated
16.4% of all cancer in females. It has been proposed that
cigarette smoking among HPV positive women is one of
the co-factors which likely influence the risk of cervical
cancer progression. The association between cervical
cancer development and the duration or the dose of
cigarette smoking of the family members, however, was
still unclear. This study is determined to evaluate the
association between passive smoking as well as other
factors such as HPV infection and cervical cancer in
Northeastern Thai women.
Methods: A case-control study was undertaken with 55
cases of SCCA and 55 age-matched healthy controls. HPV
DNA was analyzed in cervical specimens with the GP5+/
6+ primers. The information regarding sexual behaviors,
reproductive history, contraceptive use, and history of
smoking were collected from all subjects. This study
was approved by the Ethics Committee of Khon Kaen
University No. HE 450333.
* Correspondening : Wannapa Settheetham-Ishida Tel/Fax [66]-43-348394, E-mail address: [email protected]
»√’π§√‘π∑√凫™ “√ 2553; 25(3)
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Srinagarind Med J 2010; 25(3)
215
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•
Results: HPV infection, prolong oral contraceptive pills
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»√’π§√‘π∑√凫™ “√ 2553; 25(3): 215-22
use, age at first delivery, number of sexual partners and
smoking status of partners revealed statistical different
increase risk for cervical cancer with the odds ratio of 38.74,
12.72, 11.10 and 4.92-fold respectively with p<0.001.
Statistical higher risk for cervical cancer was observed in
present smoker 4.68-fold (p<0.01). Smoking duration more
than 20 years of partners increased the risk of cervical
cancer 3.05 with p<0.05. Multiple sexual partners showed
4.09-fold increased in the risk for HPV infection with p<0.01.
Conclusions: The data suggest that HPV infection,
oral contraceptive pills use, age at first delivery were
associated with cervical carcinogenesis among
Northeastern Thai women. Moreover, smoking status and
duration of smoke of partners also affect on cervical
cancer. This indicated that, passive smoking may affect
cervical cells abnormality, consequently cervical cancer
development directly in this population. Therefore,
to prevent cervical cancer or HPV infection, administration
of knowledge on sexual behaviors and effects of smoking
into public health program is important and, at the same
time, a nation-wide screening scheme for the cervical
abnormalities including HPV-typing is awaited in Thailand.
Keywords: Cervical cancer, Passive smoking, Risk
factor, HPV
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»√’π§√‘π∑√凫™ “√ 2553; 25(3)
Srinagarind Med J 2010; 25(3): 215-22
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216
Passive Smoking is an Independent Risk Factor for Cervical Cancer
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Srinagarind Med J 2010; 25(3)
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Sitakan Natphopsuk, et al.
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·∫∫ Õ∫∂“¡
Õ“ “ ¡—§√∑—Èß Õß°≈ÿà¡®–‰¥â√—∫·∫∫ Õ∫∂“¡ª√–°Õ∫
¥â«¬¢âÕ¡Ÿ≈∑—Ë«‰ª ·≈–ªí®®—¬µà“ßÊ ∑’Ë¡’º≈µàÕ°“√‡ªìπ¡–‡√Áß
ª“°¡¥≈Ÿ° ´÷Ëß·∫àßÕÕ°‡ªìπ 6 à«π‰¥â·°à¢âÕ¡Ÿ≈∑—Ë«‰ª ª√–«—µ‘
§√Õ∫§√—« ª√–«—µ‘°“√‡®√‘≠æ—π∏ÿå ª√–«—µ‘∑“ß‡æ» —¡æ—π∏å
ª√–«—µ‚‘ √§ª√–®”µ—«ª√–«—µ°‘ “√ Ÿ∫∫ÿÀ√’·Ë ≈–°“√ —¡º— °—∫§«—π
Õ“∑‘ ª√–«—µ°‘ “√ Ÿ∫∫ÿÀ√’¢Ë Õßµ—«Õ“ “ ¡—§√‡Õß ª√–«—µ°‘ “√ Ÿ∫
∫ÿÀ√’Ë¢Õß “¡’ ·≈–ª√–«—µ‘°“√ Ÿ∫∫ÿÀ√’Ë¢Õß∫ÿ§§≈„°≈♑¥
°“√‡°Á∫‡´≈≈媓°¡¥≈Ÿ°·≈–µ√«®À“‡™◊ÈÕ‰«√— ‡Õ™æ’«’
‡°Á∫‡´≈≈媓°¡¥≈Ÿ°‚¥¬„™â‰¡â Pap °«“¥‡Õ“‡´≈≈å∫√‘‡«≥
√Õ∫ª“°¡¥≈Ÿ°≈–≈“¬≈ß„π¢«¥ ∑’Ë¡’ “√≈–≈“¬ PBS ®“°π—Èπ
𔉪ªíò π ‡À«’Ë ¬ ß·≈–π”µ–°Õπ∑’Ë ‰ ¥â ‰ ª °— ¥ ¥’ ‡ ÕÁ π ‡Õ‚¥¬„™â
Genomic DNA Mini Kit (Geneaid) °“√µ√«®À“¥’‡ÕÁπ‡Õ¢Õß
‡™◊ÈÕ‰«√— ‡Õ™æ’«’ „™â‡∑§π‘§ PCR (polymerase chain reaction)
‚¥¬„™â primer GP5+/6+ ´÷Ëß¡’§«“¡®”‡æ“–°—∫ à«π L1 ∫π®’‚π¡
¢Õ߇™◊ÈÕ‰«√— ‡Õ™æ’«’
°“√«‘‡§√“–Àå¢âÕ¡Ÿ≈∑“ß ∂‘µ‘
ª√–¡«≈º≈·≈–«‘‡§√“–Àå¢Õâ ¡Ÿ≈∑“ß ∂‘µ‘ ¥â«¬ chi-square
test ‡æ◊ËÕÀ“§«“¡·µ°µà“ߢÕßªí®®—¬‡ ’ˬ߰—∫°“√‡°‘¥¡–‡√Áß
ª“°¡¥≈Ÿ° ·≈–«‘‡§√“–ÀåÀ“§à“§«“¡‡ ’¬Ë ß —¡æ—∑∏奫⠬°“√À“
§à“ odd ratio (OR) ∑’√Ë –¥—∫§«“¡‡™◊ÕË ¡—πË 95% (95% Confidence
interval; CI) ·≈–∂â“ p ¡’§à“πâÕ¬°«à“ 0.05 · ¥ß«à“¡’§«“¡
·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘
«‘∏’°“√»÷°…“
º≈°“√»÷°…“
°“√‡°Á∫µ—«Õ¬à“ß
°“√«‘®—¬π’ȇªìπ°“√»÷°…“·∫∫ case-control study ‚¥¬
§—¥‡≈◊Õ° µ√’°≈ÿࡵ—«Õ¬à“ß®“°Õ“ “ ¡—§√ ‚¥¬·∫àßÕÕ°‡ªìπ
Õß°≈ÿࡧ◊Õ °≈ÿࡺŸâªÉ«¬¡–‡√Áߪ“°¡¥≈Ÿ°∑’Ë¡“√—∫°“√√—°…“∑’Ë
‚√ß欓∫“≈»√’π§√‘π∑√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ ∑’ˉ¥â√—∫°“√
«‘π‘®©—¬«à“‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°™π‘¥ ‡‡§«¡— (squamous cell
cervical carcinoma; SCCA) ·≈–°≈ÿࡧ«∫§ÿ¡´÷Ëߧ—¥‡≈◊Õ°®“°
°≈ÿà¡Õ“ “ ¡—§√∑’Ë¡’ ÿ¢¿“楒 ‰¡à¡’ª√–«—µ‘°“√‡ªìπ¡–‡√Áß·≈–
§«“¡º‘ ¥ ª°µ‘ ¢ Õߪ“°¡¥≈Ÿ ° √«¡∑—È ß ¡’ º ≈°“√µ√«®∑“ß
欓∏‘«‘∑¬“¢Õߪ“°¡¥≈Ÿ°ª°µ‘ °≈ÿà¡≈– 55 §π ∑’Ë¡’Õ“¬ÿÕ¬Ÿà
„π™à«ß‡¥’¬«°—π (age matched 5-years interval) ´÷ËßÕ“ “ ¡—§√
∑—ßÈ Õß°≈ÿ¡à ®–‰¥â≈ß™◊ÕË ¬‘π¬Õ¡„π·∫∫øÕ√塬‘π¬Õ¡„Àâ∑”°“√
»÷°…“·≈–§”™’·È ®ß‡°’¬Ë «°—∫«—µ∂ÿª√– ß§å ·≈–¢—πÈ µÕπ°“√»÷°…“
®“°°“√»÷°…“ªí®®—¬∑’ËÕ“®‡°’ˬ«¢âÕß°—∫°“√‡°‘¥¡–‡√Áß
ª“°¡¥≈Ÿ° (µ“√“ß∑’Ë 1) æ∫«à“ µ√’∑’Ë¡’°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’
¡’§«“¡‡ ’ˬ߄π°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°‡æ‘Ë¡¢÷Èπ 38.74 ‡∑à“
‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ µ√’∑’ˉ¡à¡’°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’ (95%
CI = 9.94-211.4, p< 0.0001) °“√‰¥â√—∫¬“‡¡Á¥§ÿ¡°”‡π‘¥™π‘¥
ŒÕ√å‚¡π√«¡π“π¡“°°«à“ 5 ªï ‡æ‘Ë¡§«“¡‡ ’ˬ߄π°“√‡ªìπ
¡–‡√Áߪ“°¡¥≈Ÿ° 12.72 ‡∑à“ ‡¡◊ËÕ‡∑’¬∫°—∫ µ√’∑’ˉ¡à‡§¬‰¥â√—∫
¬“‡¡Á¥§ÿ¡°”‡π‘¥ (95% CI = 2.51-120.74, p = 0.0002) µ√’∑’Ë
¡’∫ÿµ√§√—Èß·√°‡¡◊ËÕÕ“¬ÿπâÕ¬°«à“À√◊Õ‡∑à“°—∫ 20 ªï ¡’‚Õ°“ ‡ ’ˬß
„π°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°‡æ‘Ë¡¢÷Èπ 11.10 ‡∑à“ ‡¡◊ËÕ‡∑’¬∫°—∫
µ√’∑’Ë¡’∫ÿµ√§√—Èß·√°‡¡◊ËÕÕ“¬ÿ¡“°°«à“ 20 ªï (95% CI = 3.93 33.79, p< 0.0001) ·≈– µ√’∑’Ë¡’®”π«π§ŸàπÕπ¡“°°«à“ 1 §π
¡’ ‚ Õ°“ ‡ ’Ë ¬ ß„π°“√‡ªì π ¡–‡√Á ß ª“°¡¥≈Ÿ ° ¡“°°«à “ µ√’ ∑’Ë
»√’π§√‘π∑√凫™ “√ 2553; 25(3)
•
Srinagarind Med J 2010; 25(3)
217
°“√‰¥â√—∫§«—π∫ÿÀ√’Ë∑“ßÕâÕ¡‡ªìπªí®®—¬‡ ’ˬߢÕß°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°
•
¡’§ŸàπÕπ‡æ’¬ß 1 §π À√◊Õ‰¡à¡’§ŸàπÕπ 4.92 ‡∑à“ (95% CI = 3.93 33.79, p=0.0006) à«πªí®®—¬‡°’ˬ«°—∫Õ“¬ÿ∑’Ë¡’ª√–®”‡¥◊Õπ
§√—Èß·√° Õ“¬ÿ∑’ˇ√‘Ë¡¡’‡æ» —¡æ—π∏å ®”π«π§√—ÈߢÕß°“√µ—Èߧ√√¿å
°“√§≈Õ¥∫ÿµ√·≈–°“√·∑âß∫ÿµ√æ∫«à“‰¡à‡æ‘Ë¡§«“¡‡ ’ˬ߄π
°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p >0.05)
‡¡◊Ë Õ æ‘ ® “√≥“ªí ® ®— ¬ ‡ ’Ë ¬ ߢÕß°“√µ‘ ¥ ‡™◊È Õ ‰«√— ‡Õ™æ’ «’
æ∫«à“¡’‡©æ“–ªí®®—¬°“√¡’∫ÿµ√§√—Èß·√°‡¡◊ËÕ¡’Õ“¬ÿπâÕ¬°«à“
À√◊Õ‡∑à“°—∫ 20 ªï ·≈–°“√¡’§ŸàπÕπ¡“°°«à“ 1 §π ‡∑à“π—Èπ
∑’ˇæ‘Ë¡§«“¡‡ ’ˬߢÕß°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’Õ¬à“ß¡’π—¬ ”§—≠
∑“ß ∂‘µ‘ ‚¥¬®–‡æ‘Ë¡§«“¡‡ ’ˬߢ÷Èπ‡ªìπ 4.71 ‡∑à“ ¢Õß µ√’∑’Ë
¡’∫µÿ √§√—ßÈ ·√°‡¡◊ÕË Õ“¬ÿ¡“°°«à“ 20 ªï ·≈–‡æ‘¡Ë §«“¡‡ ’¬Ë ß 4.09
‡∑à“‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ µ√’∑’Ë¡’§ŸàπÕπ‡æ’¬ß 1 §π (µ“√“ß∑’Ë 2)
Passive Smoking is an Independent Risk Factor for Cervical Cancer
·≈–‡¡◊ËÕ»÷°…“§«“¡ —¡æ—π∏å√–À«à“ߪ√–«—µ‘°“√ Ÿ∫∫ÿÀ√’Ë¢Õß
“¡’°—∫°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°æ∫«à“ µ√’∑’Ë¡’ “¡’¬—ß§ß Ÿ∫
∫ÿÀ√’ËÕ¬Ÿà¡’§«“¡‡ ’ˬ߄π°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°‡æ‘Ë¡¢÷Èπ 4.68
‡∑à“ ‡¡◊ËÕ‡∑’¬∫°—∫ µ√’∑’Ë¡’ “¡’‰¡à ∫Ÿ ∫ÿÀ√’Ë (95% CI = 1.61-13.84,
p= 0.001) πÕ°®“°π’È√–¬–‡«≈“„π°“√ Ÿ∫∫ÿÀ√’Ë¢Õß “¡’ (ªï)
¬—ß¡’§«“¡ —¡æ—π∏å°—∫°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ° ‚¥¬æ∫«à“
µ√’∑’Ë¡’ “¡’ Ÿ∫∫ÿÀ√’Ë¡“°°«à“ 20 ªï ®–¡’§«“¡‡ ’ˬߢÕß°“√
‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°‡æ‘Ë¡¢÷Èπ 3.05 ‡∑à“ (95% CI = 1.17-8.02,
p= 0.011) ·µà‰¡àæ∫§«“¡ —¡æ—π∏å√–À«à“ß√–¬–‡«≈“∑’ˇ≈‘° Ÿ∫
∫ÿÀ√’Ë¢Õß “¡’°—∫°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ° (µ“√“ß∑’Ë 3)
µ“√“ß∑’Ë 1 §«“¡ —¡æ—π∏å√–À«à“ßªí®®—¬∑’Ë»÷°…“°—∫°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°
ªí®®—¬∑’Ë»÷°…“
Õ“¬ÿ‡¡◊ËÕ¡’ª√–®”‡¥◊Õπ§√—Èß·√°
>14 ªï
<14 ªï
®”π«π§Ÿπà Õπ
1 §π
>1 §π
Õ“¬ÿ‡¡◊ËÕ¡’‡æ» —¡æ—π∏å§√—Èß·√°
>17 ªï
<17 ªï
Õ“¬ÿ‡¡◊ËÕ¡’∫ÿµ√§π·√°
>20 ªï
<20 ªï
®”π«π°“√µ—ßÈ §√√¿å
<3 §√—Èß
>3 §√—Èß
®”π«π°“√·∑âß∫ÿµ√
‰¡à‡§¬
1 §π
>1 §π
®”π«π°“√§≈Õ¥∫ÿµ√
<3 §π
>3 §π
°“√„™â¬“‡¡Á¥§ÿ¡°”‡π‘¥
‰¡à‡§¬„™â
<5 ªï
>5 ªï
°“√µ‘¥‡™◊ÈՇՙ撫’
‰¡àµ‘¥‡™◊ÈÕ
µ‘¥‡™◊ÈÕ
218
°≈ÿࡺŸâªÉ«¬¡–‡√Áߪ“°¡¥≈Ÿ°
(n=55)
°≈ÿ¡à §«∫§ÿ¡
(n=55)
OR [95%CI]
p-value
37
18
28
27
1
0.50 [0.21-1.16]
0.081
32
23
48
7
1
4.92 [1.75-15.04]
0.0006
44
11
51
4
1
3.18 [0.85-14.56]
0.052
21
34
48
7
1
11.10 [3.93 - 33.79]
0.001
21
34
30
25
1
1.94 [0.84-4.46]
0.085
31
18
6
38
15
2
1
1.47 [0.58- 3.68]
3.67 [0.59-39.10]
0.363
0.107
31
24
36
19
1
1.46 [0.63-3.40]
0.329
22
17
16
35
18
2
1
1.50 [0.58-3.83]
12.72 [2.51-120.74]
0.347
0.0002
3
52
38
17
1
38.74 [9.94-211.49]
0.001
»√’π§√‘π∑√凫™ “√ 2553; 25(3)
•
Srinagarind Med J 2010; 25(3)
»’µ°“πµå π—¥æ∫ ÿ¢ ·≈–§≥–
•
Sitakan Natphopsuk, et al.
µ“√“ß∑’Ë 2 §«“¡ —¡æ—π∏å√–À«à“ßªí®®—¬‡ ’ˬ߰—∫°“√‡ªì𵑥‡™◊ÈՇՙ撫’
°“√µ‘¥‡™◊ÈՇՙ撫’
‰¡àµ‘¥‡™◊ÈÕ (n=41) µ‘¥‡™◊ÈÕ (n=69)
ªí®®—¬‡ ’ˬß
Õ“¬ÿ‡¡◊ËÕ¡’ª√–®”‡¥◊Õπ§√—Èß·√°
>14 ªï
<14 ªï
®”π«π§Ÿπà Õπ
1 §π
>1 §π
Õ“¬ÿ‡¡◊ËÕ¡’‡æ» —¡æ—π∏å§√—Èß·√°
>17 ªï
<17 ªï
Õ“¬ÿ‡¡◊ËÕ¡’∫ÿµ√§π·√°
>20 ªï
<20 ªï
®”π«π°“√µ—ßÈ §√√¿å
<3 §√—Èß
>3 §√—Èß
®”π«π°“√·∑âß∫ÿµ√
‰¡à‡§¬
1 §π
>1 §π
®”π«π°“√§≈Õ¥∫ÿµ√
<3 §π
>3 §π
°“√„™â¬“‡¡Á¥§ÿ¡°”‡π‘¥
‰¡à‡§¬„™â
<5 ªï
>5 ªï
¿“«–°“√ Ÿ∫∫ÿÀ√’Ë
‰¡à‡§¬ Ÿ∫
¬—ß Ÿ∫Õ¬Ÿà
‡§¬ Ÿ∫
OR [95%CI]
p-value
20
21
45
24
1
0.50 [0.210-1.20]
0.090
36
5
44
25
1
4.09 [1.33-14.90]
0.006
37
4
58
11
1
1.75 [0.47-8.08]
0.361
34
7
35
34
1
4.71 [1.72-14.17]
0.0007
20
21
31
38
1
1.16 [0.50-2.72]
0.695
28
11
2
41
22
6
1
1.36 [0.53-3.63]
2.04 [0.33-21.99]
0.481
0.392
25
16
42
27
1
1.00 [0.42-2.40]
0.991
25
13
3
32
22
15
1
1.32 [0.51-3.44]
3.90 [0.93-22.97]
0.525
0.038
19
9
13
22
28
19
1
1.26 [0.92-8.06]
1.26 [0.44-3.57]
0.043
0.625
»√’π§√‘π∑√凫™ “√ 2553; 25(3)
•
Srinagarind Med J 2010; 25(3)
219
°“√‰¥â√—∫§«—π∫ÿÀ√’Ë∑“ßÕâÕ¡‡ªìπªí®®—¬‡ ’ˬߢÕß°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°
•
Passive Smoking is an Independent Risk Factor for Cervical Cancer
µ“√“ß∑’Ë 3 §«“¡ —¡æ—π∏å√–À«à“ߪ√–«—µ‘°“√ Ÿ∫∫ÿÀ√’Ë¢Õß “¡’°—∫°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°
ª√–«—µ‘°“√ Ÿ∫∫ÿÀ√’Ë¢Õß “¡’
°≈ÿࡺŸâªÉ«¬¡–‡√Áß
ª“°¡¥≈Ÿ° (n=55)
¿“«–°“√ Ÿ∫∫ÿÀ√’Ë
‰¡à‡§¬ Ÿ∫
15
¬—ß Ÿ∫Õ¬Ÿà
27
‡§¬ Ÿ∫
13
√–¬–‡«≈“„π°“√ Ÿ∫ (ªï)
‰¡à‡§¬ Ÿ∫
15
0-9 ªï
1
10-19 ªï
9
>20 ªï
30
®”π«π∑’Ë Ÿ∫ (¡«π/«—π)
‰¡à‡§¬ Ÿ∫
15
<9
23
10-19
9
>20
8
√–¬–‡«≈“∑’Ë —¡º— §«—π∫ÿÀ√’Ë®“° “¡’ (™¡./«—π)
‰¡à‡§¬ —¡º— 20
<5
33
>5
2
√–¬–‡«≈“∑’ˇ≈‘° Ÿ∫ (ªï)
‰¡à‡§¬ —¡º— 42
<5
7
>5
6
«‘®“√≥å
»√’π§√‘π∑√凫™ “√ 2553; 25(3)
OR [95%CI]
p-value
26
10
19
1
4.68 [1.61-13.84]
1.18 [0.41-3.40]
0.001
0.725
26
3
9
17
1
0.57 [0.01-8.05]
1.73 [0.48-6.15]
3.05 [1.17-8.02]
0.644
0.334
0.011
26
13
8
8
1
3.06 [1.09-8.64]
1.95 [0.53-7.16]
1.73 [0.45-6.52]
0.017
0.250
0.354
32
21
2
1
2.51 [1.07-5.92]
1.6 [0.10-23.51]
0.020
0.649
38
8
11
1
0.79 [0.22-2.77]
0.67 [0.17-2.47]
0.678
0.506
‚Õ°“ „π°“√‰¥â√—∫‡™◊ÈÕ‰«√— ‡Õ™æ’«’®“°§ŸàπÕπ ´÷Ëß Õ¥§≈âÕß
°—∫°“√»÷°…“∑’˺à“π¡“12, 14
πÕ°®“°π—Èπ°“√»÷°…“π’Ȭ—ß· ¥ß„Àâ‡ÀÁπ«à“ µ√’∑’Ë¡’∫ÿµ√
§√—Èß·√°‡¡◊ËÕÕ“¬ÿπâÕ¬°«à“À√◊Õ‡∑à“°—∫ 20 ªï ¡’‚Õ°“ ‡ ’ˬ߄π
°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°¡“°°«à“ µ√’∑¡’Ë ∫’ µÿ √§√—ßÈ ·√°‡¡◊ÕË Õ“¬ÿ
¡“°°«à“ 20 ªï ∂÷ß 11.10 ‡∑à“ ∑—Èßπ’ȇπ◊ËÕß®“°„π µ√’∑’ËÕ“¬ÿ
¬—ßπâÕ¬ ‡π◊ÈÕ‡¬◊ËÕ∫√‘‡«≥ª“°¡¥≈Ÿ°¬—ß¡’°“√æ—≤π“‰¡à ¡∫Ÿ√≥å
à ß º≈„Àâ ¡’ ‚ Õ°“ ‡ ’Ë ¬ ß„π°“√µ‘ ¥ ‡™◊È Õ ‰«√— ‡Õ™æ’ «’ ‰ ¥â ßà “ ¬15
‡™àπ‡¥’¬«°—∫°“√√—∫ª√–∑“𬓇¡Á¥§ÿ¡°”‡π‘¥ ∑’Ë¡’ŒÕ√å‚¡π
‡Õ ‚µ√‡®π (estrogen) ‡ªìπÕߧåª√–°Õ∫ ŒÕ√å‚¡π‡Õ ‚µ√‡®ππ’È
®–¡’º≈„π°“√‡æ‘Ë¡Õ—µ√“°“√·∫à߇´≈≈å„π√–¬– S (S-phase)16
·≈– àߺ≈°√–µÿâπ°“√‡æ‘Ë¡®”π«π¢Õß stratified squamous
epithelium ∫√‘‡«≥ª“°¡¥≈Ÿ°¥â“ππÕ° (ectocervix) ´÷ËßÕ“®
∑”„Àâ ‡ ´≈≈å ∫ √‘ ‡ «≥π—È π ‡°‘ ¥ °“√‡ª≈’Ë ¬ π·ª≈߉ª‡ªì π ‡´≈≈å
¡–‡√Á߉¥âßà“¬¢÷Èπ πÕ°®“°π’È¡’ß“π«‘®—¬®”π«π¡“°∑’Ë π—∫ πÿπ
¡–‡√Áߪ“°¡¥≈Ÿ°‡ªì𠓇Àµÿ°“√µ“¬¢Õß µ√’∑’Ë ”§—≠
‚¥¬‡©æ“–Õ¬à“߬‘ßË „πª√–‡∑»°”≈—ßæ—≤π“√«¡∑—ßÈ ª√–‡∑»‰∑¬
´÷Ëß®“°À≈“¬ß“π«‘®—¬ π—∫ πÿπ«à“°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’
™π‘¥∑’Ë¡’§«“¡‡ ’Ë¬ß Ÿß (high-risk HPV) “¡“√∂𔉪 Ÿà°√–∫«π
°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°‰¥â13 ´÷Ëß Õ¥§≈âÕß°—∫ß“π«‘®—¬π’È∑’Ë
æ∫«à“°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’‡æ‘Ë¡§«“¡‡ ’ˬ߄π°“√‡°‘¥¡–‡√Áß
ª“°¡¥≈Ÿ° Ÿß∂÷ß 38.74 ‡∑à“ ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ µ√’∑’ˉ¡à¡’
°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’ (95% CI = 9.94-211.4, p < 0.0001)
πÕ°®“°π’Èªí®®—¬‡ ’ˬߙπ‘¥Õ◊ËπÊ ‡™àπ ®”π«π§ŸàπÕπ Õ“¬ÿ‡¡◊ËÕ
¡’∫ÿµ√§√—Èß·√° ·≈–°“√°‘𬓇¡Á¥§ÿ¡°”‡π‘¥ ¬—ß¡’º≈„π°“√
‡æ‘¡Ë §«“¡‡ ’¬Ë ß„π°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°¥â«¬‡™àπ°—π ´÷ßË ®“°
°“√»÷°…“π’Èæ∫«à“ µ√’∑’Ë¡’§ŸàπÕπ¡“°°«à“ 1 §π ‡æ‘Ë¡‚Õ°“ ‡ ’ˬ߄π°“√‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°¡“°°«à“ µ√’∑’Ë¡’§ŸàπÕπ‡æ’¬ß
1 §π À√◊Õ‰¡à¡’§ŸàπÕπ 4.92 ‡∑à“ ´÷ËßÕ“®‡ªìπº≈¡“®“°°“√‡æ‘Ë¡
220
°≈ÿ¡à §«∫§ÿ¡
(n=55)
•
Srinagarind Med J 2010; 25(3)
»’µ°“πµå π—¥æ∫ ÿ¢ ·≈–§≥–
•
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“¡’ Ÿ∫µàÕ«—π ·≈–√–¬–‡«≈“ (™—Ë«‚¡ßµàÕ«—π) ∑’ˉ¥â√—∫§«—π∫ÿÀ√’Ë
®“° “¡’ π—È π §ßµâ Õ ßÕ“»— ¬ °“√»÷ ° …“∑’Ë ¡’ ° ≈ÿà ¡ ª√–™“°√
¡“°°«à“π’È®÷ß®– “¡“√∂ √ÿªº≈‰¥â·πàπÕπ«à“ªí®®—¬¥—ß°≈à“«
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§«—π∫ÿÀ√’Ë∑“ßÕâÕ¡´÷Ëß¡“®“°§π„°≈♑¥ ‡™àπ “¡’ “¡“√∂
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∑“ßÕâÕ¡ ´÷ßË „πª√–‡¥Áπ¥—ß°≈à“«°“√»÷°…“π’®È ß÷ ¡’§«“¡·µ°µà“ß
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„π —ߧ¡‰∑¬≈߉¥âÕ¬à“ß™—¥‡®π¡“°¢÷Èπ
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‡∑à“°—∫ 20 ªï °“√¡’§ŸàπÕπ¡“°°«à“ 1 §π ®—¥‡ªìπªí®®—¬∑’Ë¡’
º≈‡æ‘Ë¡§«“¡‡ ’ˬߢÕß°“√æ—≤𓉪‡ªìπ¡–‡√Áߪ“°¡¥≈Ÿ°„π
µ√’‰∑¬„π¿“§µ–«—πÕÕ°‡©’¬ß‡Àπ◊Õ πÕ°®“°π’È√–¬–‡«≈“
„π°“√ Ÿ∫∫ÿÀ√’Ë¢Õß “¡’ ¬—ß¡’º≈°—∫°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°
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·≈– transcription ¢Õß E6/E7 viral oncogenes ´÷Ëß à߇ √‘¡
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°“√‡æ‘Ë¡§«“¡‡ ’ˬ߄π°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’ æ∫«à“¡’‡©æ“–
ªí®®—¬°“√¡’∫ÿµ√§√—Èß·√°‡¡◊ËÕ¡’Õ“¬ÿπâÕ¬°«à“À√◊Õ‡∑à“°—∫ 20 ªï
·≈–°“√¡’§ŸàπÕπ¡“°°«à“ 1 §π ‡∑à“π—Èπ∑’ˇæ‘Ë¡§«“¡‡ ’ˬߢÕß
°“√µ‘¥‡™◊ÈÕ‰«√— ‡Õ™æ’«’Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ‚¥¬®–‡æ‘Ë¡
§«“¡‡ ’ˬߢ÷Èπ‡ªìπ 4.71 ‡∑à“¢Õß µ√’∑’Ë¡’∫ÿµ√§√—Èß·√°‡¡◊ËÕÕ“¬ÿ
¡“°°«à“ 20 ªï [ (95% CI = 1.72-14.17, p = 0.0007) ‡π◊ËÕß®“°
°“√¡’∫ÿµ√µ—Èß·µàÕ“¬ÿπâÕ¬∫àß™’È«à“ µ√’ºŸâπ—Èπ‡√‘Ë¡¡’°‘®°√√¡∑“ß
‡æ»‡¡◊ËÕÕ“¬ÿ¬—ßπâÕ¬ ´÷Ëß„π™à«ß·√°¢Õß°“√‡¢â“ Ÿà«—¬‡®√‘≠æ—π∏ÿå
π—πÈ °“√æ—≤π“¢Õ߇´≈≈å∫√‘‡«≥ª“°¡¥≈Ÿ°·≈– transformation
zone ¬—߉¡à ¡∫√Ÿ≥å ∑”„À⇴≈≈å¡’ ¿“æÕàÕπ·Õ·≈–µ‘¥‡™◊ÈÕ
‰«√— ‡Õ™æ’«’‰¥âßà“¬ ®÷ß àߺ≈„Àâ‡æ‘Ë¡§«“¡‡ ’ˬߢÕß°“√‡°‘¥
¡–‡√Áߪ“°¡¥≈Ÿ°π—Èπ¥â«¬„π√–¬–¬“«15 à«πªí®®—¬¥â“π°“√¡’
§Ÿπà Õπ¡“°°«à“ 1 §π ‡æ‘¡Ë §«“¡‡ ’¬Ë ß 4.09 ‡∑à“‡¡◊ÕË ‡ª√’¬∫‡∑’¬∫
°—∫ µ√’∑’Ë¡’§ŸàπÕπ‡æ’¬ß 1 §π · ¥ß„Àâ‡ÀÁπ«à“°“√¡’§ŸàπÕπ
À≈“¬§π “¡“√∂‡æ‘Ë¡§«“¡‡ ’ˬ߄π°“√‰¥â√—∫‡™◊ÈÕ‰«√— ®“°
§ŸàπÕπ‰¥â¡“°°«à“°“√¡’§ŸàπÕπ‡æ’¬ß§π‡¥’¬«
惵‘ ° √√¡°“√ Ÿ ∫ ∫ÿ À √’Ë ¢ Õß “¡’ ¡’ º ≈ à ß ‡ √‘ ¡ °“√‡°‘ ¥
¡–‡√Áߪ“°¡¥≈Ÿ°„π µ√’∑’Ë¡’ “¡’¬—ß§ß Ÿ∫∫ÿÀ√’ËÕ¬à“ßµàÕ‡π◊ËÕß
‚¥¬æ∫«à“ µ√’∑’Ë¡’ “¡’ Ÿ∫∫ÿÀ√’Ë¡’§«“¡‡ ’ˬ߄π°“√‡°‘¥¡–‡√Áß
ª“°¡¥≈Ÿ°¡“°°«à“ µ√’∑’Ë “¡’‰¡à Ÿ∫∫ÿÀ√’Ë 4.68 ‡∑à“ (95% CI =
1.61-13.84, p= 0.001) Õ¥§≈âÕß°—∫ß“π«‘®—¬®”π«π¡“°∑’Ë
∫àß™’È«à“ “√®“°§«—π∫ÿÀ√’Ë “¡“√∂‡¢â“‰ª Ÿà√à“ß°“¬ µ√’∑’Ë¡’
“¡’ ∫Ÿ ∫ÿÀ√’∑Ë ßÈ— ®“°°“√ Ÿ¥¥¡ ·≈–®“° “√§—¥À≈—ßË ¢ÕߧŸπà Õπ
∑’Ë¡’ “√°àÕ¡–‡√Áß18 ´÷Ë߇ªìπº≈„Àâ‡æ‘Ë¡§«“¡‡ ’ˬ߄π°“√‡ªìπ
¡–‡√Áߪ“°¡¥≈Ÿ°∑—Èß∑’Ë¡“®“°ªí®®—¬¢Õß∫ÿÀ√’ˇÕß·≈–√à«¡°—∫
à߇ √‘¡§«“¡ “¡“√∂¢Õ߇™◊ÈÕ‰«√— ‡Õ™æ’«’„π°“√‡°‘¥¡–‡√Áß10
∑—Èßπ’È√–¬–‡«≈“„π°“√ Ÿ∫∫ÿÀ√’Ë¢Õß “¡’ (ªï) ¬—ß¡’§«“¡ —¡æ—π∏å
°—∫°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°‚¥¬‡æ‘Ë¡§«“¡‡ ’ˬ߄π µ√’∑’Ë¡’
“¡’ Ÿ∫∫ÿÀ√’Ë¡“°°«à“ 20 ªï · ¥ß„Àâ‡ÀÁπ«à“°“√ Ÿ∫∫ÿÀ√’ˇªìπ
‡«≈“π“π∑”„À⇰‘¥°“√ – ¡§«“¡º‘¥ª°µ‘∑’ˇ°‘¥®“°°“√
‰¥â√—∫ “√°àÕ¡–‡√Áß ‡ªìπº≈„Àâ‡æ‘Ë¡§«“¡‡ ’ˬ߄π°“√𔉪 Ÿà
»√’π§√‘π∑√凫™ “√ 2553; 25(3)
Sitakan Natphopsuk, et al.
•
Srinagarind Med J 2010; 25(3)
221
°“√‰¥â√—∫§«—π∫ÿÀ√’Ë∑“ßÕâÕ¡‡ªìπªí®®—¬‡ ’ˬߢÕß°“√‡°‘¥¡–‡√Áߪ“°¡¥≈Ÿ°
•
°‘µµ‘°√√¡ª√–°“»
‚§√ß°“√π’ȉ¥â√—∫°“√ π—∫ πÿπ‡ß‘π«‘®—¬ ®“°‚§√ß°“√«‘®—¬
Invitation research ß∫ª√–¡“≥‡ß‘π√“¬‰¥âª√–®”ªï 2552 §≥–
·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ ‡≈¢∑’Ë‚§√ß°“√ F52225
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