实时荧光定量PCR检测HPV—DNA在宫颈癌筛查中应用

目的：探讨HPV感染与宫颈病变的关系。方法：对2008年2月-2009年3月期间在通山县人民医院皮肤性病科和妇科门诊就诊的1256位女性的宫颈拭子标本进行HPV DNA实时荧光定量PCR检测,比较不同宫颈病变级别组HPV的阳性率。结果：各病变组与正常组比较差异有显著性,P〈0.01,且随病变级别增加总阳性率逐渐上升。结论：HPV在人群具有较高的感染率,且HPV感染与宫颈病变的发生有关。实时荧光定量PCR检测HPV DNA可成为一种广泛应用的临床检验技术,作为筛查宫颈癌及癌前病变的首选方法。     

Potentialities of low-field magnetic resonance tomography in the diagnosis and treatment of invasive cancer of cervix uteri

The aim of the study was to evaluate the efficiency of low-field (0.14 T) magnetic resonance imaging (MRI) in the diagnosis and treatment of cancer of the cervix uteri. MATERIALS AND METHODS: Low-field MRI was performed in 39 patients with cancer of the cervix uteri to define the stage of the tumor and to follow up the outcomes of their treatment. Particular emphasis was laid on the determination of the size of the tumor and the presence of parametral invasion and on metastatic lesions of lymph nodes. MRI data were compared with clinical, morphological, and surgical staging results. In detecting the stage of cancer of the cervix uteri, the accuracy of MRI was 72% whereas that of clinical study was 51%. In determining parametral invasion, the accuracy of clinical study and low-field MRI was 71 and 90%, respectively. The sensitivity and specificity of MRI were 83 and 92%, respectively. The anterioposterior tumor size was an important prognostic factor in following up the outcomes of treatment as there was its close association and the incidence of tumor recurrences. The present study has indicated that the high efficiency of low-field MRI in detecting the stage of invasive cancer of cervix uteri makes it the method of choice in planning treatment and monitoring the outcomes of combined radiation therapy.     

宫颈癌癌前病变及宫颈癌患者阴道微生态失调相关因素

目的 探讨宫颈癌癌前病变及宫颈癌患者阴道微生态失调相关因素。 方法 选择2016年7月至2018年12月我院收治的200例宫颈癌和癌前病变患者为研究对象,其中宫颈癌患者100例(宫颈癌组),癌前病变患者100例(癌前组),另选50例健康女性为对照组。观察各组对象阴道微生态指标(菌群密集度、菌群多样性、pH和H2O2)水平、HPV感染情况及乳杆菌分布情况。分析患者阴道微生态变化与HPV感染的关系。 结果 癌前组和宫颈癌组阴道菌群密集度Ⅰ-Ⅳ级的患者分别占33.00%和42.00%,显著高于对照组的10.00%(χ2=15.762 9,P=0.000 1);菌群多样性Ⅰ-Ⅳ级的患者分别占35.00%和41.00%,同样高于对照组的6.00%(χ2=19.783 1,P4.5的患者分别占53.00%和56.00%,高于对照组的12.00%(χ2=29.267 3,P2O2阴性患者占比分别为63.00%和70.00%,显著高于对照组的18.00%(χ2=39.343 7,P2=63.624 2,P2=8.742 1,P结论 宫颈癌前病变和宫颈癌的发生与患者阴道微生态失调、HPV感染、乳杆菌减少密切相关;同时癌前病变的发展与阴道微生态失调具有相关性。     

HPV检测在宫颈癌、宫颈癌前病变及宫颈炎患者中的临床应用

目的:研究人类乳头瘤病毒(HPV)检测在宫颈癌、宫颈癌前病变及宫颈炎患者中的临床鉴别价值。方法:选取2013年5月到2015年5月我院确诊的宫颈病变临床资料320例,根据病理诊断结果将患者分为宫颈癌组(59例)、癌前病变组(138例)以及宫颈炎组(123例),检测并比较三组HPV阳性检出率、HPV相对含量以及HPV-DNA亚型情况。结果:宫颈炎组HPV阳性检出率、HPV相对含量及HPV-DNA各亚型阳性率均显著低于癌前病变组和宫颈癌组,且癌前病变组均显著低于宫颈癌组,比较差异具有统计学意义(P0.05)。结论:HPV有助于鉴别宫颈癌、宫颈癌前病变及宫颈炎,对宫颈病变治疗和预后具有评价作用。     

腹腔镜与宫腔镜联合治疗临床不孕不育症的疗效与价值研究

目的探讨腹腔镜与宫腔镜联合应用治疗临床不孕不育症的疗效与价值。方法随机选取我院治疗的临床不孕不育症患者78例为研究对象,按抽签顺序分为两组各39例。对照组采用传统开腹手术治疗,观察组采用腹腔镜联合宫腔镜治疗,比较两组患者手术治疗后输卵管畅通、宫内妊娠率以及临床疗效。结果与对照组比较,观察组术后输卵管通畅、宫内妊娠率明显提高,异位妊娠发生率明显降低,差异有统计学意义(P0.05);观察组患者的临床疗效明显优于对照组,差异具有统计学意义(P0.05)。结论腹腔镜联合宫腔镜治疗不孕不育症的效果显著,可提高输卵管通畅率及宫内妊娠率。     

Co-overexpression of bcl-2 and c-myc in uterine cervix carcinomas and premalignant lesions

To establish the role of co-overexpression of bcl-2 and c-myc protooncogenes in uterine cervix carcinogenesis, we examined 138 tissue samples of low grade cervical squamous intraepithelial lesions (SIL), high grade SIL, portio vaginalis uteri (PVU) carcinoma in situ and PVU carcinoma invasive, stage IA-IIA (study group) and 36 samples without SIL or malignancy (control group). The expression of bcl-2 and c-myc was detected immunohistochemically using a monoclonal antibody. Fisher’s exact test (P<0.05) was used to assess statistical significance. Overexpression of bcl-2 was found to increase in direct relation to the grade of the cervical lesions. High sensitivity was of great diagnostic significance for the detection of these types of changes in the uterine cervix. On the basis of high predictive values it can be said that in patients with bcl-2 overexpression there is a great possibility that they have premalignant or malignant changes in the uterine cervix. Co-overexpression of bcl-2 and c-myc oncogenes was found only in patients with PVU invasive carcinoma (6/26-23.0%). Statistically significant difference was not found in the frequency of co-overexpression in patients with PVU invasive carcinoma in relation to the control group (Fisher’s test; P=0.064). The method's sensitivity of determining these oncogenes with the aim of detecting PVU invasive carcinoma was 23%, while specificity was 72.2%. On the basis of high predictive values (100%), speaking in statistical terms, it can be concluded that all patients with co-overexpression of bcl-2 and c-myc oncogenes will have PVU invasive carcinoma. We confirmed in our research that co-overexpression of bcl-2 and c-myc oncogenes was increased only in PVU invasive carcinoma. However, a more extensive series of samples and additional tests are required to establish the prognostic significance of bcl-2 and c-myc co-overexpression in cervical carcinogenesis.     

False-negative Papanicolaou smears from women with cancerous and precancerous lesions of the uterine cervix

The occurrence from 1980 to 1989 of false-negative Papanicolaou smears in women with cancerous and precancerous lesions of the uterine cervix was studied. The 4,781 cases of cancer (2,814 invasive carcinomas and 593 carcinomas in situ) and precancerous lesions (418 severe dysplasias, 748 moderate dysplasias and 208 mild dysplasias) included 70 cases (1.5%) with false-negative smears. These 70 cases included 43 invasive carcinomas (61.4%), 17 carcinomas in situ and adenocarcinomas in situ (24.2%), and 10 dysplasias (14.4%); all were diagnosed histologically. The mean age of women with false-negative smears was 44.1 +/- 13.7 years. Review of the original cytologic samples showed a screening error in 41 cases (58.5%), an interpretation error in 2 cases (2.9%) and a sampling error in 27 cases (38.6%). Methods for eliminating false-negative smears are discussed.     

Can screening Chlamydia trachomatis by serological tests predict tubal damage in infertile patients?

Effectiveness of screening Chlamydia trachomatis (CT) antibody to predict tubal damage was assessed in this prospective study which was performed in a teaching hospital between September 2003 and September 2004. The study group consisted of 152 patients who underwent laparoscopy for infertility and the control group consisted of 80 fertile women who gave birth in the same hospital. CT antibody levels were measured by IFA (Indirect Fluorescence Assay for CT). Adhesions were defined by Gomel's classification system. Rate of seropositivity of CT was 34.6% in the study group and 22.5% in the control group (p>0.05). In the study group, the sensitivity, specifity, positive predictive and negative predictive values of CT positivity for tubal damage were 40%, 69.5%, 50% and 60.2% respectively. In the infertile group, the rate of tubal adhesion in the CT positive group was 50% and in the CT negative group it was 39.7% (p>0.05). However, there was a positive correlation between the severity of tubo-peritoneal adhesions and seropositivity for CT. In this study, we found out that tubo-peritoneal adhesions could not be predicted by the presence of CT inserum. There was a positive correlation between high CT seropositivity and high degree of adhesions.     

ALDH2 polymorphism for the risk of cervical carcinogenesis

To investigate the clinical significance of ALDH2 genetic polymorphisms in cervical carcinogenesis. ALDH2 polymorphisms together with human papillomavirus (HPV) types were examined in a total of 195 cervical smear in exfoliated cervical cell samples using Real-Time polymerase chain reaction (PCR) System. The frequency for the AG+AA genotype was seven in the normal group (70.0 %), 16 in the LSIL group (57.1 %), and 27 in the HSIL group (90.0 %). A significant difference was found between the LSIL and HSIL groups (P = 0.0064). Patients with HSIL lesions frequently had high-risk HPV infections and concurrently belonged to the AG+AA group. ALDH2 genotype in cervical cell samples may be associated with more severe precancerous lesions of the cervix in a Japanese population.     

薄层液基细胞学在宫颈癌及其癌前病变筛查中的价值

目的：评价薄层液基细胞学（Thin prep cytology test,TcT）检测技术对宫颈癌前病变的诊断和宫颈癌筛查的准确性及临床价值。方法：收集分析2009年5月～2010年11月在我院妇科门诊行TCT检查的受检者7340例,以细胞学诊断为未明确意义的不典型鳞状上皮细胞（ASC—US）及以上者为阳性结果,并对阳性结果行病理组织学诊断,以组织学诊断作为金标准、,结果：液基细胞学标本满意度高,对SCC、HSIL、LSIL的准确率分别为76．8％、97.3％、100％。结论：TCT结合TBS诊断系统是目前诊断宫颈癌前病变和筛查宫颈癌的理想方法川,同时也可以作为一项宫颈癌术后随访的检测指标。ASC—US患者中存在部分年轻的高危癌前病变者。     

实时三维超声输卵管造影与X线造影诊断不孕症患者输卵管病变的价值比较

目的:比较实时三维超声输卵管造影与X线造影检查诊断女性不孕症患者输卵管病变的临床应用价值。方法:选择2014年3月至2016年12月我院诊治的不孕症患者60例作为研究对象,所有患者都于月经干净后3-7 d同时随机实施实时三维超声输卵管造影与X线造影检查,观察并记录造影图像质量与诊断结果,比较两种方法的诊断效果。结果:实时三维超声输卵管造影与X线造影的图像质量优良率分别为98.3%和86.7%,实时三维超声输卵管造影的图像质量明显高于X线造影(P0.05)。实时三维超声输卵管造影与X线造影诊断不孕症患者输卵管不通畅率分别为56.7%和46.7%,实时三维超声输卵管造影组显著高于X线造影组(P0.05)。输卵管通畅性评价金标准腹腔镜下通液术诊断发现输卵管不通畅35例,在此基础上实时三维超声输卵管造影与X线造影检查不孕症的敏感性分别为97.1%和80.0%,特异性均为100.0%,超声诊断的敏感性明显高于X线(P0.05)。结论:相对于X线造影,实时三维超声输卵管造影检查不孕症患者输卵管病变的图像质量更好,有利于疾病的判断,对输卵管通畅度判断更精确,利于后期治疗及疾病预防,还可提高诊断敏感性。     

宫腔镜联合腹腔镜治疗输卵管性不孕的临床研究

目的:探讨宫腔镜联合腹腔镜治疗输卵管性不孕的临床效果,为临床治疗提供依据。方法:选择2011年1月~2013年1月因输卵管性不孕在我院妇产科就诊的患者共120例,依据手术方法平均分为A组(宫腔镜)、B组(腹腔镜)、C组(宫腔镜联合腹腔镜)和D组(开腹手术),对比各组患者手术情况(手术时间、术中出血量和住院天数)、术后输卵管再通率和术后妊娠率。结果:A、B、C、D组手术时间、术中出血量、及住院天数依次增加,差异均有统计学意义(均P0.05);C组患者术后输卵管再通率、妊娠率均显著高于A组、B组、D组(均P0.05)。结论:宫腔镜联合腹腔镜治疗输卵管性不孕,具有创伤小、术后恢复快、输卵管再通率、妊娠率高的优点,值得推广应用。     

人乳头瘤病毒与宫颈癌前病变的相关性研究

目的：探讨人乳头瘤病毒感染与宫颈癌前病变两者之间的相关性。方法：选择2009年11月～2011年12月来我院就诊的220例宫颈病变患者为研究对象,将患者分成4组,即炎症组、CINl组、CIN2组和CIN3组,各组进行人乳头瘤病毒检出率及病毒载量的比较。结果：炎症组、CINl、CIN2和CIN34组人乳头瘤病毒的检出率分别为67．2％、80％、87．3％和91．4％且4组之间比较差异有显著统计学意义（P〈O．001）。炎症组HPV感染的阳性率与CIN组比较显著降低（P〈0．005）,宫颈癌前病变各组HPV感染呈阳性的病毒载量差异有统计学意义（P〈0．05）。结论：宫颈癌前病变的严重程度和感染高危型HPV病毒载量呈正相关,随着感染高危型HPV病毒载量越高,宫颈癌前病变的程度越严重。     

Reliability of recording uterine cancer in death certification in France and age-specific proportions of deaths from cervix and corpus uteri

French uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening.     

Sister chromatid exchanges in patients with precancerous and cancerous lesions of cervix uteri

Summary The frequency of sister chromatid exchanges (SCEs) was studied in leucocytes from 46 patients with cervical carcinoma, 89 precancerous lesions, and 43 age-matched control women. The frequency of SCEs was found to be 10.15 ±2.49 in cancer, 8.83±2.15 in precancerous lesions, and 7.55±2.24 in controls. The analyses of SCE data revealed a highly significant (P<0.001) increase in precancerous and cancerous lesions compared to controls. The intra-chromosomal distribution of SCEs revealed a random increase in various chromosomal groups in patients with cancer and dysplasia compared to controls. The mean SCE level among various groups of precancerous lesions according to severity of pathological condition did not show significant differences. However, 70.8% of dysplasia cases revealed SCE levels higher than the average in controls. The increased frequencies of SCEs in the majority of cancer patients and a few, precancerous lesions indicate that individuals with high SCE levels may be at a high risk of developing cancer. Thus the usefulness of SCE levels as a preclinical marker to identify the high risk group of dysplasias needs to be ascertained by follow-up studies; these are in progress.     

全氟显4D-HyCoSy与3D-HyCoSy对输卵管性不孕症患者的诊断效果评价

摘要 目的：探讨与评价全氟显子宫输卵管四维超声造影（4D-HyCoSy）与经阴道三维超声输卵管造影（3D-HyCoSy）对输卵管性不孕症患者的诊断效果。方法：选择2018年8月到2021年11月选择在本院诊治的女性不孕症患者84例作为研究对象,都给予全氟显4D-HyCoSy与3D-HyCoSy诊断,记录图像质量与不良反应发生情况。金标准为腹腔镜检查,判断诊断效果。结果：在84例患者中,全氟显4D-HyCoSy的图像质量优良率为100.0 %,高于3D-HyCoSy的92.9 %（P<0.05）。全氟显4D-HyCoSy诊断为输卵管通畅14例,输卵管通而不畅23例,输卵管阻塞47例。3D-HyCoSy诊断：22例输卵管通畅,21例输卵管通而不畅,41例输卵管阻塞。腹腔镜诊断：15例输卵管通畅,21例输卵管通而不畅,48例输卵管阻塞。全氟显4D-HyCoSy、3D-HyCoSy对输卵管性不孕症患者的诊断敏感性为100.0 %（36/36）、97.2 %（35/36）,特异性为97.9 %（47/48）、83.3 %（40/48）。84例患者在全氟显4D-HyCoSy、3D-HyCoSy检查期间发生的不良反应主要为阴道出血、恶心呕吐、腹部疼痛等,不良反应发生率对比无差异（P>0.05）。全氟显4D-HyCoSy对输卵管性不孕症患者的诊断敏感性与3D-HyCoSy对比无差异（P>0.05）,诊断特异性高于3D-HyCoSy（P<0.05）。结论：相对于3D-HyCoSy,全氟显4D-HyCoSy在输卵管性不孕症患者的应用能提高图像质量优良率,具有很好的安全性,还具有更好的诊断特异性。     

血清Hcy，叶酸和维生素B12在胃癌及其癌前疾病中的作用

目的:探讨血清同型半胱氨酸(Hcy)、叶酸以及维生素B12在胃癌及癌前疾病中的水平及临床意义。方法:收集2014年1月至2016年8月我院收治的100例胃癌患者(胃癌组),及100例胃良性病变患者包括41例胃炎、34例胃溃疡、25例胃息肉(癌前病变组),并于同期随机选择200例健康体检者为对照组,采用循环酶法测定三组的血清Hcy,电化学发光免疫分析法测定叶酸及维生素B12水平,并分析各指标与胃癌临床病理特征的关系。结果:胃癌组、癌前病变组血清Hcy水平均高于对照组,叶酸及维生素B12水平均低于对照组,并且胃癌组血清Hcy水平高于癌前病变组,叶酸及维生素B12水平低于癌前病变组,差异有统计学意义(P0.05)。Ⅲ+Ⅳ期胃癌患者Hcy水平高于Ⅰ+Ⅱ期,进展期患者Hcy水平高于早期,有淋巴结转移患者Hcy水平高于无转移者,差异有统计学意义(P0.05);Hcy表达与性别、年龄、病变位置以及分化程度无关,差异无统计学意义(P0.05)。叶酸、维生素B12的表达在胃癌患者中与各临床病理特征(性别、年龄、TNM分期、肿瘤浸润深度、病变位置、有无淋巴结转移、分化程度)无明显关系,差异无统计学意义(P0.05)。结论:血清Hcy在胃癌患者中呈高水平表达,而叶酸及维生素B12呈低水平表达,联合检测三种指标有助于早期区分胃癌及癌前病变,同时血清Hcy还可能参与了胃癌的发生发展过程。Hcy、叶酸及维生素B12可作为早期鉴别诊断胃癌及其癌前病变的重要指标。     

金葡菌L型感染致小鼠肿瘤中CyclinD1、CDK4和P16的表达及意义

目的探讨金黄色葡萄球菌(金葡菌)L型感染C57小鼠致瘤后,CyclinD1、CDK4和P16在小鼠肿瘤及癌前病变中的表达及相关性研究。方法动物实验观察发现金葡菌L型感染90只C57小鼠后11.1%(10/90)发生肿瘤;14.4%(13/90)引起癌前病变。革兰染色、免疫组化染色,检测小鼠肿瘤和癌前病变中金葡菌L型感染率和CyclinD1、CDK4和P16蛋白的阳性表达。结果 10只小鼠肿瘤及13只小鼠癌前病变中金葡菌L型检出率与正常对照组比较差异有明显统计学意义(P0.01)。CyclinD1、CDK4和P16蛋白的阳性表达与正常对照组比较差异有统计学意义(P0.01～0.05),呈正相关。结论金葡菌L型感染可能与CyclinD1、CDK4和P16蛋白在小鼠肿瘤发生和发展中有协同作用。     

血清sCD44v6、HLA-G、G-17、Hp-IgG联合检测在胃癌与癌前病变筛查中的临床价值探讨

摘要 目的：探讨血清可溶性CD44变体6（sCD44v6）、人类白细胞抗原-G（HLA-G）、胃泌素-17（G-17）、幽门螺杆菌-免疫球蛋白G（Hp-IgG）联合检测在胃癌与癌前病变筛查中的临床价值。方法：选择2019年2月至2022年2月期间首都医科大学附属北京朝阳医院消化内科收治的121例胃癌癌前病变患者（癌前病变组）和125例胃癌患者（胃癌组）,另选择同期120例健康体检者作为对照组,检测并比较三组间血清sCD44v6、HLA-G、G-17水平以及Hp-IgG阳性率。根据Hp-IgG阳性情况,将胃癌组进一步分为Hp-IgG阳性组与Hp-IgG阴性组,比较两组间血清sCD44v6、HLA-G、G-17水平。应用Spearman秩相关分析胃癌组血清sCD44v6、HLA-G、G-17水平与Hp-IgG阳性率的相关性,应用受试者工作特征（ROC）曲线分析sCD44v6、HLA-G、G-17、Hp-IgG单独鉴别和联合四项指标鉴别胃癌癌前病变与胃癌的价值。结果：胃癌组血清sCD44v6、HLA-G、G-17水平以及Hp-IgG阳性率高于癌前病变组、对照组（P＜0.05）,癌前病变组血清sCD44v6、HLA-G、G-17水平以及Hp-IgG阳性率高于对照组（P＜0.05）,胃癌组中Hp-IgG阳性组sCD44v6、HLA-G、G-17水平高于Hp-IgG阴性组（P＜0.05）。胃癌组血清sCD44v6、HLA-G、G-17水平与Hp-IgG阳性率呈正相关（rs=0.536、0.492、0.512,P＜0.05）。联合sCD44v6、HLA-G、G-17、Hp-IgG鉴别胃癌癌前病变以及胃癌的曲线下面积为0.863,高于各指标单独鉴别。结论：血清sCD44v6、HLA-G、G-17水平以及Hp-IgG阳性率在胃癌患者与胃癌癌前病变患者中存在明显差异,胃癌患者血清sCD44v6、HLA-G、G-17水平与Hp-IgG阳性有关,联合四项指标检测在胃癌与癌前病变筛查中具有较高的临床价值。