浙江地区1088例妇科就诊患者HPV感染状况调查

高危型人乳头状瘤病毒(high risk human papillomavirus,hr-hpv)感染已被流行病学和生物学证明是子宫颈癌及癌前病变发病的主要危险因素[1-2],但中国各地子宫颈癌中hpv感染及型别分布情况可能存在较大差异[3].本研究对1 088例浙江省妇女hpv感染的流行病学进行调查,以期了解hpv感染现况,为宫颈癌的防治提供基础数据.     

温州地区宫颈癌患者人乳头状瘤病毒感染现状及危险因素分析

目的 了解温州地区宫颈癌患者人乳头状瘤病毒(human papillomavirus,hpv)的感染现状及危险因素,为hpv防治提供流行病学依据.方法 采用导流杂交基因分型技术(hybrimax)对温州地区198例宫颈癌患者的宫颈脱落细胞样本进行hpv检测及基因分型,分析hpv感染与宫颈癌临床分期、病理类型及分化程度的关系,并对不同宫颈疾病患者的hpv感染情况进行比较.采用spss 13.0软件进行统计分析.结果 198例宫颈癌患者中,hpv感染147例,占74.24%,其中重叠感染101例(51.01%),高危型hpv感染129例(65.15%),均高于宫颈炎和宫颈不典型增生患者,3组比较差异有统计学意义(x2值分别为28.28、65.34和95.22,p值均＜0.01).宫颈癌患者中,不同临床分期患者hpv感染率比较差异无统计学意义(x2=0.475,p＞0.05);鳞癌与腺癌患者的hpv感染率比较差异无统计学意义(x2=0.582,p＞0.05);不同分化程度患者的hpv感染率比较差异亦无统计学意义(x2=0.969,p＞0.05).logistic多元回归分析显示,hpv16/58型感染和年龄＞40岁是宫颈癌发生的主要危险因素.结论 温州地区宫颈癌患者生殖道有较高的hpv感染率及重叠感染率,hpv16/58感染和40岁以上妇女发生宫颈癌的危险增加,故应加强对该人群的检测并尽早采取干预措施. abstract： objective to investigate the prevalence of human papillomavirus(hpv)infections in women with uterine cervical cancer in wenzhou.methods exfoliated cells samples of cervix uteri were collected from 198 patients with cervical cancer. flow-through hybridization technique was used to detect hpv and its genotypes.the relationship of hpv infection with cervical cancer stage,histological type and differentiation degree were analyzed.the prevalence of hpv infections in patients with different cervical diseases was observed.spss 13.0 was used for statistical analysis.results in 198 patients with cervical cancer,hpv infection was occunrred in 147 (74.24%), of whom 101patients were superinfected (51.01%),and 129 patients(65.15%)were infected with the high-risk hpvs,which were significantly higher than those in cervicitis and cervical dysplasia(x2 = 28.28,65.34 and 95.22,p ＜ 0.01).hpv positive rate was not correlated with clinical stages,differentiation degree of cervical cancer(x2 = 0.475 and 0.969,p＞0.05).hpv positive rates in squamous cancer and adenocarcinoma had no statistical difference (x2 =0.582,p＞0.05).the logistic regression analysis showed that hpv 16/58 infection and age over 40might increase the risk of carcinogenesis of the cervix.conclusion shpv infection and superinfection are popular in women with cervix cancer in wenzhou.hpv16/58 infection and age over 40 years are the risk factors of cervical cancer.     

人类免疫缺陷病毒感染妇女人乳头状瘤病毒感染状况及危险因素分析

目的 调查人类免疫缺陷病毒(hiv)阳性妇女人乳头状瘤病毒(hpv)的感染状况,分析高危型hpv感染的危险因素.方法 收集178例自愿接受宫颈癌筛查的hiv阳性已婚妇女作为研究组,另选取122例hiv阴性妇女为对照组.所有受检患者填写调查问卷,检测hiv阳性妇女的cd4+t细胞计数和hiv rna载量,使用pcr方法检测hpv亚型.采用spss 16.0软件进行统计分析,并用logistic回归分析hpv感染的危险因素.结果 研究组hpv阳性者、高危型及多重hpv感染者分别是68例(38.2%)、63例(35.4%)和24例(13.5%),而对照组分别为15例(12.3%)、10例(8.2%)和4例(3.3%),两组比较差异有统计学意义(x2分别为24.77、29.08和8.91,p值均＜0.05).两组常见高危型hpv感染亚型相似,以hpv 16、52、58和hpv18亚型常见.logistic回归分析表明,cd4+t细胞计数＜350个/μl,配偶hiv阳性及性途径感染hiv为高危型hpv感染的危险因素.结论 hiv阳性妇女宫颈hpv感染率高,高危型和多重hpv感染常见.高危型hpv感染与hiv阳性妇女的免疫状态、hiv感染途径及配偶hiv状态有关. abstract： objective to evaluate the prevalence and risk factors of human papillomaviruses (hpv)infection among human immunodeficiency virus(hiv)-positive women.methods totally 178hiv-positive and 122 hiv-negative women were enrolled.structured interviews,peripheral cd4 + t cells counts and cervical specimens were obtained.polymerase chain reaction(pcr)assay was used to identify hpv types. spss 16.0 was used for statistical analysis,and logistic regression was used to identify independent prognostic factors for high-risk hpv infection. results hpv positive rate,high-risk and multiple hpv infection rates were 38.2% vs.12.3% ,35.4% vs.8.2% ,and 13.5% vs.3.3% in hivpositive women and hiv-negative women,respectively,and the differences were of statistical significance (x2 =24.77,29.08 and 8.91,p ＜0.05).the common types of high-risk hpv were similar between hiv-positive and hiv-negative women(hpv16,52,58 and 18).cd4 + t count ＜ 350/pl,hiv-positive in husband,and hiv infection through sexual contact were risk factors for high-risk hpv infection in hiv-positive women.conclusion sthe prevalence of hpv infection in hiv-infected women is high,especially for high-risk hpv infection and multiple infection.high-risk hpv infection usually occurs in hiv-positive women with low immune status,hiv infection through sexual contact and hiv-positive husband.     

5-氨基酮戊酸光动力治疗宫颈人乳头瘤病毒感染的护理体会

人乳头瘤病毒（human papilloma virus,HPV）感染除可引起女性尖锐湿疣外,宫颈HPV的感染尤其是“高危型”HPV感染是导致宫颈癌及其癌前病变的必要因素[1]。近年来,随着HPV感染率的逐年增高,宫颈鳞状上皮内瘤变（cervical intraepithelial neoplasia,CIN）和宫颈癌的发病率也随之增高并越来越年轻化[2],在临床上常用的激光、冷冻和微波等物理疗法治疗HPV引起的尖锐湿疣,但其对HPV临床感染治疗作用有限,本科室对48例女性宫颈HPV感染者尝试用光动力疗法（photodynamic therapy,PDT）治疗,取得了满意的疗效,现报道如下。     

宫颈病变患者人乳头状瘤病毒16的生物状态和晚期蛋白l1表达

目的 探讨人乳头状瘤病毒(hpv)16的存在状态及晚期蛋白l1表达与宫颈病变程度的关系.方法 收集61例宫颈病变患者为研究对象,按病理学诊断结果分为慢性宫颈炎组(27例),cin Ⅰ、cinⅡ组(10例),原位癌组(8例),早期浸润癌组(7例)和中晚期癌组(9例).采用pcr方法检测hpv分型及生物状态,采用免疫印迹法(western blot)测定晚期蛋白l1表达.组间比较采用kruskal-wallis检验,hpv16生物状态、l1蛋白表达水平与病变程度的关系采用pearson相关分析.结果 61例宫颈病变患者检出hpv16型53例,占86.9%,其中25例慢性宫颈炎患者均为游离型;cin Ⅰ、cinⅡ组6例游离型,2例整合型;原位癌组1例游离型,3例混合型和3例整合型;早期浸润癌组2例混合型,4例整合型;中晚期癌组1例混合型,6例整合型.hpv16整合型与宫颈病变程度呈正相关(r=0.705,p＜0.01).随着宫颈病变损伤程度加重,l1蛋白表达逐渐减弱,与宫颈病变程度呈负相关(r=-0.755,p＜0.01).结论 hpv16整合型及l1蛋白表达下降预示宫颈病变程度加重. abstract： objective to evaluate the relationship of biological status of hpv 16 and expression of l1 protein with the degree of cervical tumorigenesis.methods sixty-one patients with cervical lessions were enrolled and divided into five groups according to pathology of cervical lesions,including chronic cervicitis(n = 27),cervical intraepithelial neoplasia(cin) Ⅰ-Ⅱ(n = 10),carcinoma in situ(n = 8),early-stage(n =7)and mid/late-stage(n = 9)of cervical carcinoma.hpv type and its biological status were detected by pcr amplification,and l1 protein in hpv 16 positive tissues was detected by western blot.kruskal-wallis was used to compare between the groups,and pearson correlation analysis was used to evaluate the relationship of hpv biological status and l1 protain expression with cervical lesions.results fifty-three out of 61 patients with cervical lesions were detected with hpv positive(86.9%).all 25 patients with chronic cervicitis were in hpv free mode; in cin Ⅰ-Ⅱ group,6 patients were in free and 2 in integral mode; in carcinoma in situ group,1 patient in free,3 in mixed and 3 in integral mode; in the early-stage cervical cancer group,2 patients in mixed and 4 in integral mode; in mid/late-stage cancer group,1 patient in mixed and 6 in integral mode.a strong positive correlation was found between the hpv in integral mode and the severity of cervical lesions(r = 0.705,p ＜0.01).the expression of l1 protein was negatively correlated with the aggravation of cervical lesions in hpv 16-positive patients(r = -0.755,p ＜0.01).conclusion the integral mode of hpv16 and low expression of l1 protein may have predictive value for the severity of cervical lesions.     

替勃龙对术后辅助放疗的宫颈鳞癌患者生活质量的影响

宫颈癌是女性恶性肿瘤中居第二位,在发展中国家居首位[1].据世界卫生组织统计全世界平均每年发生宫颈癌45.9万例,其中我国每年平均宫颈癌发病率为13.15万例,占世界子宫颈癌新发病例总数的28.8％,过去50年宫颈癌的高发年龄集中在40岁至50岁,近年来20岁至30岁的患者逐年增多[2].郭科军等[3]报道年龄＜45岁宫颈癌的所占比例由1983-1992年的2.7％上升到1993-2002年的19.7％.本研究针对绝经前宫颈鳞癌患者,手术切除双附件,术后有明显围绝经期综合征症状,在辅助放疗早期使用替勃龙,目的是探讨替勃龙在缓解低雌激素引起的症状同时,对早期宫颈癌患者术后放疗并发症及生活质量的影响.     

高度重视人乳头状瘤病毒感染与女性生殖道肿瘤

人乳头状瘤病毒(human papillomavirus,hpv)是一种嗜上皮性病毒,属小dna病毒,广泛分布在人和动物中.目前已明确的hpv型别大约有100多种,约20种与肿瘤相关.hpv感染非常普遍,4%～20%的健康人群都曾感染过,并有多次重复感染.     

不同人乳头状瘤病毒检测方法对宫颈高度病变的诊断价值

目的 评价杂交捕获Ⅱ代(hc-Ⅱ)与聚合酶链反应(pcr)技术对人乳头状瘤病毒(human papillomavirus,hpv)dna检测及宫颈高度病变的诊断价值.方法 选取宫颈薄层液基细胞学检查(tct)异常的200例妇女为研究对象,同时用hc-Ⅱ、导流杂交基因芯片技术(hybrimax)、实时荧光定量pcr法(fq-pcr)和流式荧光杂交法检测宫颈细胞hpv dna.以病理组织学检测结果为金标准,比较4种检测方法对宫颈上皮内瘤变(cin)≥Ⅱ的诊断效果.采用spss 13.0软件进行统计学处理.结果 hybrimax、fq-pcr、流式荧光法和hc-Ⅱ对200例hpv dna阳性检出率分别为72.5%(145/200)、71.5%(143/200)、70.0%(140/200)和69.0%(138/200).4种hpv dna检测方法对不同程度宫颈病变的hpv检测阳性率差异无统计学意义(x2=0.252、0134、0.012和0.027,p值均＞0.05),但在诊断cinⅡ及以上病变的敏感度、约登指数和阴性预测值等方面比较差异有统计学意义(x2=7.923、7.819和8.108,p＜0.05).结论 对组织病理学诊断结果为cinⅡ及以上的宫颈病变,hc-Ⅱ的诊断价值优于pcr方法. abstract： objective to evaluate the application of different assays for detection of human papillomavirus(hpv)in diagnosis of high grade cervical lesions.methods two hundred subjects with abnormal thinprep liquid-based cytology test(tct)results were selected for hpv dna detection by hybrid capture 2(hc-Ⅱ) and methods based on pcr including flow-through hybridization and gene chip (hybrimax),real-time fluorescent quantitative pcr(fq-pcr)and flow fluorescent hybridization assay.cytopathological results were used as gold standards to evaluate the test performance of the above assays for diagnosing cervical intraepithelial neoplasia(cin)≥Ⅱ. spss 13.0 software was used for statistical analysis.results hpv dna positive rates of 200 samples by hybrimax,fq-pcr,flow fluorescent hybridization assay and hc-Ⅱ were 72.5%(145/200),71.5%(143/200),70.0%(140/200)and 69.0%(138/200),respectively,and the differences were not statistically si(g)nificant(x2 =0.252,0134,0.012 and 0.027,p ＞ 0.05).the sensitivity,youden index and negative predictive value of the above assays were statistically different(x2 =7.923,7.819 and 8.108,p ＜0.05).conclusion hc-Ⅱ is superior to pcr methods in diagnosis of cin Ⅱ and above.     

宫颈环形电刀切除术后应用碘仿纱条促进创面愈合

慢性宫颈炎是妇科常见病、多发病,也是诱发宫颈癌的高危因素.宫颈环形电刀切除术(LEEP)治疗慢性宫颈炎疗效肯定,但存在术后阴道长时间大量排液、阴道出血、创面愈合时间长及术后需禁性生活3个月、禁重体力劳动等缺点[1].笔者采用碘仿纱条应用于宫颈LEEP术后30例患者,效果满意,报告如下.     

锥形切除术与根治性切除术治疗早期宫颈癌的对照研究

目的探讨宫颈锥形切除术与根治性宫颈切除术治疗早期宫颈癌的临床疗效差异。方法前瞻性分析于2018年4月至2020年4月在本院确诊为早期宫颈癌的患者60例随机分为研究组与对照组各30例,实验组予以宫颈锥形切除术,对照组行根治性宫颈切除术。观察并比较两组患者手术效果、术后并发症评价、两组患者阴道流血、尿潴留和感染等术后并发症情况。观察比较两组患者1年内的复发率。结果两组患者手术指标比较,对照组手术时间和术中出血量多余实验组,两组间差异具有统计学意义(P0.05);住院时间和术后肛门首次排气时间比较,两组差异不具备统计学意义(P0.05)。两组患者术后的不良反应的发生率比较,两组差异不具备统计学意义(P0.05)。对照组术后1年内有2例患者宫颈癌复发,实验组患者1年内有2例患者宫颈癌复发。两组差异不具备统计学意义(P0.05)。结论宫颈锥形切除术治疗早期宫颈癌患者具备一定的优势,特别是宫颈锥形切除术更适用于育龄期女性,值得临床借鉴和运用。