ACS患者行冠状动脉支架植入术后“双抗”治疗的病理生理影响

目的探讨急性冠状动脉综合征(ACS)患者行冠状动脉支架植入(PCI)后阿司匹林+替格瑞洛或氯吡格雷抗凝治疗对血小板聚集性、血管内皮功能、炎症介质水平的影响。方法选取2015年4月至2016年5月该院行PCI的ACS患者100例为研究对象,采用随机数表法分为观察组和对照组各50例,观察组术后予以阿司匹林+替格瑞洛行抗凝治疗,对照组术后给予阿司匹林+氯吡格雷抗凝,术后均随访1年,比较两组用药1年内血小板聚集率,对比两组治疗前后血清内皮素-1(ET-1)、一氧化氮(NO)、纤溶酶原激活抑制剂-1(PAI-1)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、人可溶性CD40配体(sCD40L)水平,记录术后终点事件与不良反应。结果观察组用药后1、6个月、1年血小板聚集率均低于对照组(P0.05);观察组治疗后血清ET-1(100.20±1.87)ng/L、PAI-1(3.20±1.34)μg/L、hs-CRP(12.20±1.65)mg/L、IL-6(10.29±1.74)pg/mL、sCD40L水平(1.20±0.27)μg/L较对照组明显下降(P0.05),而NO水平(58.22±1.74)mg/L高于对照组(P0.05);观察组术后1年内终点事件发生率6.00%、不良反应发生率8.00%略低于对照组10.00%、10.00%,但差异比较无统计学意义(P0.05)。结论 ACS患者在PCI术后应用阿司匹林联合替格瑞洛行抗凝治疗效果优于阿司匹林联合氯吡格雷,前者对血小板聚集性、血管内皮功能、炎症介质水平有明显改善作用,且安全可靠,值得在临床推广应用。     

鲜竹沥的本草考证与现代研究进展

鲜竹沥被中医誉为“痰家圣剂”,具有清热化痰、开窍定惊等作用,临床上主要用于治疗痰热咳嗽、痰黄气促、中风痰盛等证。其炮制工艺及质量标准的研究是实现其工艺现代化和质量标准化的关键。笔者在文献调研基础上,对鲜竹沥进行本草考证,梳理鲜竹沥的药用历史沿革,对比其传统与现代制备工艺的优缺点。基于历史文献记载,提出鲜竹沥传统及现代炮制工艺尚存在诸多问题,传统工艺产量低、生产工艺较为粗放,不能满足大规模绿色制造的需求。目前关于鲜竹沥基原、品种及炮制工艺对比研究的文献较多,但大多仅限于化学成分方面,未对其药效物质基础及作用机制进行深入研究,同时鲜竹沥的药理药效也多限于镇咳祛痰方面,鲜有其他药理药效的相关报道。综上分析,建议后续研究工作可从5个方面进行：①正本清源,丰富和完善鲜竹沥的用药资源;②规范鲜竹沥的炮制工艺,建立相关质量标准体系;③阐明鲜竹沥药理作用机制,加强鲜竹沥的药理药效及临床应用的基础研究;④传承古法炮制,研究开发鲜竹沥专用制造设备,规范生产操作规程;⑤对制备过程中的副产物进行综合利用。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.     

细胞学检测为非典型鳞状细胞且人乳头瘤病毒阴性妇女的宫颈癌患病风险评估

目的 评估宫颈癌筛查中非典型鳞状细胞(ASC-US)但人乳头瘤病毒(HPV)阴性的妇女罹患中度及以上宫颈上皮内瘤样病变(CIN2+)的风险。方法 汇总1999-2008年在我国开展的17项以人群为基础的宫颈癌筛查横断面研究,共30371名17~59岁妇女参加筛查,所有妇女均进行了液基细胞学检查(LBC)、HPV检测(hybrid capture 2, HC2)和醋酸染色肉眼观察法(VIA),任一结果阳性者转诊阴道镜。最终28810名具有完整细胞学、HPV、病理检测结果的妇女纳入分析,分别以细胞学正常且HPV阴性组(LBC-/HPV-)、细胞学正常组(LBC-)为参照,评估细胞学为ASC-US且HPV阴性组(ASC-US/HPV-)的CIN2+患病风险。结果 LBC-/HPV-、LBC-和ASC-US/HPV-组分别有22003、24139和1834名妇女,CIN2+的患病率分别为0.05%、0.36%和0.16%。分别以LBC-/HPV-组、LBC-组为参照,ASC-US/HPV-组罹患CIN2+的风险分别为3.00(95%CI:0.85~10.65)和0.46(95%CI:0.15~1.45),其校正OR值分别为4.00(95%CI:1.08~14.87)、0.47(95%CI:0.15~1.49)。结论 ASC-US/HPV-妇女CIN2+的患病风险介于LBC-和LBC-/HPV-妇女之间。依据"同等风险、同等管理"的原则,可采用对LBC-者的3年筛查间隔,而对于卫生资源相对匮乏地区可采用对LBC-/HPV-者的5年筛查间隔。     

汉族和蒙古族女性HPV感染率及型别分布的差异分析

目的 评价我国汉族和蒙古族女性自然人群及不同宫颈病变级别中的高危人乳头瘤病毒型别分布及感染状况,为不同民族宫颈癌筛查和疫苗防控策略的制定提供理论依据。方法 2017年6月在我国山西省襄垣县、阳城县和内蒙古自治区鄂托克旗3个农村地区开展以人群为基础的多中心宫颈癌筛查研究,共纳入研究对象9 517名。所有研究对象均通过自我采样方法采集2份宫颈阴道分泌物标本,分别进行careHPV及PCR HPV检测（不分型）,并对任意阳性标本进行基于PCR方法的HPV分型检测。上述两种方法任意阳性者转诊阴道镜,阴道镜下若有病变于病变处直接活检,阴道镜下不满意者行宫颈管搔刮术。病理结果作为最终疾病诊断金标准。结果 汉族女性HPV感染者1 842人（21.83%）,蒙古族女性HPV感染者269人（24.93%）,两个民族HPV感染率差异有统计学意义（χ²=5.328,P=0.021）。蒙古族女性宫颈上皮内瘤样变1级的检出率[2.83%（30/1 059）]高于汉族女性[0.87%（73/8 378）],差异有统计学意义（χ²=33.509,P<0.001）,但宫颈上皮内瘤样变2级及以上的检出率差异无统计学意义[蒙古族：1.04%（11/1 059）;汉族：0.95%（80/8 378）,χ²=0.069,P=0.793]。两民族宫颈上皮内瘤样变2级及以上女性HR-HPV型别分布排在前三位的均是HPV16、52、58型。汉族和蒙古族女性多重感染率分别为41.37%、44.35%,两民族间差异无统计学意义（χ²=0.764,P=0.382）。结论 蒙古族女性的HPV感染率高于汉族女性,对汉族和蒙古族女性进行宫颈癌的综合防控时,应提高对HPV16、52、58型的重视。     

男性假两性畸形合并精原细胞瘤1例

患者，40岁，已婚，原发闭经，未生育。因盆腔肿物在外院行“双侧附件＋大网膜切除术”，术后3个月来我院复查。体检：女性体态，四肢发育正常，无胡须，喉结不突出，腋毛稀少，乳腺发育正常。妇科检查：女性外阴，阴毛稀少，阴蒂不大．阴道短小。术中见右“卵巢”肿物13cm×10cm×9cm，左“卵巢”大小3cm×2．5cm×2cm，未见子宫。术前外院外周血激素资料不详。其父母非近亲结婚，[第一段]     

阴道滴虫与宫颈HR-HPV 感染及宫颈癌发生的相关性

 目的 探讨阴道滴虫是否能增加高危人乳头瘤病毒（HR-HPV）感染和宫颈癌发生的危险。方法 对受检者进行液基细胞学检查和HR-HPV DNA检测，并在细胞学诊断中记录是否存在滴虫。对所有细胞学诊断非典型鳞状细胞（ASC）及以上病变、HR-HPV DNA阳性病例和部分细胞学阴性及HR-HPV DNA阴性病例进行阴道镜检查及活检。分别比较滴虫在HR-HPV DNA阳性组和阴性组、细胞学及组织学各级诊断中的存在率。结果 在13024例受检者中有1687例（12．95％）涂片中有滴虫。滴虫存在率在HR-HPV DNA阳性组与阴性组中无显著统计学差异（P〉0．05），在细胞学阴性病例组显著高于鳞状上皮内病变组（P〈0．05），在组织学阴性病例组显著高于在≥CIN2病例组（P〈0．05）。结论 滴虫的存在不增加HR-HPV感染率，也不增加宫颈癌发生的危险。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.