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.     

针吸穿刺细胞学在妇科肿瘤诊断中的临床价值

[目的]探讨针吸穿刺细胞学在妇科肿瘤及其转移灶诊断中的临床价值。[方法]对259例妇科恶性肿瘤转移灶（盲穿）及51例盆腔肿物（B超引导下）进行针吸穿刺。[结果]针吸穿刺细胞学诊断对转移灶组诊断的敏感性为96.3％，特异性为100％。对盆腔肿物组的敏感性和特异性均为100％.310例针吸患者未发现针道种植及感染。[结论]针吸穿刺细胞学在妇科恶性肿瘤及转移灶诊断中敏感性及特异性高，对妇科肿瘤及其转移灶的诊断具有重要的临床价值。     

针吸细胞学诊断肝细胞癌的标准探讨

目的 探讨肝细胞癌（ＨＣＣ）的针吸细胞学诊断标准。方法 分析６１例ＨＣＣ针吸细胞学涂片，并与１９例肝转移瘤和１６例肝非肿瘤病变对照，找出与ＨＣＣ有关的形态改变，用逐步Ｌｏｇｉｓｔｉ回归方法选择区别ＨＣＣ与肝转移瘤、ＨＣＣ与肝非肿瘤病变的最有用的形态特征。     

DNA定量分析技术作为食管癌及癌前病变初筛方法的探索性研究

[目的]探索DNA定量分析方法作为食管癌癌前病变的初筛方法的可行性。[方法]选取食管癌高发区林州市40～69岁内镜筛查确诊的食管癌及其各级癌前病变患者79例,通过脱落细胞学检查获得食管上皮细胞标本,双盲进行液基细胞学和DNA定量分析诊断。基于病理诊断结果,比较DNA定量分析与液基细胞学的筛查能力。[结果]基于中度不典型增生及以上,DNA定量分析中至少2个异倍体细胞数的灵敏度86.0%,特异度65.5%,优于细胞学≥ASCUS灵敏度为82.0%,特异度为65.5%;DNA定量分析≥4个异倍体细胞数或≥ASCUS的灵敏度和特异度分别为90.0%和62.1%。[结论]DNA定量分析方法初筛食管癌及其癌前病变的灵敏度与特异度略优于液基细胞学,在诊断效率、重现性、预后预测等方面颇具优势。作为初筛方法具有可行性,但尚需大样本量人群筛查验证。     

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.     

宫颈原位腺癌和微小浸润腺癌的脱落细胞学

原发于宫颈柱状上皮的腺癌占所有宫颈癌的10%。一般在组织学检查对,大约所有宫颈腺癌的8%还是原位癌。最近Boon 等人回顾研究了5例在最初宫颈活检时漏诊的宫颈原位腺癌,他们强调原位腺癌在3～7年后可能发展为浸润型腺癌。因此,宫颈原位腺癌的脱落细胞学侦察是所有诊断细胞学室的重要任务.     

液基薄片与免疫细胞化学结合鉴别恶性肿瘤细胞的类型

目的：探讨液基薄层细胞涂片（TLC）和免疫细胞化学（ICC）结合鉴别恶性肿瘤细胞类型的意义。方法：利用薄层细胞涂片进行免疫细胞化学检测，观察抗体的表达，判断恶性肿瘤细胞的分型及来源。结果：针吸穿刺涂片标本130例进行免疫细胞化学检测，使用21种不同抗体鉴别恶性肿瘤细胞的类型、56例分化差的癌细胞需要鉴别为腺癌、鳞癌和小细胞癌，其免疫细胞化学结果43例与组织病理结果相符，符合率为76．8％；47例需要鉴别为小细胞癌或非霍奇金氏淋巴瘤（NHL），有46例与组织病理学结果相符，符合率为97．9％；27例小细胞型肿瘤鉴别其组织来源，27倒均与组织病理学结果相符，符合率为100％，包括横纹肌肉瘤、NHL、血管肉瘤、恶性黑色素瘤等。20例Cyltospin涂片ICC结果中19例与TLC一致；间叶肿瘤和淋巴瘤的免疫细胞化学结果容易识别；在具有癌巢的涂片，免疫细胞化学结果易产生假阳性。结论：针吸穿刺标本的TLC与免疫细胞化学结合鉴别恶性肿瘤细胞的类型，其结果与组织病理结果符合率高，可以辅助细胞学疑难病例的诊断，为临床治疗提供依据。     

多种检测方法在子宫颈癌及癌前病变筛查中的应用评估

目的评估多种检测方法在子宫颈癌及癌前病变筛查中的应用价值及可行性，为子宫颈癌筛查方案提供依据。方法对子宫颈癌高发区江西省修水县大桥乡妇女进行以人群为基础的研究，对已登记的2499名年龄为30～49岁农村已婚妇女分别做人乳头瘤病毒（HPV）检测、新柏氏薄层液基细胞学（TCT）、醋酸染色后肉眼观察（VIA）、碘染色后肉眼观察（VILI）以及电子阴道镜检查。全部检查方法均以独立、双盲方式进行。对VIA、VILI及电子阴道镜三项检查中任何一项存在子宫颈可疑病变的妇女行子宫颈活检；对以上三项检查均未发现可疑病变，但子宫颈脱落细胞HPV阳性或TCT结果阳性（ASCUS以上级别）的妇女，2周后给予子宫颈活检。观察HPV、TCT、VIA、VILI、电子阴道镜等筛查方法单独使用或联合使用进行子宫颈癌及其癌前病变筛查的敏感度、特异度、阳性预测值、阴性预测值。宫颈组织病理诊断均经国际癌症研究所病理确诊。筛查时将病理诊断为子宫颈上皮内瘤变（CIN）1级（CINl）纳入阴性结果，将CIN2以上（包括CIN2）病变纳入阳性结果。宫颈细胞学按TCT（thinprep cytology test）标准制片，细胞学诊断按照2001年TBS（The Bethesda System）细胞病理分类标准判读诊断。结果2499名受检妇女中，2432名纳入研究（67名妇女因HPV或TCT阳性未行活检故未列入统计），其中HPV阳性妇女387例；TCT阳性妇女153例。宫颈活检病理诊断共检出CIN及子宫颈癌99例，其中CIN237例，CIN359例，宫颈癌3例。HPV、TCT、HPV＋TCT、VIA、VILI、VIA＋VILI、阴道镜检等筛查方法的敏感度分别为96．67％、89．47％、97．98％、56．57％、36．36％、63．64％、39．39％。特异度分别为85．00％、96．91％、86．97％、94．60％、96．23％、92．97％、98．14％。结论HPV＋TCT用于宫颈癌及癌前病变筛查的敏感度高于其他筛查方法。     

利用分子生物学方法检测鼻咽癌颈部转移性淋巴结中EB病毒基因研究(二)

目的利用分子生物学方法聚合酶链反应技术（ＰＣＲ）和Ｓｏｕｔｈｅｒｎ印迹杂交（ＳＢＨ）为隐性鼻咽癌和原发灶不明的颈部转移癌提供诊断和鉴别诊断的参考依据。材料与方法利用ＰＣＲ基因扩增技术和Ｓｏｕｔｈｅｒｎ印迹杂交检测经针吸活检取材或活检取材的２０例鼻咽癌（ＮａｓｏｐｈａｒｙｎｇｅａｌＣａｒｃｉｎｏｍａ，ＮＰＣ）（实验组）３３份标本和２６例非鼻咽癌（对照组）２７份标本中ＥＢ病毒（Ｅｐｓｔｅｉｎ－Ｂａｒｒｖｉｒｕｓ，ＥＢＶ）。结果在ＮＰＣ组中ＥＢＶ基因检测，１７／２０例是阳性，１８份针吸活检取材标本中１３／１８呈阳性；对照组中仅３／２０例ＥＢＶ检测呈阳性，其中２例为霍奇金病，１例鼻咽腺样增殖体。结论ＥＢ病毒基因检测结果再次显示本研究能准确地为隐性鼻咽癌提供诊断和鉴别诊断的参考依据，而且针吸活检取材较石腊切片取材更省时，痛苦小而经济。应强调的是分析ＥＢＶ检测结果应与病理，临床检查相结合     

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。