鼻腔鼻窦内翻性乳头状瘤的临床分期及术式选择

鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma,SNIP)是鼻腔最常见的良性肿瘤,三个特征使SNIP与其它鼻腔肿瘤有很大的不同:局部破坏性大,复发率较高,有癌变可能。SNIP分期至关重要,其在SNIP术式选择以及预后评估方面具有公认的价值,但目前还没有普遍接受的分期系统。手术是SNIP首选治疗方式,术式可分为鼻外入路、鼻内镜入路以及联合入路,但是切除SNIP的最佳术式仍然存在争议。本文对SNIP分期系统以及术式管理的最新进展进行综述。     

Recurrent respiratory papillomatosis in northern Sweden: Clinical characteristics and practical guidance

Conclusion: Recurrent respiratory papillomatosis (RRP) patients with high surgical treatment frequency (≥ 1/year, HF) were significantly younger and had a more widespread laryngeal disease compared to a low frequency treated group (< 1 treatment/year, LF). This study confirms the existence of a clinical RRP group, not primarily related to HPV sub-type, but more care-intensive and in need of more vigilant follow-up. Objectives: RRP is associated with high morbidity due to its influence on breathing and voice. The purpose of this study was to characterize RRP patients in northern Sweden and investigate possible predictor factors affecting therapeutic needs. Method: Patients from the regional referral area (northern Sweden) were categorized for age, disease duration, juvenile or adult onset, profile of disease development, number of surgical sessions in relation to disease duration, laryngeal deposition of papilloma, gender, and HPV sub-types, in order to identify patients with increased need for frequent surgical treatment. Results: The median age of the RRP patients (n = 48) was 44.5 years; 34 (71%) were males and 14 (29%) females, most were infected with HPV 6. Patients with high surgical treatment frequency/year were significantly younger and showed more widespread papillomatous vegetation in the larynx, compared to the low frequency treated group.     

高危型HPV阳性宫颈癌患者miRNA-34a-5p的表达及临床意义

目的　探讨高危型人乳头状瘤病毒（high risk-human papilloma virus, HR-HPV）阳性宫颈癌患者组织及血清中微小RNA（microRNA, miRNA）-34a-5p的表达及其对宫颈癌的诊断价值。方法　将100例HR-HPV阳性宫颈癌患者（宫颈癌组）、70例宫颈上皮内瘤变（cervical intraepithelial neoplasia, CIN）患者（CIN组）、70例HR-HPV阳性子宫良性病变或者HPV单纯阳性的健康体检者（对照组）作为研究对象。采集上述研究对象的血清标本及70例行手术治疗的宫颈癌组患者癌组织及癌旁组织。使用实时荧光定量PCR技术测定组织及血清中miRNA-34a-5p水平，并分析miRNA-34a-5p与宫颈癌临床、病理指标的关联及血清miRNA-34a-5p对宫颈癌的诊断价值。结果　①对照组血清中miRNA-34a-5p的相对表达量高于CIN组和宫颈癌组：（0.933±0.097）vs.（0.554±0.099）vs.（0.369±0.099），差异有统计学意义（F=741.401，P=0.000）；宫颈癌组患者术前血清中miRNA-34a-5p相对表达量低于术后1周，差异有统计学意义（t=8.305，P=0.000）。有无淋巴结转移和有无远处转移的宫颈癌患者血清中miRNA-34a-5p相对表达量的差异有统计学意义（P均＜0.05）。②宫颈癌组患者癌旁组织中miRNA-34a-5p的相对表达量高于癌组织，差异具有统计学意义（t=40.313，P=0.000）。③宫颈癌组患者癌组织中的miRNA-34a-5p表达水平与血清中的表达水平呈正相关（r=0.908，P=0.000）。④以0.508为miRNA-34a-5p相对表达量的最佳临界值诊断宫颈癌，其灵敏度为83.6%，特异度为79.4%，AUC为0.860，95%置信区间为0.803～0.917。结论　HR-HPV阳性宫颈癌患者癌组织和血清中miRNA-34a-5p表达下调，对宫颈癌诊断及预后监测具有一定的参考价值。     

派特灵与奥平栓治疗宫颈高危型、低危型HPV感染的疗效及对免疫功能的影响

目的探讨派特灵与奥平栓用于宫颈高危型、低危型人乳头瘤病毒(HPV)感染中的疗效及对免疫功能的影响。方法选取于无锡市第五人民医院就诊的HPV感染患者,根据HPV检测结果,分别按照随机数字表法分为高危型的观察组和对照组各54例和低危型的观察组和对照组各30例。对照组予奥平栓治疗,观察组在对照组基础上联合使用派特灵,对比患者HPV病毒载量、治疗有效率、免疫因子表达水平及不良反应发生情况。结果经治疗,各组HPV病毒载量水平均较治疗前明显下降(P<0.05),且高危型和低危型观察组的HPV病毒载量均明显低于对照组,差异均有统计学意义(P<0.05);高危型与低危型观察组患者治疗有效率普遍高于对照组,差异均有统计学意义(χ^2=2.170,P=0.030;χ^2=2.160,P=0.031);经治疗,各组Th17、Treg、骨髓来源的抑制性细胞(MDSC)水平均较治疗前明显下降(P<0.05),且高危型与低危型观察组Th17、Treg、MDSC水平均明显低于对照组,差异均有统计学意义(P<0.05);高危型与低危型观察组患者不良反应总发生率普遍低于对照组,差异均有统计学意义(χ^2=2.110,P=0.035;χ^2=2.050,P=0.040)。结论派特灵与奥平栓可提高宫颈高危型、低危型HPV感染患者治疗效果,提高免疫功能。     

A proposal for classification of oropharyngeal squamous cell carcinoma: Morphology and status of HPV by immunohistochemistry and molecular biology

The current three-tier grading system (well, moderate and poorly differentiated) used to morphologically classify head and neck squamous cell carcinoma (HNSCC) is inadequate for categorisation of oropharyngeal squamous cell carcinoma (OPSCC) owing to the lack of prognostic value. The aim of this study was to assess the validity of a classification system for OPSCC based on morphology and human papilloma virus (HPV) infection status. Haematoxylin and eosin slides of 121 patients (100 M, 21 F, age range 40-89 years) with OPSCC were reviewed and categorised as histological types I, II and III. The presence of HPV was assessed by immunohistochemistry with p16 and RNAscope In situ hybridization (ISH). The follow-up period was 36 months. Ninety-six patients were p16+ and clinical stage I. Patient survival with types I, II and III was 93%, 50% and 96%, respectively. Twenty-five patients were p16−: 10 clinical stage I and 15 stage III. Amongst this group, no type I morphology was identified. At follow-up, 65% of type II and 75% of type III patients were alive. All p16+ cases were also positive for E6/E7 mRNA high-risk HPV by ISH, while 23 p16− cases were negative and two were positive. Cox regression identified three predictors of mortality: older age (HR = 1.14, 95% CI = 1.06-1.23, P = .001); female gender (HR = 0.22.95% CI 0.05-0.88, P = .033); and type II morphology (HR = 13.1, 95% CI = 1.09-157.0, P = .043). OPSCC morphological classification in three sub-types, along with HPV infection status, seems to reflect the outcome of patients with OPSCC.     

惠州地区女性体检人群中 HPV 感染情况调查

目的 筛查广东省惠州地区女性体检人群人乳头瘤病毒 (HPV) 感染情况，分析其型别特征、年龄分布特点及宫颈病 变程度。方法 收集 2016 年 8 月-2017 年 6 月共 702 例广东省惠州地区女性体检人群的宫颈脱落细胞标本，采用 Luminex 200 的流式荧光技术检测 27 种人乳头瘤病毒 (HPV) 的基因型，包括高危型别 (17 种 )：16、18、31、33、35、39、45、51、52、56 、 58、59、66、68、26、53 和 82，低危亚型 (10 种 )：6、11、40、42、43、44、55、61、81 和 83。同时对 HPV 分型阳性的标本行 液基细胞学检测 (TCT)。分析 HPV 流行率、感染型别、年龄分布及宫颈病变程度。结果 702 例女性体检人群中 HPV 感染者人 数为 101 例，感染率为 14.4%。HPV 单一感染型占 82.2%(83 例 /101 例 )，以高危亚型为主 (83.1%，69 例 /83 例 )，前 3 位感染亚 型分别是 52 型 (24.1%，20 例 /83 例 )、16 型 (10.8%，9 例 /83 例 )、58 型 (10.8%，9 例 /83 例 )。多重亚型感染占 17.8%(18 例 /101 例 )。 ≤30岁、31~40岁、41~50岁、>50岁年龄组感染率分别为18.7%、14.4%、14.0%和11.7%，各年龄层感染率无统计学差异(P＞0.05)。 其中 92 例 HPV 分型阳性患者同时进行了 TCT 检测，25% 人群宫颈有炎症细胞或出血，10.9% 人群出现了非典型鳞状细胞不能 排除高级别上皮内病变 (ASC-H) 和低度鳞状上皮内病变 (LSIL)。结论 广东省惠州地区女性体检人群中 HPV 感染主要以 52 型、 16 型、58 型为主，且为单一感染，其中部分 HPV 感染体检人群宫颈已经出现了病变。流式荧光技术可以精确分出 27 种最见的 HPV 亚型，对 HPV 的筛查具有良好的应用前景。