Characteristics of women under 20 with cervical intraepithelial neoplasia

The relationship between risk of cervical neoplasia and various sociodemographic, reproductive and sexual characteristics was studied in 126 women (cases) with an abnormal Papanicolaou test finding and 1914 controls seen at the same clinic in which cases were detected but showing no evidence of cervical neoplasia. All the subjects of this study were under the age of 20. Number of sexual partners and clinical occurrence of genital warts emerged as the most important determinants of the risk of cervical intraepithelial neoplasia (CIN) in these very young women (Relative Risk (RR) for three or more sexual partners = 2.45, 95% Confidence Interval (CI) 1.63-3.70, RR for occurrence of genital warts, adjusted for number of sexual partners = 9.15, 95% CI: 5.06-16.26). Also having grown up in a 'problem' family seemed to increase the probability of developing CIN (RR adjusted for number of partners = 1.64, 95% CI 1.06-2.52). For all other investigated characteristics, cases and controls were remarkably similar. These include socioeconomic status, parity, smoking habits, use of various contraceptive methods and also indicators of sexual activity such as age of first having sexual intercourse, and duration and frequency of intercourse. Although this group of women under 20 only allows the study of less severe precursors of cervical cancer, it helps to highlight the earliest effect of purported risk factors for cervical neoplasia, chiefly sexual habits, at a time very close to their being established.     

Treatment failure and recurrence of cervical intraepithelial neoplasia in HIV-infected women

Evaluation of: Reimers LL, Sotardi S, Daniel D et al.: Outcomes after an excisional procedure for cervical intraepithelial neoplasia in HIV-infected women. Gynecol. Oncol. 119, 92-97 (2010). In a retrospective cohort study of 136 HIV-infected women who had a loop electrosurgical excision procedure (LEEP) or cone procedure for cervical intraepithelial neoplasia (CIN), Reimers et al. show that treatment failure and recurrence of CIN was common. Most recurrent CIN lesions, and those detected at treatment failure, were high-grade lesions. Both treatment failure and subsequent recurrence of CIN were found to be high in women with poorly controlled HIV, after LEEP, and those with positive cervical tissue margins following treatment. Based on these data the authors suggest that cervical conization may be superior to LEEP in the treatment of CIN in HIV-infected women.     

Risk factors for cervical intraepithelial neoplasia in southwestern American Indian women

The authors assessed risk factors for cervical intraepithelial neoplasia (CIN) among southwestern American Indian women using case-control methods. Cases were New Mexico American Indian women with biopsy-proven grade I (n = 190), grade II (n = 70), or grade III (n = 42) cervical lesions diagnosed between November 1994 and October 1997. Controls were American Indian women from the same Indian Health Service clinics with normal cervical epithelium (n = 326). All subjects underwent interviews and laboratory evaluations. Interviews focused on history of sexually transmitted diseases, sexual behavior, and cigarette smoking. Laboratory assays included polymerase chain reaction-based tests for cervical human papillomavirus infection, tests for gonorrhea and chlamydia, wet mounts, and serologic assays for antibodies to Treponema pallidum, herpes simplex virus, and hepatitis B and C viruses. In multiple logistic regression analysis, the strongest risk factors for CIN II/III among American Indian women were human papillomavirus type 16 infection (adjusted odds ratio (OR) = 7.6; 95% confidence interval (CI): 2.4, 23.2), any human papillomavirus infection (OR = 5.8; 95% CI: 3.3, 10.0), low income (OR = 3.3; 95% CI: 1.7, 6.2), and history of any sexually transmitted disease (OR = 2.0; 95% CI: 1.1, 3.5). Unlike previous research, this study found no strong associations between CIN and sexual activity or cigarette smoking.     

醋酸染色肉眼观察法对中国女性宫颈上皮内瘤样病变筛查效果的Meta分析

目的 通过诊断试验Meta分析,评价在中国女性中使用醋酸染色肉眼观察法(VIA)对宫颈癌及其癌前病变进行初筛的效果.方法 以“醋酸”、“宫颈上皮内瘤样病变”、“宫颈癌”、“visual inspection with acetic acid”、“CIN”和“cervical cancer”作为检索词分别检索万方数据库、中国知网(CNKI)、维普中文科技期刊全文数据库、Pubmed、Cochrane图书馆等,并对所获文献中的参考文献进行二次检索,收集关于在中国妇女中开展VIA初筛宫颈癌及其癌前病变的相关文献,共检索到相关文献40篇.采用SAS 8.02进行双变量随机效应模型进行统计学分析.结果 最终有22篇文献符合纳入标准,包括中文文献19篇,英文文献3篇,纳入研究对象共计23 330名.入选文献年限跨度为2004-2010年,研究对象年龄范围为15～ 81岁.按不同筛查病变阈值分层后可见,VIA初筛轻度及以上宫颈上皮内瘤样病变(CIN1+)的加权诊断比值比(DOR) [4.11 (95％ CI:3.20 ～5.04)]与中度及以上病变(CIN2+)[4.45(95％CI:3.73 ～5.15)]相近.CIN1+和CIN2+在40岁及以下中国女性中VIA的DOR[CIN1+为4.22(95％ CI:3.29～5.16);CIN2+为4.53(95％CI:3.46 ～5.47)]也均与40岁以上女性相近[CIN1+为3.66(95％ CI:2.27 ～5.37);CIN2+为4.26(95％ CI:3.32～5.26)].对于CIN2+,县级医院筛查效果与市级及以上医院无区别,DOR分别为4.62(95％CI:3.13 ～5.93)和4.48(95％CI:3.71 ～5.16).结论 VIA对于各级病变和各年龄段人群筛查效果较为一致,县级医院的医生经培训后能够达到与市级医院一样的水平.     

宫颈上皮内瘤变宫颈环形电切除术后对育龄妇女生育的影响

目的探讨育龄妇女宫颈上皮内瘤变(cervical intraepithelial neoplasias,CIN)行宫颈环形电切除术(loop electrosurgical excision procedure,LEEP)术后对生育能力及妊娠结局的影响。方法选取2010年6月至2012年6月在肇庆市端州区妇幼保健院因CIN行LEEP的育龄妇女118例(CINⅠ29例,CINⅡ64例,CINⅢ25例)中于2013年6月前正常妊娠的育龄妇女107例作为观察组。选取同期在本院住院分娩的健康孕妇121例作为对照组。比较两组的分娩方式及妊娠结局。结果 (1)观察组术后妊娠率90.68%,与普通人群妊娠率(93%)比较,差异无统计学意义(P0.05)。(2)观察组剖宫产率高于对照组(P0.05);两组非社会因素剖宫产率比较差异无统计学意义(P0.05)。(3)两组流产的发生率比较差异无统计学意义(P0.05);观察组早产、胎膜早破的发生率高于对照组(P0.05);观察组新生儿出生体重低于对照组(P0.05)。(4)观察组CINⅠ、CINⅡ、CINⅢ患者流产率比较,差异无统计学意义(P0.05)。CINⅢ组术后早产率、胎膜早破发生率、新生儿低体重发生率均高于CINⅠ组和CINⅡ组(P0.05);而CINⅠ组和CINⅡ组术后流产率、早产率、胎膜早破发生率、新生儿低体重发生率相比较,差异无统计学意义(P0.05)。结论 CIN患者行LEEP术只要严格控制好切除范围,对患者妊娠能力无影响,亦不影响分娩方式。CINⅢ患者术后早产率、胎膜早破发生率、新生儿低体重发生率均明显高于CINⅠ和CINⅡ患者。     

LEEP术在绝经后高级别CIN患者诊疗的价值评估

目的 探讨LEEP术在绝经后高级别CIN患者中的诊疗价值.方法 对2008年1月至2015年12月于浙江省衢州市妇幼保健院行子宫颈LEEP术的354例患者临床资料进行分析,以绝经后患者36例为实验组,同期1:3选择绝经前患者108例为对照组,分析临床症状、细胞学检查、HR-HPV检查、阴道镜检查及LEEP术后病理结果.结果 实验组阴道镜检查满意率显著低于对照组(χ2=17.779,P=0.000).以LEEP术后病理结果为诊断金标准,实验组LEEP术后病理级别升级者显著高于对照组(χ2=4.866,P=0.027),实验组阴道镜下活检病理的准确性显著低于对照组(χ2=3.992,P=0.046).实验组患者行LEEP术后病理结果提示切缘阳性率高于对照组,但两组间无显著性差异(χ2=3.416,P=0.065),其中实验组内切缘阳性率明显高于对照组,两组间差异有显著性意义(χ2=5.797,P=0.016);实验组外切缘阳性率高于对照组,但两组间无显著性差异(χ2=0.254,P=0.615).结论 绝经后女性仍建议定期行宫颈癌筛查,包括宫颈TCT及HR-HPV检测.绝经后患者的阴道镜检查满意率及准确性均下降;对阴道镜活检后诊为CIN的患者应行LEEP进一步确诊诊断.     

宫颈上皮内瘤变的筛查方法研究

目的:进一步评价液基薄层细胞学检测系统、HC-Ⅱ检测、阴道镜检查、组织病理学检查在宫颈上皮内瘤变(CIN)早期诊断中的应用价值。方法:回顾性分析763例液基细胞学检查结果异常的患者,对其进行人乳头状瘤病毒(HPV)感染、阴道镜及组织病理学检查,将检测结果进行对比研究。结果:阴道镜与液基薄层细胞学、HCⅡ检测HPV感染诊断宫颈上皮内瘤变的敏感度相比,差异均有显著性(P<0.001,P<0.01),HCⅡ检测HPV的敏感度最高。随着液基薄层细胞学结果的病变级别升高,HPV感染阳性率提高,ASCUS组和LSIL组的阳性率有统计学差异(P<0.001),病理活检阳性率亦不断提高,各组之间的阳性率均有统计学差异(P<0.001)。白色上皮图像对于慢性宫颈炎和CINⅠ的诊断意义较大,而镶嵌图像对于CINⅢ和宫颈癌的诊断意义较大。各年龄段妇女患宫颈上皮内瘤变的比例无显著性差异(P>0.05),但不同年龄段妇女患宫颈高度病变(CINⅡ、CINⅢ及鳞癌)的比例有统计学差异(P<0.05)。结论:细胞学筛查异常者,应采用HCⅡ检测HPV感染情况,对于HPV感染的病例应同时行阴道镜下多点活检。生育年龄段的妇女应定期行细胞学筛查、HCⅡ检测HPV感染及阴道镜检查。     

Contraceptive and reproductive risk factors for cervical intraepithelial neoplasia in American Indian women

OBJECTIVES: To evaluate contraceptive and reproductive risk factors for cervical intraepithelial neoplasia (CIN) in southwestern American Indian women. METHODS: We conducted a clinic-based case-control study. Cases were American Indian women with biopsy-proven CIN I, CIN II or CIN III. Controls were from the same clinics and had normal cervical epithelium. All subjects underwent structured interviews focused on contraceptive and reproductive factors. Laboratory assays included polymerase chain reaction (PCR)-based tests for cervical human papillomavirus (HPV) infection. RESULTS: We enrolled 628 women in the study. The strongest risk factors for CIN II/III included HPV infection (adjusted odds ratio [OR] = 7.9, 95% CI : 4.7-13.2), and low income (OR = 3.1, 95% CI : 1.7-5.7). The use of an intrauterine device (IUD) ever (OR = 3.0, 95% CI : 1.4-6.1) and currently (OR = 4.1, 95% CI : 1.1-14.6), and > or = 3 vaginal deliveries (OR = 5.2, 95% CI : 2.4-11.1) were associated with CIN II/III. History of infertility was also associated with CIN II/III (OR = 2.1, 95% CI : 1.0-4.2). CONCLUSIONS: The data suggest that history of infertility, IUD use and vaginal deliveries were associated with CIN among American Indian women.     

安吉县育龄妇女 HPV感染及 CIN患病情况的调查分析

目的：调查安吉县育龄妇女宫颈上皮内瘤变（ CIN）的患病情况,以及人乳头瘤病毒（ HPV）感染状况,以获得更合理的预防与治疗新方案。方法选取2008年1月至2013年4月在浙江省安吉县人民医院妇产科门诊进行宫颈癌筛查,有性生活的978例育龄妇女为研究对象,根据液基细胞学检查及HPV检测结果,将其分为HPV阳性组和阴性组,分析CIN病变程度及与HPV感染的状况。结果①HPV感染率14．5％,CIN1患病率16．9％,CIN2/3患病率3．6％;②HPV阳性人群中CIN1患病率与HPV阴性组的CIN1患病率差异显著（χ^2＝211．8,P＜0．01）,HPV阳性组CIN1患病率（54．9％）显著高于HPV阴性组的（9．7％）;HPV阳性人群中CIN2/3患病率与HPV阴性组的CIN2/3患病率有显著性差异（χ^2＝166．6,P＜0．01）,HPV阳性组CIN2/3患病率为22．5％,显著高于HPV阴性组（0．5％）;③CIN2/3组的HPV检测阳性率（88．9％）显著高于CIN1（50．9％）（χ^2＝17．5,P＜0．01）。结论安吉市女性的CIN患病率与HPV感染率较高,HPV感染率越高,提示CIN病变越严重。     

层粘连蛋白及其受体与宫颈上皮内瘤样病变和子宫颈癌

层粘连蛋白及其受体是一类广泛存在于基底膜带中的多功能大分子糖蛋白 ,近年来研究证明它们与肿瘤的浸润和转移密切相关 ,深入探讨层粘连蛋白及其受体粘着及与肿瘤的相互作用 ,将为进一步研究肿瘤的浸润及转移提供理论依据 ,本文就层粘连蛋白及其受体与宫颈上皮内瘤样病变和子宫颈癌的关系进行综述。     

宫颈上皮内瘤样变中HPV基因型的研究

目的:探讨不同基因型的HPV感染与各级别CIN发病的关系。方法:回顾性分析天津医科大学总医院2007年11月~2009年12月妇科门诊就诊患者中经组织学检查确诊为CIN的患者共284例。HPV基因型的检测采用PCR扩增、基因芯片探针杂交分型检测法。结果:随CIN级别进展,HPV感染率逐渐升高。CINⅠ中主要为LR-HPV感染;CINⅢ中主要为单一高危型HPV-16感染,HPV-58为第二优势感染的基因型。HPV-16感染率在CINⅠ与CINⅡ、CINⅡ与CINⅢ之间差异均具有高度统计学意义(P<0.01)。结论:随CIN病情发展和病变严重,HPV感染率逐渐升高,HPV感染的基因型不同,引起CINⅠ的HPV基因型主要为HPV-11、6,引起CINⅡ的HPV基因型主要为HPV-16、6,引起CINⅢ的HPV基因型主要为HPV-16、58。HPV-16感染率与宫颈上皮内瘤样变的级别之间存在着从量变到质变的关系。     

宫颈上皮内瘤变的病因及诊断

宫颈上皮内瘤变(CIN)是与宫颈浸润癌密切相关的一组癌前病变。HPV被确认为子宫颈癌发生的必要条件。目前国内外较普遍采用细胞学+宫颈多点活检(碘染或阴道镜下)+颈管刮术的联合早诊方法。     

宫颈上皮内瘤变的诊断和治疗

宫颈上皮内瘤变是宫颈癌的癌前病变,诊治宫颈上皮内瘤变对宫颈癌的防治具有重要意义。科学地执行宫颈癌的三阶梯诊断程序(细胞学检查-阴道镜检查-组织学诊断)可以有效地诊断宫颈癌和宫颈上皮内瘤变,同时减少宫颈癌的防治成本。选择合理的方法治疗宫颈上皮内瘤变可以达到较好的治疗效果,也能最大限度地保留患者的生育功能,治疗后应加强随访。     

Oral contraceptive and progestin-only use correlates to tissue tumor marker expression in women with cervical intraepithelial neoplasia

BackgroundThe study was conducted to investigate correlations between combined oral contraceptive (COC), any progestin-only contraceptive, medicated intrauterine device (MID) or systemic progestin-only (Syst-P) use and tumor marker expression in cervical intraepithelial neoplasia compared to nonusers.Study DesignOne-hundred ninety-five women of fertile age with cervical biopsies ranging histologically from normal epithelium to carcinoma in situ were recruited consecutively. Combined oral contraceptive, Syst-P and MID users were investigated according to the expression of 11 tumor markers.ResultsOverexpression of cyclooxygenase-2 (Cox-2) was observed in COC users, while interleukin 10 was underexpressed. When users of progestogen-only contraceptives were analyzed, there was a lower expression of cytokeratin 10 and interleukin 10. When only MID users were analyzed, a high expression of p53 was found. Expression of Cox-2, p53 and retinoblastoma protein differed between COC and MID users.ConclusionThe study showed molecular alterations, which, in general, have not been studied previously in COC users and have never been studied in progestogen-only users. These biological events might be involved in epidemiological correlations found between hormonal contraceptive use and cervical neoplasms.     

丰台区已婚妇女宫颈病变与HPV感染的分析

目的 探讨北京市丰台区已婚妇女宫颈病变与HR-HPV感染的现患状况及其相关性.方法 采用横断面调查方法,对北京市丰台区882名已婚妇女进行问卷调查、妇科检查、宫颈液基细胞学检测.结果 ①882例调查对象平均年龄45.2±8.0岁,宫颈病变发病高峰年龄为30～34岁(12.16%);②宫颈病变患者53例,患病率为6.01%;③HR-HPV感染率10.77%,HR-HPV感染阳性人群中CIN 的患病率为31.6%,明显高于HR-HPV阴性人群中CIN 的患病率2.9%;④宫颈病变的相关因素还包括孕次.结论 30～34岁为北京市丰台区已婚妇女宫颈病变的高发年龄组;HR-HPV感染是宫颈病变的高危因素;针对宫颈病变的相关危险因素采取积极的健康宣教和有效的预防措施,降低宫颈癌的发病率.     

高频电波刀治疗宫颈上皮内瘤变90例分析

目的:探讨高频电波刀(leep刀)在治疗宫颈上皮内瘤变(CIN)中的临床价值。方法:2008年7-12月,对90例CIN患者进行高频电波刀切除术治疗,CINⅠ及CINⅡ行环形电刀切除术,CINⅢ及部分原位癌行高频电波刀锥切。结果:一年后,行宫颈液基细胞学(TCT)检查,88例正常(97.78%),2例复发(2.22%)。结论:Leep刀治疗宫颈上皮内瘤变疗效好、愈合快、标本符合病理学要求。     

农村少数民族已婚妇女CIN患病及危险因素分析

目的 了解农村少数民族已婚妇女宫颈上皮内瘤变(CIN)患病现状及其危险因素,为预防和控制CIN提供依据.方法 采取整群抽样方法随机抽取黔南地区18 ～55岁3 968名农村已婚少数民族妇女进行问卷调查、妇科检查、宫颈细胞涂片液基薄层细胞学(TCT)及宫颈分泌物高危人乳头状瘤病毒(HR-HPV)检测,并对TCT结果异常者行阴道镜下宫颈活组织检查,对结果进行分析.结果 3 968名已婚妇女TCT结果异常者477人,占12.02％(477/3 968),病理诊断为CIN者371例,总患病率为9.35％ (371/3 968),占TCT结果异常者的77.78％,其中水族234例,患病率为5.89％,毛南族59例,患病率为1.49％,布依族47例,患病率为1.18％,苗族31例,患病率为0.78％;水族CIN患病率与其他3个民族比较,差异有统计学意义(x2=34.48,P＜0.01);多因素Logistic回归分析结果显示,HR-HPV感染、滴虫性阴道炎史、口服避孕药避孕、年龄＜40岁、吸烟、性伴侣数≥2、初次性生活年龄＜18岁和民族等因素与CIN患病有关.结论 黔南地区宫颈上皮内瘤变患病率较高,应加强防治宣传,提高CIN防治知晓率.     

子宫颈冷刀锥切及成形术治疗宫颈上皮内瘤变临床分析

目的:探讨子宫颈冷刀锥切及成形术在宫颈上皮内瘤变诊治中的应用价值。方法:回顾性分析2005年1月～2007年5月行子宫颈冷刀锥切及成形术的133例病例的相关资料。对术前阴道镜下宫颈多点活检的组织学结果与宫颈锥形切除术后的病理结果进行比较。结果:子宫颈锥形切除术后与术前阴道镜病理结果诊断完全相符者65例,占48.9%;不符合者68例,占51.1%。其中有30例(22.5%)宫颈锥切术后病理检查较阴道镜下多点活检程度重,38例(28.6%)程度较轻。手术平均时间为37.10min,平均出血量为34.77ml。术后有17例(占12.8%)局部少量出血,多发生在术后2～3天,8例(占6.02%)术后出现切口局部感染,抗炎治疗后恢复,2例(占1.5%)于术后10天、13天由于缝线脱落出现活动性出血。结论:子宫颈锥形切除术与阴道镜下活检病理诊断存在一定的差距,可以弥补阴道镜下活检的不足,且有治疗作用。在子宫颈锥切术基础上行成形术较传统的手术可以减少术中、术后出血。子宫颈冷刀锥切术是一项易操作、经济、实用的临床诊疗方法。     

宫腔镜下宫颈锥切术治疗宫颈上皮内瘤样变疗效观察

目的探讨宫腔镜下宫颈锥切术（TCRC）治疗宫颈上皮内瘤样病变的可行性及临床疗效。方法在宫腔镜下对CINⅡ、Ⅲ期患者57例行TCRC（TCRC组）,36例行宫颈环形电切术LEEP（LEEP组）。观察两组手术时间、出血量及术后病理情况。结果TCRC组平均手术时间为（15．2&#177;3．1）min,术中平均出血量为（6．1&#177;1．7）ml;LEEP组平均手术时间为（14.0&#177;2．8）min,术中平均出血量为（11．4&#177;2．2）ml,两组出血量比较,差异有统计学意义（P〈0．05）。结论与宫颈环形电切术比较,宫腔镜下宫颈锥形切除术出血量少。