533名中老年人高同型半胱氨酸血症的危险因素调查

摘要：目的研究中老年人高同型半胱氨酸血症（hyperhomocysteinmia,HHcy）的危险因素,为人群干预提供依据。方法以天津市5个社区及2所老年公寓55岁及以上的中老年志愿者698人为研究对象,进行问卷调查、膳食调查和血清同型半胱氨酸检测;分析HHcy组和非高同型半胱氨酸血症（N—HHcv）组中老年人生活方式、膳食叶酸和VitB。摄入量的差异。结果533人完成了全程研究。总人群HHcy患病率随年龄增长而升高（P〈0．001）,男性（57．0％）高于女性（35．7％）,P〈0．001。与男性不吸烟者比较,男性吸烟者HHcy患病率（x2=0．047,P=0．828）、血清tHcy水平（t=-1．020,P=0．310）的差异无统计学意义。服用叶酸、VitB6、VitB12者的血清tHcy平均浓度（15．2μmol／L）明显低于不服用者（16．9μmol／L）,HHcy患病率（39．7％）低于不服用者（46．2％）,P〈0．05。HHcy组中老年人平均每日膳食叶酸、VitB。摄入量（207．9μg／d,0．37ms／d）均低于N—HHcy组（295．4μg／d,0．53ms／d）,P〈0．05。膳食叶酸、VitB6的摄入量均与血清tHcy水平呈负相关,相关系数分别为-0．439（P=-0．000）和-0．390（P=-0．000）。结论吸烟与HHcy患病率和tHcy水平无关。日常服用叶酸、VitB6和VitB12或富含上述维生素的膳食有助于保持较低的tHcy水平。     

2型糖尿病患者血清GH、IGF—Ⅰ的浓度改变及相关因素的研究

目的 通过放免分析法观察2型糖尿病患与Ⅰ型糖尿病患血清GH／IGF-Ⅰ轴改变的异同。方法 对19例Ⅰ型糖尿病和98倒2型糖尿病患的血清基础GH及IGF-Ⅰ浓度进行测定。将2型糖尿病患血清IGF—Ⅰ维度与其各项临床厦生化指标进行多元相关回归分析。结果 Ⅰ型糖尿病患GH水平(2．53±0．51μg／L)明显高于对照组(1．36±0．27μg／L,P<005);IGF-Ⅱ水平(191．5±14．1μg／L)则显低于对照组(266．3=17．1μg／L,P<0．01)。2型糖尿病患GH(0．60±0．11μg／L)水平与对照组(0．74±0．07μg／L)无显差别(P>0．05),IGF-Ⅰ(126．1±3．2μg／L)水平较正常(153．45：83μg／L)明显降低(P<0．05)。2型糖尿病患血清IGF-度与年龄(P<0．05)及HbAlc(P<0．05)呈负相关,与平均动脉压(P<0．05)和空腹胰岛索(尸<0．01)呈正相关。结论 2型糖尿病患GH／IGF—Ⅰ轴有着与Ⅰ型糖尿病患不同的改变,这种异常改变可能与持续高血糖水平有关。     

乌鲁木齐市213名汉族孕妇膳食营养状况调查

目的：了解乌鲁木齐市汉族孕妇膳食营养摄入及各种营养素达标情况,以便改善和提高孕妇的营养状况。方法随机选择自治区妇幼保健院营养门诊就诊的213名汉族孕妇作为调查对象,采用问卷方式24小时膳食回顾法对每个调查对象进行膳食调查,建立数据库,与《中国居民膳食营养素参考摄入量（ DRIs）》进行比较分析。结果孕妇膳食结构不合理,虽然孕期蔬菜与水果类摄入量已达到中国营养学会推荐摄入量,但其他种类食物却低于推荐摄入量。孕早期能量摄入2086．70kcal,孕中期3200．40kcal,孕晚期3650．70kcal,分别占RNI的90．70％、128．00％和130．40％;孕早期蛋白质摄入61．60kcal,孕中期71．70kcal,孕晚期71．30kcal,分别占RNI的82．10％、89．60％和83．90％,而且植物性蛋白质摄入过多,动物性蛋白摄入量低于全国30％的平均水平;孕妇膳食中钙、铁主要来源是植物性食物,分别占65％和90％,但在植物性食物中钙、铁的吸收率很低;维生素C、维生素B 6以及叶酸摄入不足,其中叶酸摄入量严重缺乏,孕早期叶酸摄入68．50μg,孕中期84．90μg,孕晚期93．20μg,分别占RNI的11．40％、14．20％和15．50％。结论孕妇各期膳食结构不合理;孕早期热能及营养素不能满足机体需要,孕中、晚期膳食较为合理,但维生素B6、维生素C、叶酸的摄入水平严重不足;动物性蛋白、钙、铁摄入不足。     

HPV16感染和雌孕激素水平与宫颈癌的相关性分析

目的分析人乳头瘤病毒(HPV) 16感染和雌孕激素水平与宫颈癌的相关性,探讨感染性疾病在恶性肿瘤病理过程中的作用。方法选取2017年1月-2018年2月丽水市人民医院收治的宫颈癌患者85例作为病例组,选取同期非宫颈癌女性患者80例作为对照组。对比两组患者宫颈细胞中的HPVs DNA和HPV16 DNA阳性率及两组患者血清雌二醇(E_2)、孕酮(P)水平。结果病例组患者的HPVs DNA、HPV16 DNA阳性率72. 94%、44. 71%显著高于对照组的10. 00%、3. 75%,差异均有统计学意义(P0. 01)。病例组患者血清E2、P水平(46. 65±25. 71) pg/ml、(2. 46±1. 35) ng/ml均显著高于对照组的(28. 03±22. 07) pg/ml、(1. 19±1. 12) ng/ml,差异均有统计学意义(P 0. 01)。Logistic多元回归分析结果显示,宫颈癌的发生与HPV16 DNA阳性、血清E2水平具有相关性(P0. 05)。结论宫颈癌患者具有较高的HPV16感染率和血清雌孕激素水平,二者均与宫颈癌的发病具有独立相关性,可能共同参与了宫颈癌的病理过程。     

膳食因素与宫颈癌关系的病例对照研究

目的　探讨膳食因素与宫颈癌发生的关系。方法　采用以医院为基础的病例对照研究 ,调查山西省肿瘤医院妇科 2 0 0 4年 1～ 5月经病理确诊的宫颈癌新发病例 (n =132 )和同期就诊的良性肿瘤患者 (n =133)的相关因素和膳食情况 ,膳食摄入情况的调查采用半定量食物频数问卷的方法。采用非条件Logistic回归计算各因素与宫颈癌的OR值及其 95 %CI。结果　在调整非膳食因素的影响后发现 ,深色蔬菜 (OR =0 34,95 %CI =0 15～ 0 76 )和膳食叶酸 (OR =0 36 ,95 %CI=0 14～ 0 95 )是宫颈癌发生的保护性因素 ,且存在剂量 -反应关系 (趋势检验P <0 0 1)。结论　宫颈癌的发生可能与膳食因素有关 ,摄入较多的深色蔬菜特别是富含叶酸的食物可能会降低宫颈癌发生的危险性。     

盆腔淋巴结HPV16／18DNA检测在宫颈癌的应用

目的探讨宫颈癌患者盆腔淋巴结高危型人乳头状瘤病毒16／18（HPV16／18）DNA检出情况与宫颈癌临床病理特征的相关性,同时探讨宫颈癌原发灶和盆腔淋巴结组织中HPVDNA检出的相关性及意义。方法采用前瞻性研究方法,收集鄂州市中心医院自2011年1月至2012年6月间收治的行宫颈癌根治术患者的石蜡标本,采用聚合酶链反应（PCR）方法,检测33例宫颈癌组织及115枚盆腔淋巴结组织中HPVN／18DNA。结果33例宫颈癌患者中盆腔淋巴结HPV16／18阳性检出率为54．55％（18／33）,其阳性检出率与临床分期、有无淋巴结转移、病理分化程度、肌层浸润深度、有无宫体及阴道侵犯有关,差异均有统计学意义（χ2值分别为9．528、5．241、10．481、7．187、3．915、7．274,均P〈0．05）。宫颈癌组织HPV16／18阳性检出率为72．73％（24／33）,与盆腔淋巴结HPV16／18阳性检出率进行相关分析,二者呈正相关（r=0．398,P〈0．05）。淋巴结转移组与淋巴结未转移组总淋巴结个数的HPV16／18阳性检出率进行比较,差异有统计学意义（χ2=36．449,P〈0．05）。结论检测盆腔淋巴结有助于发现早期隐匿性转移,HPV可以作为检测微转移的特异性标志物。     

叶酸对人宫颈癌细胞增殖抑制的作用及其与HPV16相互关系的研究

目的探讨体外补充不同剂量叶酸对HPV阴性细胞C33A和HPV16阳性细胞CaSki的细胞增殖及凋亡的影响以及叶酸与HPV16的相互关系。方法倒置显微镜下观察叶酸对两种细胞基本生长状态的改变及形态的变化;采用MTT法和流式细胞术观察不同浓度叶酸(0.1、1.0、10、50、100、500、1 000和2 000μg/ml)对两种宫颈癌细胞的增殖抑制、细胞周期及凋亡情况;采用RT-PCR技术检测CaSki细胞中HPV16 E2/E6 mRNA的表达水平。结果补充叶酸对C33A和CaSki细胞的增殖均有抑制作用,细胞形态发生改变,细胞数量明显减少。随着叶酸浓度的增加,对两种宫颈癌细胞的生长抑制率逐渐上升(C33A:r=0.948,P=0.010;CaSki:r=0.895,P=0.006),G0/G1期细胞比例逐渐增大,细胞凋亡率亦随之升高(C33A:r=0.989,P<0.001;CaSki:r=0.994,P<0.001),呈现线性关系。但对C33A和CaSki两种细胞的增殖抑制及凋亡的影响程度无明显差异。当补充叶酸时,CaSki细胞HPV 16E2和E6基因mRNA的表达水平在对照组、叶酸缺乏组和叶酸实验组之间的差异无统计学意义。结论补充叶酸可抑制宫颈癌细胞的增殖,促进凋亡;未发现在宫颈癌细胞中叶酸与HPV16存在交互作用。     

内源性雌、孕激素与人乳头瘤病毒在宫颈癌发生中的协同作用研究

目的探讨雌、孕激素对宫颈癌发生的作用及其与人乳头瘤病毒(HPV)的协同作用。方法采用热启动PCR和ELISA法，对141例宫颈癌和129名健康妇女进行了HPVs、HPV16、雌二醇(E2)和孕酮(P)含量的测定。结果宫颈癌组HPVs和HPV16的阳性率分别为75．2％和46．8％，显著高于健康对照组；血清中E2和P的平均浓度均为病例组高于对照组，差异有统计学意义，特别是E2水平与宫颈癌之间呈剂量反应关系；E2与HPVs之间呈正相加交互作用，且有统计学意义。结论HPV感染，特别是HPV16感染在宫颈癌发生中起重要作用；内源性雌激素的升高可增加宫颈癌发生的危险性；高水平的雌二醇和HPV感染对宫颈癌的发生可能具有协同作用。     

新生儿缺氧缺血性脑病血清和脑脊液中胰岛素样生长因子-I水平变化及相关性研究

目的观察新生儿缺氧缺血性脑病(HIE)血清、脑脊液中胰岛素样生长因子-I(IGF-I)水平的变化及相关性,探讨IGF-I在新生儿HIE发病机制及预后中的作用。方法用放射免疫法(RIA)检测 41例HIE组新生儿生后12 h-24 h及10 d-12 d血清、脑脊液及10例正常足月新生儿(对照组)血清中 IGF-I的水平变化。结果①生后12 h-24 h,轻、中、重度HIE组血清IGF-I的水平分别为(32．94± 8.43)ng／ml,(22．56土5．51)ng／ml,(15．77土3．60)ng／ml,明显低于对照组(79．28士13．28)ng／ml(P< 0.01);且HIE程度越重,IGF-I的水平越低(P<0．05)。②生后10d-12d,轻、中度HIE组及重度HIE无症状组血清中IGF-I的水平分别为(67．22±21．52)ng／ml,(68．54±22．88)ng／ml,(52．58土14．11) ng／ml,分别较各组生后12 h-24 h的水平增高(P<0．01),仍低于对照组(P<0．01),其脑脊液中的水平分别为(6．18土0．87)ng／ml,(5．74±0．94)ng／ml,(5．08±0．87)ng／ml,也较生后12 h-24 h时的水平,分别为(4．43±1．16)ng／ml,(3．19±0．84)ng／ml,(1．97±0．45)ng／ml均明显增高(P<0．01);重度HIE有症状组血清和脑脊液的IGF-I水平分别为(22．49±10．58)ng／ml和(2．26±0．70)ng／ml,虽较生后12 h -24 h增高,分别为(14．22±3．37)ng／ml,(1．87±0．80)ng／ml,但差异无显著意义(P>0．05),然而却明显低于其他各组的水平(P<0．01)。③HIE组血清与脑脊液的IGF-I水平呈正相关关系(r=0．84,P< 0．05)。结论 IGF-I是一种重要的神经保护因子,其水平的改变可能与新生儿HIE的发生、发展及预后有关。     

还原叶酸载体基因多态性与宫颈癌关系的病例对照研究

目的 探讨叶酸代谢相关酶基因还原叶酸载体基因(RFC-1)多态性与宫颈癌易感性的关系以及与人乳头瘤病毒(HPV)16在宫颈癌发生中的交互作用.方法 采用以医院为基础的频数匹配病例对照研究,选择经病理学确诊的宫颈鳞状细胞癌新发病例107例作为病例组,子宫肌瘤患者107例作为对照组,应用特异性PCR和限制性片段长度多态性(RFLP)分别检测HPV16及RFC-1基因A80G多态性.结果 (1)HPV16感染率病例组(56.07%)高于对照组(31.78%),调整OR值为3.25(95%CI:1.74～6.08).(2)病例组与对照组各基因型频率符合Hardy-Weinberg平衡,病例组RFC.1基因80AA、AG和GG各基因型频率在病例组和对照组间差异有统计学意义(X2=6.66.P=0.03).A80G等位基因在两组的分布存在差异(X2=7.41,P=0.01).(3)RFC-1基因ASOG多态性与宫颈癌易感性的分析结果显示,与携带AA基因型者相比,携带GG基因型者患宫颈癌的危险性增高(OR=2.42.95%CI:1.01～5.81).(4)REC-1基因多态性与HPVl6感染经logistic回归模型分析,在宫颈癌发生中交互作用无统计学意义.结论 RFC-1基因A80G位点的纯合型(GG)可增加宫颈癌发生的危险.     

Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer in U.S. women.

Previous observational epidemiologic studies of folate and cervical cancer, as well as folate supplementation trials for cervical dysplasia, have produced mixed results. We examined the relationship between serum and RBC folate and incident invasive cervical cancer in a large, multicenter, community-based case-control study. Detailed in-person interviews were conducted, and blood was drawn at least 6 mo after completion of cancer treatment from 51% of cases and 68% of controls who were interviewed. Blood folate was measured with both microbiologic and radiobinding assays. Included in the final analyses were 183 cases and 540 controls. Logistic regression was used to control for all accepted risk factors, including age, sexual behavior, smoking, oral contraceptive use, Papanicolaou smear history and human papillomavirus (HPV)-16 serology. For all four folate measures, the geometric mean in cases was lower than in controls (e.g., 11.6 vs. 13.0 nmol/L, P < 0.01 for the serum radiobinding assay). Folate measures using microbiologic and radiobinding assays were correlated (serum: r = 0.90; RBC: r = 0.77). For serum folate, multivariate-adjusted odds ratios (OR) in the lowest vs. highest quartile were 1.3 [95% confidence interval (CI) = 0.8--2.9] and 1.6 (0.9--2.9), using the microbiologic and radiobinding assays, respectively. For RBC folate, comparable OR were 1.2 (0.6--2.2) and 1.5 (0.8--2.7). Similar risks were obtained when restricting analyses to subjects with a history of HPV infection. Thus, low serum and RBC folate were each moderately, but nonsignificantly, associated with increased invasive cervical cancer risk. These findings support a role for one-carbon metabolism in the etiology of cervical cancer.     

叶酸与DNA甲基转移酶1在宫颈癌及癌前病变中的作用

目的 探讨叶酸和DNA甲基转移酶1(DNMT1)与宫颈癌发生发展的关系及其在宫颈癌变中的相互作用.方法 选择经病理学确诊的宫颈鳞状细胞癌(SCC)患者100例、宫颈上皮内瘤样变(CrN)患者101例和宫颈炎(CI)患者109例为研究对象.在收集全部对象人口学特征、生殖因素等相关资料的同时,检测血清叶酸水平(RIA法)、人乳头瘤病毒16的感染状况(PCR法)和DNMT1蛋白的表达量(Westernblot法).采用SPSS 16.0分析软件,进行相关资料的t检验、x2检验、因素与疾病之间关联强度指标(OR值95%CI)的计算及交互作用分析.结果 在SCC、CIN和CI组,血清叶酸含量分别为(2.60±1.61)、(3.14±2.08)和(3.32±1.74)ng/ml,DNMT1蛋白表达水平分别为2.40±0.99、1.88±0.33和0.89±0.29,随着宫颈病变的加重叶酸含量逐渐降低,DNMT1蛋白表达水平逐渐增高,两者呈负相关关系(r=-0 186,P=0001).交互作用分析显示,叶酸水平低和DNMTl蛋白高表达在CIN和SCC组均存在正相加交互作用,OR值分别为2.50(95%CI:1.21～9.22)和6.03(95%CI:2.79～21.72),交互作用指标超额危险度、交互作用归因危险比和交互作用指数在CIN组分别为0.92、0.36和2.59,在SCC组分别为2.47、0.41和1.96.结论 血清叶酸水平低及DNMT1蛋白高表达均是导致宫颈癌和癌前病变发生的危险因素,两者存在协同作用.

Abstract：

Objective To explore the effect of folic acid and DNA methyltransferase 1 (DNMT1) on cervical cancer and cervix precancerous lesion. Methods 100 patients with cervix squamouscell carcinoma (SCC), 101 patients with cervical intraepithelial neoplasm (CIN) and 109 patients with cervix inflammation (CI) diagnosed by histology were included in this study. Radioimmunoassay (RIA), polymerase chain reaction (PCR) and Western blot were used to detect the levels of serum folate, HPV16 infection and the expression of DNMT1 protein,respectively. Results The average levels of serum folate were (2.60 ± 1.61) ng/ml, (3.14 + 2.08) ng/ml and (3.32+1.74) ng/ml,and the expression of DNMT1 protein were 2.40 + 0.99,1.88 + 0.33 and 0.89 ± 0.29 in the group of SCC, CIN and CI, respectively.The relationship of folate levels and DNMT1 protein expression showed inverse correlation (r=-0.186, P=0.00l). The results in our study indicated that there was an additive interaction between low-level of serum folate and high-expressionof DNMT1 protein related to the risk of CIN and SCC, with OR value as 2.50(95%C/: 1.21-9.22) and 6.03 (95%C/: 2.79-21.72) respectively. The relative excessrisk of interaction (RERI) , attributableproportion of interaction (API) and synergy index (S) were 0.92, 0.36 and 2.59 in the CIN group while 2.47, 0.41 and 1.96 in the SCC group. Conclusion The low level of serum folate and high expression of DNMT1 protein seemed to be associated with high risk of cervical cancer and its precancerous lesion. It suggested that there might be a synergistic action between serum folate and DNMT1 in the progression of cervix carcinogenesis.     

人乳头瘤病毒16 E2、E6癌基因在子宫颈癌中的表达及E2缺失分析

目的探讨人乳头瘤病毒（HPV）16型E2、E6癌基因的表达及含量变化在子宫颈癌发生中的作用，以及E2基因的缺失与子宫颈病变的关系。方法收集山西省肿瘤医院经病理学确诊的141例子宫颈癌新发病例作为病例组，同时选择在同一医院住院、经组织病理学确诊的137例子宫肌瘤患者为良性肿瘤对照组，从社区妇科体检的1582名妇女中随机抽取129名妇女为健康对照组。利用多重PCR对从子宫颈组织和脱落细胞中提取的DNA进行HPVl6 E2、E6基因扩增，在VILBER凝胶成像仪上利用Bio-ID＋＋软件分析E2、E6基因的相对含量。结果HPVl6E6阳性率在子宫颈癌组、子宫肌瘤组和健康对照组分别为46．8％、24．1％和2．3％，HPVl6E2阳性率分别为36．2％、19．0％和0．0％，差异均有统计学意义。子宫颈癌组和子宫肌瘤组中E2缺失率分别为22．73％和21．21％，健康对照组未检出E2阳性者。HPVl6E6和E2含量均为病例组高于对照组，在子宫颈癌组内E6含量明显高于E2（t=2．70，P=0．009），两者的比值为1．24。结论子宫颈癌患者HPVl6E2、E6癌基因的阳性表达率和表达量均高于子宫肌瘤患者和健康妇女，E6癌基因的高表达在子宫颈癌发生中起重要作用，而E2基因的缺失在子宫颈癌变过程中可能发挥着不可忽视的作用。     

Risk factors of invasive cervical cancer in Mali

BACKGROUND: Cervical cancer is the most common cancer in women in Mali and the second commonest cause of cancer mortality. METHODS: As part of an international effort to evaluate the role of human papillomavirus (HPV) in the aetiology of cervical cancer, we conducted a hospital-based case-control study in three medical centres in Bamako during 1994-1995. A total of 82 cases (invasive cervical cancer patients) and 97 controls matched to the cases for age were included. Information on risk factors was collected through personal interview. Serum antibodies to HPV 16, 18 and 31 virus like particles (VLP) were detected using ELISA assays. Polymerase chain reaction was used to detect HPV DNA in frozen biopsies of cases. RESULTS: Human papillomavirus 6, 18, 31 VLP were detected in 60.4% of cases and 45.4% of controls (P = 0.03). Overall, HPV DNA was identified in 96.9% of the cervical cancer cases. Risk factors for cervical cancer were parity >10 versus <5 children ([odds ratio] OR = 4.8, 95% CI : 1.5-14.7), never having practised vaginal douching (OR = 17.6, 95% CI : 4.2-74.7), re-using home-made feminine napkins (OR = 45.9, 95% CI : 8.8-238.7) and having a husband with more than two wives (OR = 5.3, 95% CI : 1.3-21.3). CONCLUSIONS: These data provide further evidence on the role of HPV in cervical cancer and show that high parity and poor genital hygiene conditions were the main co-factors for cervical cancer in this population with prevalent HPV infection.     

Serum One-Carbon Metabolites and Risk of Cervical Cancer

Most cases of cervical cancer are associated with human papilloma virus (HPV) infection of high risk types. In folate deficiency, heterogeneous nuclear ribonucleoprotein E1 (hnRNP-E1) interferes with HPV16 viral capsid protein synthesis. We aimed to study the importance of 1-carbon metabolism in cervical carcinogenesis by examining serum vitamin B₁₂ (cobalamin), homocysteine, folate levels, and the RNA and protein expression of HPV16 L1, L2, E6, E7, and to correlate them with hnRNP-E1 expression and HPV infection in normals, squamous intraepithelial lesions (SILs), and cervical cancer subjects. Serum cobalamin, folate, and homocysteine were estimated using kits, RNA by real time PCR and proteins by Western blotting. We observed that lower folate and vitamin B₁₂ levels were associated with HPV infection. hnRNP-E1 progressively decreased from normals (100%) to SILs (75%) to cervical cancer (52.6%). The findings show that HPV16 E6 and E7 are overexpresed whereas HPV16 L1 and L2 are downregulated at mRNA and protein levels in cervical cancer as compared to normals and SILs. The results indicate that perhaps the reduced expression of hnRNP-E1 might be involved with the cervical cancer pathogenesis, with folate playing a role in the natural history of HPV infection.     

宫颈癌危险因素的流行病学研究

宫颈癌病因复杂，多数研究者认为是多因素综合作用的结果。本文通过病例－对照研究，应用分子及血清流行病学方法，探讨引起宫颈癌的危险因素。应用ＨＰＶ６／１１、ＨＰＶ１６／１８探针，通过斑点分子杂交技术，检测宫颈癌和对照宫颈组织ＤＮＡ中的感染，结果病例组和对照组ＨＰＶ６／１１阳性率分别为２４．６％、２７．５％，差别无显著性，ＨＰｙ１６／１８阳性率分别为４５．６％、９．８％，差别有显著性；应用ＰＣＲ技术检测两组宫颈组织ＤＮＡ中ＨＳＶ－２感染，结果病例组和对照组阳性率分别为２８．１％、７．８％，Ｌｏｇｉｓｔｉｃ回归平衡年龄因素后差别无显著性；应用ＥＬＩＳＡ方法检测血清中ＨＣＭＶ抗体阳性率，结果病例组和对照组ＩｇＭ阳性率分别为１２．３％、５．９％，差别无显著性。用多因素Ｌｏｇｉｓｔｉｃ回归平衡各因素间的作用，最后分析结果表明，文化程度、产次、ＨＰＶ１０／１８感染与宫颈癌的发生有关，其ＯＲ值分别为０．５７、１．８５、３１．９６。     

血清叶酸与RAR - β、MGMT甲基化在宫颈上皮内瘤变中的交互效应

目的 探讨血清叶酸与RAR - β、MGMT 启动子区CpG岛甲基化在宫颈上皮内瘤变（CIN）中的交互效应。方法 基于课题组建立于山西省（介休市和阳曲县）的已婚妇女人群队列,选取2014年6月 - 9月病理学确诊的CIN患者（CINⅠ147例、CINⅡ/Ⅲ 134例）及正常宫颈妇女（156例）为研究对象。收集全部对象人口学特征及相关因素,采集空腹静脉非抗凝血与宫颈脱落细胞。采用化学发光免疫法检测血清叶酸浓度,甲基化特异性PCR法检测基因CpG岛甲基化状态,导流杂交法判定HPV感染状况。采用Kruskal - Wallis H检验、χ2检验、趋势χ2检验进行资料分析,非条件logistic回归模型和交互作用指标评价交互效应。结果 血清叶酸在NC、CINⅠ和CINⅡ/Ⅲ组总体分布差异有统计学意义（P＜0.001）。低血清叶酸（≤23.13 nmol/L）可增加CINⅠ和CINⅡ/Ⅲ的发生风险（OR = 6.78,95%CI:3.75～12.26;OR = 64.13,95%CI:18.34～224.20）,且随病变进展,血清叶酸逐渐降低（χ2趋势 = 92.69,P＜0.001）。CIN组RAR - β、MGMT CpG岛甲基化率均高于NC组,且甲基化率随病变进展逐渐上升（χ2趋势 = 20.19,P＜0.001;χ2趋势 = 15.35,P＜0.001）。在各组中低血清叶酸与RAR - β、 MGMT CpG岛高甲基化均呈正相加交互作用（CINⅠ:S = 2.23,95%CI:1.63～8.08,S = 1.21,95%CI:1.01～10.01;CINⅡ/Ⅲ:S = 2.43,95%CI:1.72～6.80,S = 2.83,95%CI:1.55～8.10）,但未显示相乘交互作用（P＞0.05）。结论 低血清叶酸和RAR - β、 MGMT CpG岛高甲基化均可增加CIN的风险,且可能存在相加交互作用。     

Effect of orange juice, folic acid, and oral contraceptives on serum folate in women taking a folate-restricted diet

The effect of folate intake from orange juice on serum folate was evaluated in 60 women (age 20-39) during 9 weeks of a folate-restricted diet. Twenty-one were users of oral contraceptives (OCA). Folate intake from the restricted diet was 159 +/- 5 micrograms/day, as assessed by dietary surveys. Serum folate of women taking OCA was lower than in nonusers at the inception of the study (P less than 0.01). During the initial 2 weeks of restricted diet, serum folates decreased significantly (13.8 +/- 1.8 to 8.5 +/- 0.4 ng/ml; P less than 0.002). This decrease was further prevented by supplementation of the diet for 7 weeks with 100 micrograms/day of total folate from reconstituted frozen orange juice or synthetic folic acid (PteGlu). Both folate supplements were effective (P less than 0.05) in increasing serum folate (9.4 +/- 1.0 to 14.5 +/- 1.4 ng/ml, orange juice; 8.4 +/- 0.7 to 20.5 +/- 5.8 ng/ml, folic acid). Serum folates were similar in women taking either orange juice or folic acid. Serum folate of nonsupplemented women decreased from 10.2 +/- 0.8 to 8.3 +/- 0.4 ng/ml (P less than 0.05). No difference between serum folates of OCA users and nonusers was detected during the restricted diet or folate supplementation. These data indicate that folate in reconstituted orange juice was as available as folic acid, and that utilization of both folate forms and folate in a mixed diet was unaffected by oral contraceptives.     

血清叶酸与口腔癌发病关联的病例对照研究

目的  探讨血清叶酸与口腔癌发病的关系。 方法  采用病例对照的研究方法, 收集福建医科大学附属第一医院2010年9月-2018年1月经病理确诊的口腔癌新发病例225例为病例组, 收集同时期社区和医院体检的健康人群225例为对照组。采用非条件Logistic回归分析模型, 分析血清叶酸与口腔癌发病风险的OR及其95%CI值, 并进行分层分析和相乘交互作用分析。 结果  病例组血清叶酸中位数为5.7 ng/ml, 低于对照组的8.2 ng/ml(P < 0.001), 差异有统计学意义; 无论性别、吸烟与否及摄入蔬菜水果的频次多少, 血清叶酸水平与口腔癌的发病风险均存在负相关; 叶酸与性别、吸烟、摄入蔬菜、水果在口腔癌的发生中存在相乘交互作用。 结论  高血清叶酸水平与口腔癌的发病风险呈负相关, 保证适量叶酸摄入、减少烟草消耗和适量增加蔬菜水果可能降低口腔癌的发病风险。