TCT联合高危型HPV基因检测在绝经后妇女宫颈上皮内瘤变筛查的价值评估

目的:评价宫颈薄层液基细胞检测(TCT)联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变(CIN)筛查的价值。方法:选取TCT检查结果异常,包括意义不明不典型鳞状细胞(ASCUS)、低度鳞状上皮内瘤变(LSIL)、高度鳞状上皮内瘤变(HSIL)和鳞状上皮癌(SCC)的163例绝经后妇女为研究对象,荧光定量PCR(FQ-PCR)法检测高危型人乳头状瘤病毒(HR-HPV16、18、31、33、45、52、56、58)分型,并以阴道镜下宫颈活检病理学诊断作为诊断金标准进行对比研究。结果:①不同年龄段绝经妇女TCT结果异常的类型构成比,差异无统计学意义(P>0.05)。②HPV分型检测阳性者80例,感染率49.1%,随着TCT检查宫颈病变级别的升高,HR-HPV感染率亦逐步增加,与低级别比,差异有统计学意义(P<0.05)。③163例TCT异常患者中,病理学诊断阳性51例(CINⅠ级24,CINⅡ级9例,CINⅢ级6例,宫颈浸润癌12例),阳性率31.3%(51/163)。随着TCT检查宫颈癌变级别的增高,宫颈组织病理学诊断阳性率逐步增加,差异有统计学意义(P<0.01)。④宫颈炎组中HR-HPV阳性40例,感染率35.71%,宫颈CIN阳性组中HR-HPV阳性29例,感染率74.4%(其中CIN I级70.8%,CIN II级77.8%,CIN III级83.3%),宫颈浸润癌组中HR-HPV阳性11例,感染率91.7%,随着宫颈病变病理级别的升高,HR-HPV感染率呈上升趋势(P<0.01)。⑤TCT联合HPV检测、单独HPV检测对CIN及宫颈癌筛查的敏感度均高于TCT检查,分别为96.1%、78.4%、66.7%(P<0.01)。TCT联合HPV分型检测、单独HPV检测对CIN及宫颈癌筛查的假阴性率低于TCT检测,有显著性统计学差异(P<0.01)。3种筛查方法的特异度、假阳性率比较,无统计学差异(P>0.05)。结论:TCT联合高危型HPV基因分型检测在绝经后妇女宫颈上皮内瘤变筛查中具有重要意义。     

HPV L1壳蛋白检测联合细胞学、HPV检测诊治宫颈病变的临床价值

目的探讨HPV L1壳蛋白检测联合细胞学检查、HPV检测在宫颈病变诊治中的临床价值。方法:收集2014年7月~2015年6月期间,在新乡医学院第一附属医院妇科门诊因体检或发现宫颈异常就诊的符合入组条件的女性1052例,进行TCT筛查、HPV分型检测,对一项或两项结果异常者进行子宫颈组织活检术,并对TCT结果异常患者采用免疫细胞化学的方法检测HPV L1壳蛋白的表达。结果 156例TCT结果异常中,意义未明确的非典型鳞状上皮细胞(ASCUS)、低度鳞状上皮内病变(LSIL)、高度鳞状上皮内病变(HSIL)、鳞状细胞癌(SCC)的HR-HPV阳性率,分别为19.1%(13/68)、35.3%(18/51)、77.8%(21/27)、100%(10/10)。各组之间比较,差异有统计学意义(P0.05)。TCT异常结果中ASCUS、LSIL、HSIL、SCC在病理组织学CIN及以上阳性率分别为54.4%(37/68),60.8%(31/51),85.2%(23/27),100%(10/10)。各组之间的比较,差异有统计学意义(P0.05)。随着组织病理学诊断病变级别越高,HPV L1壳蛋白阳性表达率逐渐下降。结论 TCT和HPV分型检测在宫颈癌筛查中必不可少。HPV L1壳蛋白检测可以预测宫颈癌前病变的进展趋势。三者联合应用可以及早发现宫颈癌前病变,并对病变进展风险进行合理的评估。     

HPV L1壳蛋白联合高危HPV分型、CA125、SCC-Ag在宫颈癌诊断中的应用价值

目的 探讨人乳头瘤病毒（HPV）L1壳蛋白联合HPV分型、糖类抗原125(CA125)、鳞状上皮细胞癌抗原（SCC-Ag）在宫颈癌诊断中的应用价值。方法 选取2021年1月至2022年12月在北京市垂杨柳医院治疗的宫颈疾病患者214例,其中宫颈癌患者45例,高度宫颈上皮内瘤变（CINⅡ和CINⅢ型）患者56例,低度CIN病变（CINⅠ）患者47例,宫颈炎患者66例,分析各患者HPV L1壳蛋白、高危HPV分型、血清CA125和SCC-Ag的差异。结果 低度CIN低病变组HPV L1壳蛋白阳性率明显高于其他患者（P <0.05）;宫颈炎和高度CIN病变HPV L1壳蛋白阳性率明显高于宫颈癌（P <0.05）。随着宫颈病变程度加重,高危HPV阳性率明显升高（P <0.05）,血清CA125和SCC-Ag明显升高（P <0.05）。HPV L1壳蛋白联合高危HPV分型、CA125、SCC-Ag诊断的ROC曲线下面积为0.630,诊断价值不高。结论 HPV L1壳蛋白、高危HPV分型、血清CA125和SCC-Ag在不同宫颈病变患者中有明显差异,其中高危HPV分型、血清C...     

宫颈上皮内瘤变及早期宫颈癌组织中P16、HPV L-1壳蛋白的表达及与HR-HPV载量相关性研究

目的:探讨宫颈上皮内瘤变(CIN)及早期宫颈癌组织中P16、HPV L-1壳蛋白的表达及与高危型人乳头瘤病毒(HR-HPV)载量的相关性。方法:分别采用免疫组化法和第二代杂交捕获法(hybrid captureⅡ,HC-2)检测26例慢性宫颈炎组织、83例低度鳞状上皮内病变(LSIL)(CINⅠ83例)、109例高度鳞状上皮内病变(HSIL)(CINⅡ49例,CINⅢ60例)、11例早期宫颈鳞癌组织中P16蛋白、HPV L-1壳蛋白的表达及HR-HPV载量,并分析其相关性。结果:1在宫颈癌前病变中随病变级别增高,HR-HPV阳性率增加,差异有统计学意义(P0.01)。各组织学分级中病毒载量分布差异有统计学意义,HSIL(44.95%)及早期宫颈癌组织(63.64%)中皆以低病毒载量(1~100 RLU/CO)为主。从慢性宫颈炎、LSIL、HSIL到早期宫颈癌,P16蛋白阳性表达率分别为11.54%(3/26),55.42%(46/83),85.32%(93/109),100.00%(11/11),差异有统计学意义(P0.01);L-1壳蛋白阳性率分别为15.38%(4/26),28.92%(24/83),14.68%(16/109),0.00%(0/11),差异有统计学意义(P0.05)。2229例宫颈组织中,随HPV载量增加,P16蛋白表达增强;L-1壳蛋白阳性表达率增加,差异有统计学意义(P0.01)。3在慢性宫颈炎组中,P16蛋白阳性表达与HPV载量呈正相关(r=0.491,P0.05)。在LSIL组中,P16蛋白与HPV载量(r=0.459,P0.01)及L1壳蛋白表达(r=0.297,P0.01)皆呈正相关。4在HSIL及早期宫颈癌组中,P16蛋白、L-1壳蛋白表达与HPV载量三者之间无明显相关性(P0.05)。结论:P16、HPV L-1壳蛋白异常表达是宫颈癌前病变发生发展的早期分子事件,对判断CINⅠ有参考价值,可能比HR-HPV载量更具有预测价值。     

TCT、HPV检测联合阴道镜下宫颈活检在宫颈癌前病变及宫颈癌诊断中的应用价值

目的 探讨液基薄层细胞检测（TCT）、人乳头瘤病毒（HPV）联合阴道镜下宫颈活检诊断宫颈癌前病变与宫颈癌的价值。方法 选取120例疑似宫颈病变患者为研究对象,以组织病理学检查为金标准,分析TCT、HPV、阴道镜下宫颈活检诊断宫颈癌前病变及宫颈癌的价值。结果 120例疑似宫颈病变患者中,组织病理学检查检出阳性69例;以组织病理学检查结果为金标准,TCT、HPV联合阴道镜下宫颈活检诊断宫颈癌前病变与宫颈癌灵敏度、准确度高于单独诊断,差异有统计学意义（P<0.05）;kappa检验显示,TCT、HPV联合阴道镜下宫颈活检检查结果与金标准的一致性极好（kappa=0.949,P<0.05）。结论 TCT、HPV联合阴道镜下宫颈活检能够诊断出宫颈癌前病变与宫颈癌,具有一定的诊断效能。     

HPV L1壳蛋白检测在宫颈病变筛查中的分流管理价值

目的探讨HPV L1壳蛋白检测在HR-HPV阳性、TCT≤LSIL宫颈病变筛查中的分流管理价值。方法对HR-HPV阳性、TCT≤LSIL的687例妇女宫颈脱落细胞标本进行HPV L1壳蛋白检测,评价其筛查宫颈病变的灵敏度、特异度、阳性预测值、阴性预测值等。结果 HPV L1壳蛋白阳性率与宫颈病变的严重程度呈负相关（rs=-0.316）。细胞学结果NILM组中,HPV L1壳蛋白检测筛查宫颈病变（≥CIN1）的灵敏度75.4%、特异度33.9%、阳性预测值18.8%、阴性预测值87.2%;ASC-US组以上各值为71.4%、92.4%、81.8%、87.1%;LSIL组以上各值为77.0%、87.7%、89.1%、74.6%。结论 HPV L1壳蛋白对宫颈病变有预测价值,且可对HR-HPV阳性、细胞学≤ASC-US受检者进行分流管理。     

水通道蛋白1在宫颈病变中的表达及意义

目的:检测宫颈病变组织中水通道蛋白1的表达,探讨该蛋白在宫颈癌形成和演进进程中的意义。方法:用免疫组织化学SP法检测83例石蜡包埋宫颈组织中水通道蛋白1的表达,结合临床病理分型分析其表达的意义。结果:水通道蛋白1在慢性宫颈炎、宫颈上皮内瘤样病变(CIN)和宫颈癌组织中的阳性率分别为4.0%,33.3%和74.2%,3组样本中水通道蛋白1阳性率的差异有统计学意义(P<0.05),宫颈癌病理学分级1+2级和3级相比,差异有统计学意义(P<0.01)。水通道蛋白1表达阳性率与CIN的分级,与宫颈癌临床分期、组织学分型和淋巴结转移无关(P>0.05)。结论:水通道蛋白1在宫颈癌前病变和宫颈癌组织中表达升高,可能在宫颈癌的发生发展过程中起重要作用。     

CD44v6与人乳头瘤病毒在宫颈鳞癌及癌前病变中的相关性研究

目的:观察CD44v6与人乳头瘤病毒(HPV)在宫颈鳞癌及癌前病变中的相关性,以探讨两者联合检测在宫颈癌早期诊断中的意义。方法:采用免疫组化(SP)法检测宫颈鳞癌、宫颈上皮内瘤变(CIN)Ⅰ、CINⅡ、CINⅢ及正常宫颈组织各20例石蜡标本中CD44v6的表达,同时用荧光定量聚合酶链反应(FQ-PCR)法检测上述组织中HPV-DNA的相对含量,将两者检测的结果进行统计学分析并研究其相关性。结果:CD44v6在对照组、CINⅠ组、CINⅡ组、CINⅢ组及宫颈鳞癌组中细胞表达的阳性率逐渐升高,5组比较差异有统计学意义(P<0.05);HPV感染率也逐渐升高,5组比较差异有统计学意义(P<0.05);CD44v6与HPV感染呈正相关(rs=0.341,P=0.01)。结论 :CD44v6的异常表达和HPV感染与宫颈癌的发生、发展关系密切,两者联合检测对宫颈癌的早期诊断有一定的临床意义。     

高危型HPV检测联合TCT在宫颈癌筛查中的应用分析

目的探讨高危型人乳头瘤病毒(HPV)检测联合液基波层细胞学(TCT)技术在宫颈癌筛查中的临床价值。方法选取2014年5月~2015年5月我院收治的疑似宫颈癌癌前病变女性1000例为研究对象,分别应用HPV检测联合TCT进行筛查及传统宫颈涂片进行筛查。同时对其宫颈病变处进行组织活检。结果 HPV检测联合TCT筛查的细胞学检查阳性率与组织活检病理学阳性率相符度显著高于传统宫颈涂片筛查的结果,差异有统计学意义(P0.05)。结论 HPV检测联合TCT可显著提高早期宫颈癌筛查准确率,临床应用价值较高。     

高危型人乳头瘤病毒与TCT联合检测用于宫颈病变筛查

目的:评价高危型人乳头瘤病毒与TCT联合检测在宫颈疾病中的应用价值进行癌前病变筛查及高危型HPV16、18DNA检测,以组织病理学诊断为金标准,比较薄层液基细胞学(TCT)与高危HPV感染联合TCT的筛查效果。结果:1820例受检者中CINⅠ38例、CINⅡ42例、CINⅢ30例,SCL1例、高危HPV感染106例占5.82%TCT异常112例占6.15%,HPV或TCT阳性总数152例占8.35%,HPV或TCT阳性与单独TCT阳性及单独HPV阳性组比较,各级别宫颈病变的检出率有统计学意义,P<0.05.结论:TCT在宫颈病变筛查中敏感度高,TCT与HPV联合可提高筛查敏感度。     

宫颈锥切术在诊断宫颈上皮内瘤样病变和早期宫颈癌中的价值

目的探讨宫颈锥切术能否被阴道镜多点活检所代替以及宫颈锥切术在诊断宫颈上皮内瘤样病变（CIN）和早期宫颈癌中的价值。方法回顾分析近5年来,在江苏大学附属宜兴医院妇产科因宫颈病变同时行阴道镜多点活检和宫颈锥切术（包括冷刀和电圈环切术即LEEP术）的患者120例,采用自身对照法,对比研究宫颈锥切术和阴道镜多点活检的病检结果的差异。结果宫颈锥切术与阴道镜下多点活检病理符合者59例（49．17％）;不符合者61例（50．83％）,宫颈锥切术后病理诊断加重者35例（占29．17％）,浸润癌漏诊率达10．00％。宫颈锥切术的主要并发症为出血。结论宫颈锥切术在诊断CIN和早期宫颈癌具有重要价值,不能被阴道镜多点活检所取代。要重视切缘是否阳性和加强术后的随访。     

Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence

OBJECTIVE: The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance. DESIGN, SETTING AND METHODS: A prospective cohort study was performed in two groups of patients at risk of cervical incompetence with singleton gestations attending the Royal Women's Hospital, Melbourne, Australia, from 1996 to 2000. The first group was managed by their obstetric carers with an elective cerclage, while the second group was managed conservatively as part of a cervical surveillance program offered to patients attending the Department of Perinatal Medicine for pregnancy care. This program consists of weekly visits from 16 weeks' gestation and involves alternating transvaginal ultrasound assessment of cervical morphometry with cervico-vaginal bacteriology and fetal fibronectin swabs. Empiric insertion of a cerclage is undertaken when there is evidence of significant cervical shortening (cervical canal <2.5 cm in length at 相似文献   

腹腔镜下宫颈环扎术治疗宫颈机能不全16例临床分析

目的探讨腹腔镜下宫颈环扎术治疗宫颈机能不全的效果和安全性。方法对2008年8月至2011年12月中山大学附属第一医院妇科16例经阴道宫颈环扎手术失败和无法行经阴道宫颈环扎术的宫颈机能不全患者,在非孕期行腹腔镜下宫颈环扎术,观察术后妊娠情况。结果 16例患者手术过程均顺利,无一例中转开腹。有10例患者妊娠,其中8例孕足月剖宫产,1例孕31周剖宫产分娩,1例妊娠20周时因胎膜早破导致难免流产,开腹手术剪断环扎带后经阴道娩出胎儿。行剖宫产患者平均分娩孕周为37.9周,较术前平均流产孕周平均延长17.9周。另6例患者中5例现术后1～3个月,尚未计划妊娠,1例术后1+年,未避孕未孕。结论腹腔镜下宫颈环扎术安全有效,可明显延长妊娠时间,增加活产率,可作为宫颈机能不全的治疗方法之一。     

Brain metastasis from cervical carcinoma

The aim of this study was to describe the features of patients with brain metastasis from cervical cancer. Twelve patients with brain metastasis from cervical cancer were identified. Information regarding symptoms, treatment, and survival was analyzed. The incidence of brain metastasis in our population was 0.77%. Median patient age at initial diagnosis of cervical cancer was 43.5 years (range 29-57 years) compared with 44.5 years (range 31-58 years) at identification of brain metastasis. Six patients had FIGO stage IB disease; three had stage IIB disease; and one each had stage IIIA, IIIB, and IVB disease. The median interval from diagnosis of cervical cancer to identification of brain metastasis was 17.5 months (range 1.1-96.1 months). All but one patient presented with neurologic symptoms. Eight patients received whole-brain irradiation and steroids, three received steroids alone, and one underwent surgery, followed by irradiation. All the patients who received whole-brain irradiation experienced improvement in their symptoms. Median survival from diagnosis of brain metastasis to death was 2.3 months (range 0.3-7.9 months). Five patients who received chemotherapy after brain irradiation had a median survival of 4.4 months compared to 0.9 months for those who received no additional treatment after brain irradiation (P= .016). Most patients with brain metastasis from cervical cancer presented with neurologic sequelae. Brain irradiation improved these symptoms. Survival after diagnosis of brain metastasis was poor; however, patients who received chemotherapy after brain irradiation appeared to have improved survival.     

Angiogenesis in cervical intraepithelial neoplasia and early-staged uterine cervical squamous cell carcinoma: clinical significance

The objective of this study is to evaluate angiogenesis in cervical intraepithelial neoplasia (CIN), microinvasive squamous cell carcinoma (MIC), and early-staged squamous cell carcinoma (SCC), stage IB-IIA of the cervix. Microvessel density (MVD) was evaluated and correlated with other pathologic prognostic factors and disease outcomes. Four hundred seventy-four cervical specimens were studied. Among these, 100 were designated normal cervix, 30 CIN1, 32 CIN2, 178 CIN3, 74 MIC, and 60 early-staged SCC. MVD per high-power field (x400) of early-staged SCC, MIC, and CIN3 were significantly higher in comparison to CIN2, CIN1, and control subjects (P<0.05). There was no statistically significant difference in MVD between control group, CIN1, and CIN2. In early-staged SCC, no correlation between MVD and pelvic lymph node status, parametrial involvement, depth of stromal invasion, and lymphovascular space invasion was found. Patients with bad outcomes (recurrence or death) showed no statistically different MVD from the ones who had unremarkable clinical courses.     

宫颈机能不全的孕期诊断及评价

宫颈机能不全（cervical incompetence,CIC）孕期诊断主要依靠：既往病史和临床症状、阴道检查、超声检查结果;对CIC的诊断通常仅限于单胎妊娠。至少两次28周前的妊娠流产（无痛性宫颈扩张）病史可作为CIC诊断的独立指标;在妊娠24周前的初产妇或经产妇（无多次流产史的）,当阴道超声提示其宫颈长度﹤25 mm和（或）查体时发现宫颈有进行性的变化,结合一次以上的14-36周妊娠流产（或早产史）或明确的CIC发生高危因素可以作出CIC的诊断。     

Prediction of disease persistence after conization for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3

We attempted to determine the significant variables and to predict the probability of disease persistence after conization for microinvasive cervical carcinoma and cervical intraepithelial neoplasia grade 3 (CIN3). We analyzed 133 patients from 2001 to 2002 who had a subsequent hysterectomy after conization. The histological findings of the cone specimens, together with the clinical parameters, were correlated with the presence of residual dysplasia in the hysterectomy specimen. The probability of having residual dysplasia was calculated based on the function of the significant variables obtained by logistic regression analysis. Of the 133 patients, 42 (31.6%) had residual disease in their hysterectomy specimens. Using multivariate analysis only for the postmenopausal state, positive endocervical curettage, positive margin, and microinvasive carcinoma were predictive of residual dysplasia. The probabilities of having residual dysplasia were about 0.99, 0.84, 0.4, 0.07, and 0.01 in patients with a presence of all four, any three, any two, any one, and no risk factors, respectively. The best cutoff probability determined by the receiver operating characteristic curve was 0.32, yielding a sensitivity of 81% and a specificity of 88%. Based on these results, patients with the presence of any two or more of the risk factors mentioned above should be considered as a high-risk group for having disease persistence after conization for the treatment of CIN3 and microinvasive carcinoma.