人乳头瘤病毒感染的年龄及其亚型的分布特征

目的探讨2 933例妇科门诊就诊患者人乳头瘤病毒(HPV)感染者的年龄以及基因亚型的分布特征。方法采用导流杂交技术进行21种HPV基因亚型检测。结果 2 933例检测者中,HPV感染者951例,感染率为32.42%;检测人数中,25~34岁组居多,但以55~64岁组感染率最高,其次为45~54岁组;除HPV43型以外,其余20种亚型均被检测出,其中阳性率比较高的亚型是HPV16,HPV52,HPV58,均为高危型,阳性率依次为16.06%,13.26%,13.26%;在951例HPV感染阳性患者中,单一亚型感染者占71.4%,多重感染者占28.6%,各年龄段多重感染以二重感染最多见,25岁以下多重感染的阳性患者中,三重、四重感染也较易见。结论2 933例妇科门诊就诊患者感染HPV的感染率较高,以单一高危基因型感染最为常见,主要包括HPV16型、HPV52型、HPV58型等,并且年龄与HPV的感染率以及感染类型有一定的关系。     

内蒙古少数民族地区人乳头瘤病毒检测结果分析

目的：研究内蒙古锡林郭勒盟少数民族地区女性人乳头瘤病毒（HPV）感染状况以及病毒基因亚型在人群中的分布情况,为临床防治宫颈癌、预防性疫苗的接种及研发提供依据。方法：对1398例于2014年1月～2015年1月在锡盟妇产科门诊就诊及体检的妇女进行23种HPV基因型检测。结果：1398例妇女中共检出370例HPV感染者,总阳性率为26.46%（370/1398）,其中蒙古族与汉族妇女感染HPV阳性率分别为26.05%（193/741）,26.94%（177/657）,汉族妇女阳性率稍高于蒙古族,但差异无统计学意义（P>0.05）;共检出高危亚型18种、低危亚型5种,其中高危亚型组阳性率23.75%（332/1398）,明显高于低危亚型组1.65%（23/1398）和高-低危混合感染组1.07%（15/1398）,差异具有统计学意义（P<0.05）;检出的18种高危亚型阳性率从高到低依次为HPV-58（12.97%）,16（11.62%）,52（11.62%）,51（11.35%）,53（8.92%）,18（6.76%）,68（5.68%）,31（5.41%）,56（4.86%）,66（4.32%）,59（3.78%）,35（1.89%）,33（1.08%）,39（1.08%）,73（0.81%）,82（0.54%）,83（0.54%）,45（0.54%）;5种低危亚型阳性率从高到低依次为HPV-81（3.789%）,43（2.79%）,42（1.62%）,6（1.35%）,11（0.54%）;370例HPV感染者中,单一高危亚型感染阳性率为77.84%（288/370）,单一低危亚型感染阳性率为6.22%（23/370）,二重感染阳性率为16.76%（62/370）,三重以上感染阳性率为5.401%（20/370）;≤30岁年龄组检出阳性率最高为44.44%,其次为51～60岁年龄组35.66%,≥61岁年龄组检出阳性率最低为17.07%。结论：内蒙古锡林郭勒盟少数民族地区女性HPV总感染率26.46%,高危亚型HPV-58,16,52,51,53,18,低危亚型HPV-81,43,42是主要的感染亚型;感染以单一高危亚型为主。HPV感染人群以≤30岁和51～60岁年龄段为高发。HPV亚型分布具有一定的区域性,对该地区妇女宫颈癌的防治和预防性疫苗的接种有重要的指导意义。     

厦门市女性人乳头瘤病毒感染和基因型分布状况

目的 研究厦门市女性人乳头瘤病毒（HPV）的感染和基因型分布状况。方法 随机抽取厦门市15～80岁女性27 300例,并分为门诊组（14 847例）和体检组（12 453例）,对所有人进行HPV-DNA检测。结果 HPV阳性率为12.85%(3507/27 300),其中高危型HPV阳性率为8.52%(2327/27 300),占阳性的66.35%(2327/3507)。最常见的高危型为HPV-52和58。高危型HPV感染者有14.48%(337/2327)感染多种高危亚型。妇科门诊组HPV阳性率、高危型HPV阳性率、高危型HPV阳性占比及多重高危型HPV感染在高危型HPV感染中的占比均显著高于体检组（15.79%vs. 9.34%,P <0.001;11.23%vs. 5.29%,P <0.001;71.16%vs. 56.66%,P <0.001;16.31%vs. 9.86%,P <0.001）,以上指标在不同年龄组间也有显著差异（均P <0.05）。妇科门诊组高危型HPV感染的高峰年龄为≥60岁、50～59岁和<30岁,体检组为≥60岁和&l...     

宫颈病变患者高危因素分析

目的探讨宫颈病变的高危因素,为宫颈癌的防治工作提供依据。方法将569例宫颈病变患者(病例组)与348例宫颈正常的妇女(对照组)进行对比分析。结果病例组HPV感染率达88.58%,与对照组HPV感染率14.94%相比较,差异有显著性(P<0.001)。两组患者初次性交年龄,多个性伴侣及肿瘤家族史相比较,均有统计学意义。结论宫颈病变的高危因素包括:HPV感染,初次性交年龄过小,多个性伴侣及肿瘤家族史。     

381例孕前妇女高危型HPV感染检测分析

目的:分析高危型人乳头瘤病毒(HPV)在孕前妇女中的感染情况。方法:将381例孕前检查妇女以年龄分为≤25岁组、26～30岁组和31～35岁组,应用高危型人乳头瘤病毒多重核酸扩增荧光定量检测技术进行高危型HPV感染检测,比较3个年龄组之间高危型HPV感染情况。结果:381例孕前妇女检测高危型HPV感染总阳性率为11.54%(44/381),≤25岁组、26～30岁组和31～35岁组高危型HPV感染率分别为15.78%(14/95)、9.35%(19/203)和13.25%(11/83)。3组结果间比较无显著性差异(P>0.05)。结论:HPV感染好发于育龄女性,加强孕前妇女高危型HPV检测对孕前检查工作     

Detecting the genotype and viral load of human papillomavirus in Fuzhou with real-time fluorescence quantitative PCR

目的 利用实时荧光定量PCR技术进行HPV-DNA分型定量检测,观察HPV亚型感染的分布情况,初步探讨HPV感染主要基因型别及病毒载量与宫颈病变的关系.方法 随机收集本院妇科门诊患者108例,建立病历档案,采集患者宫颈脱落细胞样本,进行HPV-DNA分型定量检测.结果 108例门诊患者检出HPV阳性14例,阳性率为12.96%,其中单纯HPV次要高危阳性感染9例,占64.28%;单纯HPV-16阳性感染2例,单纯 HPV-31阳性感染1例;HPV-16、HPV-31和HPV次高危型三重感染1例,HPV-16和HPV-18/45的二重感染1例.结论 本组患者HPV次高危型感染亚型几率最大,HPV高危型和次要高危型的感染与宫颈病变有高度的相关性,且病毒的感染量与病变的程度有一定的相关性,同时也显示HPV实时荧光定量PCR技术是一种有效的HPV检测手段.     

实时荧光定量PCR法测定福州地区高危型HPV感染型别与病毒载量

目的利用实时荧光定量PCR技术进行HPV-DNA分型定量检测,观察HPV亚型感染的分布情况,初步探讨HPV感染主要基因型别及病毒载量与宫颈病变的关系。方法随机收集本院妇科门诊患者108例,建立病历档案,采集患者宫颈脱落细胞样本,进行HPV-DNA分型定量检测。结果108例门诊患者检出HPV阳性14例,阳性率为12.96%,其中单纯HPV次要高危阳性感染9例,占64.28%;单纯HPV-16阳性感染2例,单纯HPV-31阳性感染1例;HPV-16、HPV-31和HPV次高危型三重感染1例,HPV-16和HPV-18/45的二重感染1例。结论本组患者HPV次高危型感染亚型几率最大,HPV高危型和次要高危型的感染与宫颈病变有高度的相关性,且病毒的感染量与病变的程度有一定的相关性,同时也显示HPV实时荧光定量PCR技术是一种有效的HPV检测手段。     

已婚妇女人乳头瘤病毒感染的流行病学调查

目的了解体检者中已婚妇女人乳头瘤病毒(HPV)感染状况,为宫颈癌的防治提供依据。方法对体检者中已婚妇女进行HPV感染检测,并记录其社会情况、性行为、生育情况等信息进行流行病学分析。结果 1 033例已婚妇女中共筛检出HPV感染者139例,感染率为13.46%。不同文化程度、初次发生性行为时间、生育胎数、流产次数与HPV感染率比较,差异有统计学意义(P<0.05)。而年龄、性行为时间长短与HPV感染无关。结论加强性知识教育、普及相关知识、加强性行为安全均有助于降低HPV感染率。     

洛阳嵩县地区女性HPV感染情况及其影响因素分析

目的:探究洛阳嵩县地区女性HPV感染情况及其影响因素。方法:选取318例在我院检查HPV与接受调查问卷妇女,使用基因芯片技术对HPVDNA进行检测,观察其种类,并分析影响因素。结果:318例妇女中,HPV阳性妇女共112例(35.22%),高危基因型中,HPV16、HPV58、HPV52为感染最高的3种,分别为51例(16.04%)、18例(5.66%)、10例(3.14%)。初次性生活年龄、性伴侣数量、避孕套使用,均出现差异,具有统计学意义(P<0.05)。结论:洛阳嵩县地区女性HPV类型以HPV16、HPV58、HPV52型较为常见,多由于首次性生活年龄小与配偶感染HPV而引发。     

北京市海淀医院HPV筛查结果及感染的影响因素

目的 分析北京市海淀医院人乳头瘤病毒(HPV)筛查结果及其感染的影响因素。方法 选取2020年1月至2021年12月于北京市海淀医院进行HPV筛查的6 770例受检者为研究对象,所有受检者行HPV基因分型检查,统计受检者HPV感染情况;调查并比较受检者相关资料,分析受检者HPV感染的影响因素。结果 6 770例受检者中1 423例筛查结果呈阳性,HPV感染率为21.02%;感染组受检者初次性行为年龄较未感染组小,性伴侣数量较未感染组多,吸烟/被动吸烟、女性流产史占比较未感染组高,性生活时使用避孕套占比较未感染组低,差异有统计学意义(P<0.05);经Logistic回归分析结果显示,初次性行为年龄较大为HPV感染的保护因素(OR<1,P<0.05),性伴侣数量多、吸烟/被动吸烟、女性有流产史为HPV感染的危险因素(OR>1,P<0.05)。结论 北京市海淀医院HPV筛查人群HPV感染发生率较高,初次性行为年龄较小、性伴侣数量多、吸烟/被动吸烟、女性有流产史均为HPV感染的影响因素。     

Glucocorticoids and the risk of osteoporosis

Background: Glucocorticoid-induced osteoporosis (GIO) refers to a clinical condition in which a class of corticosteroids increases the susceptibility of bones to fracture. Numerous recent studies have improved our understanding of the underlying biology of this condition, whereas data from randomized controlled trials have provided clinicians with more options for prevention of GIO. Objective: To review the pathophysiology and epidemiology of GIO, as well as current pharmacologic treatment and prevention modalities available. To review the state of healthcare provider concordance with GIO prevention guidelines. Methods: Representative examples of various cellular and molecular processes underlying GIO were included, with an emphasis towards more recent discoveries. The data used to describe the epidemiology of GIO were derived from both randomized controlled studies and observational studies, framed through a discussion of known osteoporosis risk factors. Results/conclusion: Progress has been made in clarifying the pathophysiologic mechanisms that result in GIO. Although the options for preventions and treatment of GIO continue to expand, provider compliance with preventive measures remains suboptimal.     

“二孩”政策后高危妊娠因素的变化

目的通过对甘家口地区过去五年(2012~2016年)已建立的"北京市母子健康档案"进行分析,探讨不同生育政策对北京市孕产妇高危因素产生的影响,为高危孕产妇社区管理提供参考和理论依据。方法选取末次月经在2012年1月1日~2016年12月31日在甘家口社区卫生服务中心建立"北京市母子健康档案"的孕产妇,对其建档时的一般资料及高危因素进行统计分析。结果 "双独二孩和单独二孩"政策下建档数量没有明显变化,"全面二孩"政策下建档数有明显增加(23.6%);二胎数量随着政策调整所占比例逐年提高,高龄产妇和瘢痕子宫占据产科高危因素的前两位且比例逐年上升,以上均有统计学意义(P<0.005)。结论逐步调整的"二孩"政策为北京市各级妇幼保健机构带来严峻挑战,社区围产保健工作人员应努力提高专业知识,加强对高龄、瘢痕子宫等具有高危因素的孕妇筛查及孕期追访,以确保母婴平安健康。     

GI risk and risk factors of NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used drugs in the United States. Ulcers are found at endoscopy in 15% to 30% of patients using NSAIDs regularly. The annual incidence of upper gastrointestinal (GI) complications such as bleeding with regular NSAID use is approximately 1.0% to 1.5%, whereas the annual rate of upper GI clinical events (complicated plus symptomatic uncomplicated ulcers) is approximately 2.5% to 4.5%. Upper GI symptoms such as dyspepsia also occur in many patients taking NSAIDs--at a relative risk of about 1.5 to 2 compared with that in patients without NSAID use. Important risk factors for upper GI clinical events include older age, prior history of upper GI events, use of corticosteroids or anticoagulants, and high-dose or multiple NSAIDs (including NSAID plus low-dose aspirin). Lower GI clinical events such as bleeding may also occur with NSAIDs, although they are less common and less well studied than upper GI events. The decision to employ a protective strategy to decrease NSAID-associated GI clinical events is based on risk stratification. Strategies employed include the use of non-NSAID analgesics, use of lowest effective dose of NSAID, use of medical cotherapy (eg, proton pump inhibitor, misoprostol), or use of coxibs.     

Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease.

A number of affluent countries are moving to eliminate thiomersal (thimerosal), an ethylmercury preservative, from vaccines as a precautionary measure because of concerns about the potential adverse effects of mercury in infants. The WHO advocates continued use of thiomersal-containing vaccines in developing countries because of their effectiveness, safety, low cost, wide availability and logistical suitability in this setting. The guidelines for long-term mercury exposure should not be used for evaluating risk from intermittent single day exposures, such as immunisation using thiomersal-containing vaccines. Similar or higher mercury exposures likely occur from breast feeding and the health benefit of eliminating thiomersal from a vaccine, if any, is likely to be very small. On the other hand, the benefits accrued from the use of thiomersal-containing vaccines are considerably greater but vary substantially between affluent and developing regions of the world. Because of the contribution to overall mercury exposure from breast milk and diet in later life, the removal of thiomersal from vaccines would produce no more than a 50% reduction of mercury exposure in infancy and <1% reduction over a lifetime. Different public policy decisions are appropriate in different settings to achieve the lowest net risk, viewed from the perspectives of the individual vaccinee or on a population basis. In developing regions of the world, at least over the next decade, far more benefit will accrue from protecting children against widely prevalent vaccine-preventable diseases by focusing efforts aimed at improving infant immunisation uptake by using current, inexpensive, domestically-manufactured, thiomersal-containing vaccines, than by investing in thiomersal-free alternatives.     

Evaluating the risk decision process

In order to ensure that risk assessment and risk management serve their purposes efficiently, it is essential to systematically evaluate actual practices. In this overview, it is proposed that such evaluation studies constitute an important field of study that should be recognized as a sub-discipline of regulatory toxicology with its own research issues and its own methodologies. Previous such evaluation studies are summarized. Methods are described that can be used for comparing different risk assessments of one of the same substance, for checking the consistency of harmonized classifications with the available data, for assessing the actual margin of safety (i.e. size of uncertainty factors) in exposure limits, and for comparing different lists of exposure limits. In conclusion, some important problem areas for future evaluation studies are pointed out.