江西省修水县宫颈癌筛查分析

目的:了解我国宫颈癌高发之一的江西省修水妇女宫颈癌的流行状况和高危型人乳头状瘤病毒(HPV)感染与宫颈癌的关系。方法:对江西修水县2460名妇女进行妇科检查,宫颈刮片细胞学检查,对可疑病例采集其宫颈细胞进行高危型HPVDNA检测(HCⅡ)或对其行阴道镜检查。结果:以病理诊断为金标准,普查的2460例已婚妇女中宫颈癌10例,CINⅡ6例,CINⅠ8例。该人群宫颈癌的患病率为40650/10万,高危型HPVDNA检出率为245%(70/286),HPVDNA检出率随病变程度加重呈趋势性增高,χ2=773,P<001。结论:江西省修水县是宫颈癌高发区,女性生殖道高危型HPV感染是当地宫颈癌及宫颈内瘤样病变(CIN)高发的重要危险因素。对宫颈癌高发区进行有效筛查十分必要。     

川沙县宫颈癌普查随访资料分析

川沙县自1971年开始对全县20岁以上已婚妇女进行妇女病普查普治。受检者均作妇科检查及宫颈刮片检查,对临床有可疑病变及刮片见癌细胞、癌疑细胞或不典型增生细胞者进行复查,癌症确诊均须经病理切片证实。每两年普查一次,至1977年连查四次,1984年又查一次,五次共查616,820人次,查出宫颈癌323例。现分析如下:     

年轻妇女宫颈癌150例临床分析

目的分析年轻妇女宫颈癌早期发现、诊断及治疗的现状。方法选择我院1996年1月至2005年1月住院的小于35岁的年轻宫颈癌患者150例,术前给予宫颈刮片、宫颈活检,术后给予病理细胞学检查并辅以化疗或放疗。结果150例宫颈癌中,有102例曾有过或性伴侣有过HPV感染,感染率为68%;诊断方法:肉眼分辨阳性者42例,占28%;宫颈刮片阳性者72例,占48%;宫颈活检阳性者36例,占24%;手术前后辅以放化疗,有96例随诊5年,存活74例,5年存活率为77.1%。结论宫颈癌发病与HPV感染关系密切,宫颈刮片是宫颈癌早期诊治的有效方法,手术前后辅以放化疗是治疗宫颈癌的重要方法,可以提高5年生存率。     

宫颈癌患者宫颈粘液CEA测定的临床意义

应用放射免疫技术对50例宫颈癌患者及24例非恶性肿瘤患者的宫颈粘液及外周血CEA的含量进行了测定，结果：宫颈癌患者宫颈粘液CEA测定值及阳性率明显高于对照组（P＜0．05，P＜0．01）。良、恶性病变的宫颈粘液CEA均明显高于外周血中CEA含量（P＜0.01，P＜0．02）。而宫颈癌患者血CEA测定值及阳性率与对照组比较均无差异（P＞0．05）。宫颈癌患者治疗前、后宫颈粘液CEA测定值差异有显著性（P＜0.01）。作者认为：宫颈粘液CEA的测定对宫颈癌的诊断及疗效评价较血CEA的测定更有意义。     

血清肿瘤标志物水平在宫颈癌病情监测及预后评估中的价值

目的 探讨血清肿瘤标志物水平在宫颈癌患者病情监测及预后评估中的价值。方法 选取2016年1月至2020年1月间上海市金山区亭林医院收治的300例宫颈肿瘤患者,其中宫颈良性疾病组患者165例,宫颈癌组患者135例,另选取100例健康体检者作为对照组。对三组血清甲胎蛋白(AFP)、癌胚抗原(CEA)和人附睾蛋白4(HE4)水平进行检测,分别记录AFP、CEA、HE4低表达与高表达宫颈癌患者的1年内生存时间。采用Kaplan-Meier法进行生存分析,诊断效果评价采用受试者工作特征(ROC)曲线。结果 三组血清AFP、CEA、HE4水平比较,差异有统计学意义(均P<0.05),且宫颈癌组血清AFP、CEA、HE4水平高于宫颈良性疾病组、对照组,差异有统计学意义(P<0.05);AFP、CEA、HE4诊断宫颈癌病情的敏感度77.5%～81.0%,特异度38.0%～91.0%。ROC曲线分析显示,AFP、CEA、HE4诊断宫颈癌病情的曲线下面积(AUC)分别为0.598、0.928、0.898。分别以血清AFP(3.62±1.23)ng/ml、CEA(6.90±2.32)ng/ml、...     

年轻妇女宫颈癌150例临床分析

目的分析年轻妇女宫颈癌早期发现、诊断及治疗的现状。方法选择我院1996年1月至2005年1月住院的小于35岁的年轻宫颈癌患者150例，术前给予宫颈刮片、宫颈活检，术后给予病理细胞学检查并辅以化疗或放疗。结果150例宫颈癌中，有102例曾有过或性伴侣有过HPV感染，感染率为68％；诊断方法：肉眼分辨阳性者42例，占28％；宫颈刮片阳性者72例，占48％；宫颈活检阳性者36例，占24％；手术前后辅以放化疗，有96例随诊5年，存活74例，5年存活率为77．1％。结论宫颈癌发病与HPV感染关系密切，宫颈刮片是宫颈癌早期诊治的有效方法，手术前后辅以放化疗是治疗宫颈癌的重要方法，可以提高5年生存率。     

人乳头瘤病毒水平与宫颈局部免疫功能对高危型人乳头瘤病毒感染宫颈癌患者的影响

目的 探讨人乳头瘤病毒(HPV)水平与宫颈局部免疫功能对高危型HPV感染宫颈癌患者的影响.方法 收集76例宫颈癌患者(宫颈癌组)、40例慢性宫颈炎患者(慢性宫颈炎组)和40例宫颈上皮内瘤变患者(宫颈上皮内瘤变组)临床资料.检测并比较3组患者HPV水平和免疫功能指标[CD4+、CD8+、CD4+/CD8+、CD56+和调节性T细胞(Treg)]水平;比较有无淋巴结转移宫颈癌患者HPV水平和免疫功能指标水平;比较死亡和生存宫颈癌患者HPV水平和免疫功能指标水平.应用Pearson相关性分析法分析HPV水平与各免疫功能指标的相关性.结果 宫颈癌组患者HPV、CD8+和Treg水平最高,宫颈上皮内瘤变组患者次之,慢性宫颈炎组患者最低,差异均有统计学意义(P﹤0.05);宫颈癌组患者CD4+、CD4+/CD8+、CD56+水平最低,宫颈上皮内瘤变组患者次之,慢性宫颈炎组患者最高,差异均有统计学意义(P﹤0.05).淋巴结转移和死亡宫颈癌患者CD4+、CD4+/CD8+、CD56+水平均低于无淋巴结转移和生存患者,HPV、CD8+、Treg水平均高于无淋巴结转移和生存患者,差异均有统计学意义(P﹤0.05).CD4+、CD4+/CD8+和CD56+与HPV水平均呈负相关(r=-0.48、-0.35、-0.40,P﹤0.05),CD8+、Treg与HPV水平均呈正相关(r=0.45、0.26,P﹤0.05).结论 高危型HPV感染宫颈癌患者HPV水平呈异常高表达且患者宫颈局部免疫功能明显降低,是导致患者持续感染高危型HPV和加重宫颈病变的重要原因.     

宫颈癌患者临床分期与免疫功能的关系研究

目的比较不同分期的宫颈癌患者的免疫功能状况,研究两者之间的相关性。方法将0~Ⅳ期宫颈患者患者(观察组)共70例,与同期健康女性(对照组)60例纳入研究,比较2组患者外周血中T淋巴细胞和NK细胞数量。结果宫颈癌患者外周血中的CD3+、CD3+CD4+和NK细胞数量以及CD3+CD4+/CD3+CD8+比值均低于对照组,差异有统计学意义(P<0.05)。宫颈癌患者分期和T细胞亚群及NK细胞数量有相关性(P<0.05)。结论宫颈癌患者存在免疫功能下降的状况,并且分期越晚免疫功能越差,同时T细胞亚群数量及比例、NK细胞数量可以作为检测宫颈癌患者免疫功能的指标。     

宫颈肠上皮型腺癌2例临床病理观察

目的:探讨宫颈肠上皮型腺癌的临床病理学特征,组织发生及其鉴别诊断。方法:对2例宫颈肠上皮型腺癌进行组织学观察,并行特殊染色及免疫组化染色标记。结果:其组织学特点是宫颈腺体分枝繁茂,大小不一,腺上皮间夹杂多少不等的杯状细胞,细胞核呈杆状或卵圆形,显示异型,核分裂像多见。AB(PH2.5)/PAS杯状细胞阳性,胞浆着蓝色,宫颈腺上皮显示红色。免疫表型CEA强阳性,CgA部分细胞阳性。结论:宫颈肠上皮型腺癌较少见,诊断时需与宫颈肠化,转移性粘液细胞癌及不典型A-S征鉴别。     

SCCAg、CYFRA21-1、CEA联合检测在中晚期及复发宫颈鳞癌诊断和治疗中的临床价值

[目的]探讨血清鳞状细胞癌肿瘤相关抗原(SCCAg)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)对判断中晚期宫颈鳞癌同步放化疗疗效及在复发宫颈癌诊断、治疗和预后评估中的作用。[方法]随机选取468例接受同步放化疗的中晚期宫颈鳞癌患者(KPS≥70分),检测患者同步放化疗前后血清中SCCAg、CYFRA21-1、CEA的水平变化。比较复发转移者与未复发转移者,以及复发转移者治疗前后血清中SCCAg、CYFRA21-1、CEA的变化情况。[结果]SCCAg、CYFRA21-1、CEA联合检测较单项检测诊断中晚期宫颈癌的灵敏度明显提高(P<0.05),灵敏度随临床分期的进展而升高,差异有统计学意义(P<0.05);放化疗后,患者血清中SCCAg、CYFRA21-1、CEA水平均明显下降,其差异有显著统计学意义(P<0.001)。复发及转移患者较无瘤生存患者血清中SCCAg、CYFRA21-1、CEA的水平明显升高,差异有统计学意义(P<0.001);复发患者治疗后完全缓解(CR)及部分缓解(PR)者血清中SCCAg、CYFRA21-1、CEA较治疗前明显降低,差异有统计学意义(P<0.05),稳定(SD)及病情进展(PD)患者,治疗前后比较差异无统计学意义(P>0.05)。[结论]SCCAg、CYFRA21-1和CEA联合检测对中晚期宫颈癌及复发宫颈癌的诊断、疗效评价、预后预测及病情监测有一定的临床价值。     

新疆子宫颈癌的端粒酶活性研究

目的：探讨端粒酶活性与宫颈癌发生发展的关系及其在宫颈癌中的临床诊断价值。方法：用TRAP－ELISA法检测34例宫颈癌和21例正常宫颈的新鲜组织及脱落细胞标本的端粒酶活性,并进行比较。结果：宫颈癌细胞中端粒酶阳性检出率为88．2％,显著高于正常宫颈细胞的阳性检出率（9．5％）,端粒酶活性水平与宫颈癌临床分期,组织学分化无关。脱落细胞检测宫颈细胞的端粒酶活性与新鲜组织检测的结果一致。结论：端粒酶活性可作为宫颈癌的肿瘤标记物。用TRAP－ELISA法对宫颈脱落细胞行端粒酶检测有助于宫颈癌的筛查。     

P53和bcl-2在宫颈上皮内瘤样变及宫颈癌中的表达

目的　探讨P53 和bcl 2表达产物在宫颈癌中过度表达的意义及二者间的相互关系。方法　采用免疫组化SP法分别对 10例宫颈上皮内瘤样变和 5 7例宫颈癌中P53 蛋白和bcl 2蛋白进行了检测 ,并以 11例正常宫颈鳞状上皮作对照。结果　P53 蛋白在CIN中的表达与对照组间差异显著 (P <0 .0 1) ;P53 蛋白在宫颈浸润癌中的表达与对照组间有显著性差异 (P <0 .0 1) ;P53 蛋白在CIN与宫颈浸润癌中的表达差别无显著性 (P >0 .0 5 ) ;P53 蛋白在宫颈浸润癌病理Ⅱ级和Ⅲ级中的表达明显高于病理I级 (P <0 .0 5 ) ;P53 蛋白在宫颈癌结节型中的表达明显高于溃疡型 (P <0 .0 5 ) ;bcl 2蛋白在CIN中的表达强度明显高于对照组 (P <0 .0 5 ) ;bcl 2蛋白在宫颈浸润癌中的表达不仅表达率而且表达强度均明显高于正常对照 (P <0 .0 1) ;bcl 2蛋白在宫颈癌中的表达与在CIN中的表达差别无显著性 (P >0 .0 5 ) ;在宫颈癌中P5 3蛋白表达和bcl 2蛋白的过表达间有明显正相关 (P <0 .0 5 )。结论　P53 和bcl 2的过表达与宫颈癌的发生和发展相关     

宫颈腺癌癌胚抗原表达的意义

用ＡＢＣ免疫组织化学技术，对３５例宫颈腺癌、１０例正常宫颈及慢性宫颈炎组织进行了ＣＥＡ研究。结果，宫颈腺癌ＣＥＡ的阳性率为７４．３％（２６／３５），不同组织分型的ＣＥＡ阳性率虽无差异，但ＣＥＡ着色强度及分布具有一定特征。外生型腺癌的ＣＥＡ阳性率为４５．４％（５／１１），低于内生型的８５．７％（１２／１４）及溃疡型的９０％（９／１０）（Ｐ＜０．０５）。无瘤生存期≥３年组的ＣＥＡ阳性率４４．４％（４／９），低于＜３年组的８５％（１７／２０）。本文提示宫颈腺癌ＣＥＡ表达及分布特征有助于其组织学类型的鉴别，并对其患者的预后判断有重要价值。     

宫颈癌患者血清miR-196a的表达及其与SCC-Ag及CEA的相关性研究

目的:探讨宫颈癌患者血清miR-196a的表达与鳞状细胞癌抗原（SCC-Ag）及癌胚抗原（CEA）的相关性,分析血清miR-196a、SCC-Ag及CEA水平对宫颈癌的诊断价值。方法: 选取2016年1月至2019年3月海南妇产科医院收治的158例宫颈癌患者（宫颈癌组）、80例CIN患者（CIN组）和60例健康体检正常女性（对照组）,检测各组血清miR-196a、SCC-Ag及CEA水平,分析其与宫颈癌患者临床病理特征的关系。应用ROC曲线分析血清miR-196a、SCC-Ag及CEA水平对宫颈癌的诊断价值。Pearson相关分析血清miR-196a与SCC-Ag及CEA水平的相关性。结果: 宫颈癌组血清miR-196a（5.26±1.25 vs 1.65±0.41,1.18±0.24）、SCC-Ag（ng/ml）（4.16±1.20 vs 0.68±0.25,0.52±0.13）及CEA（ng/ml）（14.50±4.17 vs 3.72±0.81,3.05±0.63）水平均明显高于CIN组和对照组（P<0.01）。宫颈癌患者血清miR-196a表达水平与临床分期、淋巴结转移、浸润深度、SCC-Ag及CEA阳性有关（P<0.05）。ROC曲线分析显示,血清miR-196a、SCC-Ag及CEA水平诊断宫颈癌的最佳截断值分别为3.84、2.37 ng/ml、9.60 ng/ml,三项联合诊断宫颈癌的曲线下面积最大（0.912,95%CI:0.854～0.974）,其敏感度和特异度为90.4%和86.5%。相关分析显示,宫颈癌患者血清miR-196a与SCC-Ag及CEA水平均呈正相关（r=0.817,P<0.01,r=0.748,P<0.01）。结论: 血清miR-196a表达水平在宫颈癌患者中明显升高,且与SCC-Ag及CEA水平均呈正相关,三项联合检测对宫颈癌诊断具有较高的价值。     

Clinical significance of telomerase activation and telomeric restriction fragment (TRF) in cervical cancer

Telomerase activation was examined in 50 cases of cervical cancer, 27 normal cervix and five cervical cancer cell lines using the sensitive polymerase chain reaction (PCR)-based TRAP (telomeric repeat amplification protocol) assay. Telomeric restriction fragment (TRF) length of these specimens was measured by Southern hybridisation. Telomerase activation was common in cervical cancers and was detected in 46/50 cases (92%). Telomerase activity was weak in normal cervix and was detected only in 2/27 cases (7.4%). Telomerase activity was detected in all stages of cervical cancer suggesting that it is an early event in cancer progression. The clinical significance of telomerase activation was analysed in 47 squamous cell carcinoma of the cervix. High telomerase activity was more frequently detected in advanced diseases (100% in stage III and stage IV cervical cancers combined) compared with early diseases (68.6% in stage I and stage II cancers combined). The difference was statistically significant (P < 0.02). Telomerase activity was not statistically correlated with other clinical parameters examined. This is the first report of telomeric length in human cervical cancer. Both shortening and elongation of TRF length in cervical cancers was observed. Advanced cervical cancers tended to have a wider range of variation of TRF length compared with early disease and normal cervix. There was no obvious relationship between TRF length and the clinical parameters examined including clinical staging, differentiation status of tumour, human papilloma virus (HPV) infection, recurrence rate, tumour size and invasion depth. The clinical significance of TRF length appears to be limited in cervical cancers. Our results indicate that telomerase activity is closely associated with tumour cells and may be useful as a marker for detection of tumour cells in cervical biopsies.     

Long-term follow-up studies on herpes simplex antibodies in the course of cervical cancer. II. Antibodies to surface antigen of Herpes simplex virus infected cells.

In a serological follow-up of 88 women with active invasive cervical carcinoma, antibodies to membrane antigen of Herpes simplex virus (HSV)-infected cells were measured by the use of the mixed hemadsorption method. Sera were collected at the time of initial treatment and then at regular intervals. As controls, 85 healthy age-matched women and 70 patients suffering from other types of cancer were tested similarly. During the 6-to 60-month observation period 16 patients in the cervix carcinoma group died. The reactivity with membrane antigen of HSV-infected cells was positive in 71% of the cervical carcinoma patients, whereas the figure for the other cancer group was 27% and for the age-matched control group 27%. In the group of 16 patients who died, only 3 demonstrated antibodies against surface antigens of HSV-infected cells. In most cases radiation treatment of the tumor did not significantly alter the mixed hemadsorption titer but in 10 surviving patients there was a significant increase in reactivity as the tumor was treated; 1 patient who had recurrence of her cancer lost reactivity in later sera. Among the 11 cervix carcinoma patients in stage I (by clinical definition carcinoma strictly confined to the cervix) all but one showed positive reaction against the surface antigen of HSV-infected cells; the patient lacking reactivity was the only one out of the 11 patients in stage I who had a recurrence of her cancer. The results confirm that low or missing antibody titers to membrane antigen of HSV-infected cells are of prognostic significance, and decreasing antibody titers to membrane antigens run parallel to the severity of the lesions. There was poor correlation between antibody titers against membrane antigens and neutralizing antibody titers.     

Increase of NAD glycohydrolase activity in uterine cervix cancers is caused by infiltration of lymphocytes

CD38 is a type II transmembrane glycoprotein which is expressed by hematopoietic and nonhematopoietic cells in human. It has two functions of ADP-ribosyl cyclase and cyclic ADP-ribose hydrolase activities and the sum of these two enzyme activities is identical with NAD glycohydrolase (NADase) activity. The levels of NADase activity in human cervical carcinoma and normal cancer tissue were measured. With a total of 12 patients with cervical cancer and 11 women with normal cervix, cancer tissues were found to have significantly higher NADase and ADP-ribosyl cyclase activities than the control group. Moreover, immunoblot analysis showed an increase of immunoreactivity against CD38 in cervical cancer tissues compared with normal tissues. Immunohistochemical data indicated that the increase of CD38 expression was due to increased infiltration of lymphocytes.     

Expression of keratinocyte growth factor receptor (KGFR/FGFR2 IIIb) in human uterine cervical cancer

Keratinocyte growth factor receptor (KGFR), also known as FGFR2 IIIb, is a splice variant of FGFR-2. KGFR is expressed in many types of epithelial cell and is activated with four known ligands [FGF-1, FGF-3, FGF-7 (also known as KGF) and FGF-10] that are predominantly synthesized by mesenchymal cells. KGFR is highly expressed in the late-proliferative phase of a normal endometrium and in endometrial adenocarcinoma. In the present study, we attempted to determine the expression and localization of KGFR in human cervical cancer cell lines and cervical cancer tissues. The KGFR protein was detected in CaSki and HeLa cells, but not in ME-180 cells of cervical cancer cell lines. In non-cancer cervical tissues, KGFR immunoreactivity was weakly expressed in the surface of squamous epithelial cells and vascular smooth muscle cells. Immunohistochemically, the KGFR protein was detected in squamous cell carcinoma in 36 of 42 (86%) cervical cancer patients. In cervical cancer tissues, KGFR was detected in 17 of 18 (94%) of patients with the keratinizing type and 19 of 24 (79%) of patients with the non-keratinizing type of cervical cancer. Furthermore, KGFR was prominently localized in proliferating reserve cells and squamous metaplastic reserve cells adjacent to cancer cells. In contrast, KGFR was not detected in cervical ductal cells in cancer or non-cancer cervical tissues. These findings may indicate that KGFR mediates the growth and differentiation of reserve cells and squamous cell carcinoma in the cervix.     

宫颈癌组织中ADAM-19、Ki-67的表达及临床意义

目的研究早期宫颈癌组织中去整合素基质金属蛋白酶-19（a disintegrin and metallopro-teinase,ADAM-19）、癌细胞增殖指数（Ki-67）的表达及临床意义。方法应用免疫组化sP法检测18例正常宫颈上皮（normal cervical epithelium,NCE）、22例宫颈上皮内瘤变（cervical intraepithelialneoplasm,CIN）和82例宫颈早期浸润癌（invasive cervix carsinoma,ICC）组织中ADAM-19和Ki-67的表达情况。结果在宫颈癌中ADAM-19表达于癌细胞浆和或细胞膜;Ki-67表达于细胞核。从正常宫颈上皮（normal cervical epithelium,NCE）到宫颈上皮内瘤变（cervical intraepithelial neoplasm,CIN）再到宫颈浸润癌（invasivecarsinomacervix,ICC）,ADAM-19、Ki-67的阳性表达率逐步升高（P〈0．05）。ADAM-19在宫颈浸润癌中的表达与盆腔淋巴结转移、脉管浸润、间质浸润、国际妇产科联盟（FIGO）分期、组织学分级和Ki-67表达有关（P〈0．05）;但与年龄和组织学类型无明显相关性（P〉0．05）。有盆腔淋巴结转移、脉管浸润、突破深层间质浸润、FIGO分期为Ⅱ期、组织学分级为Ⅲ级及Ki-67高度表达者,其ADAM-19阳性表达率显著高于无盆腔淋巴结转移、无脉管浸润、浸润深度在浅层间质以内、FIGO分期为Ⅰ期、组织学分级未超过Ⅱ级及Ki-67表达在中度以内者（P〈0．05）。结论ADAM-19阳性表达可能在癌细胞增殖和侵袭转移中起重要作用。ADAM-19过度表达者,癌细胞增殖活跃,更易发生侵袭转移,但并非唯一决定因素。检测宫颈癌中ADAM-19表达对进一步了解宫颈癌生物学行为和判断其预后有一定价值。