新疆维吾尔自治区石河子市城区18 378例子宫颈癌筛查人群的hrHPV感染状况研究

背景　子宫颈癌（CC）是女性高发的恶性肿瘤，其病因明确，通过规范的筛查，可以有效预防CC的发生。基于细胞学的CC筛查计划在医疗资源缺乏的新疆维吾尔自治区并不可行，因此了解石河子市高危型人乳头瘤病毒（hrHPV）感染状况，对优化石河子市基于hrHPV为初筛的CC筛查方案具有重要意义。目的　分析新疆维吾尔自治区石河子市城区30~65岁参加CC筛查人群的hrHPV感染状况。方法　收集2018年12月至2019年5月，在石河子大学医学院第一附属医院、石河子市人民医院和石河子市妇幼保健院以hrHPV为初筛的18 378例女性CC筛查数据（hrHPV-DNA检测、薄层液基细胞学检查、阴道镜与组织病理学检查结果），按感染情况分为hrHPV16型阳性和hrHPV18型阳性、hrHPV16型阳性、hrHPV18型阳性，按照年龄大小分为30~39岁、40~49岁、50~59岁、60~65岁组，并比较不同组间的筛查结果有无差异。结果　18 378例接受CC筛查人群中，hrHPV感染率为15.32%（2 816/18 378）。hrHPV单一感染占11.38%（2 092/18 378），多重感染占3.94%（724/18 378）。最常见的6种单一hrHPV感染类型依次为hrHPV52型（2.37%）、hrHPV16型（1.65%）、hrHPV53型（0.97%）、hrHPV51型（0.90%）和hrHPV39型（0.87%）、hrHPV68型（0.87%），而hrHPV18型位于第11位（0.36%）。hrHPV16型阳性和hrHPV18型阳性与hrHPV16型阳性女性子宫颈病变的检出率（分别为35.71%和30.86%）均高于hrHPV18型阳性（8.95%）女性（P<0.05）。hrHPV52型感染人数最多，但未检出1例CC前病变及CC的患者。其他亚型感染行阴道镜子宫颈活组织检查提示，≥低级别鳞状上皮内病变（LSIL）人群中，hrHPV58型、hrHPV56型、hrHPV51型、hrHPV33型和hrHPV39型是主要感染类型。此外，不同年龄组间hrHPV感染率比较，差异有统计学意义（χ2=7.866，P=0.049）。结论　石河子市城区女性hrHPV感染率较高，单一感染为主。在该地区应特别关注hrHPV16型的防治工作。     

Cervical pathology in West Virginia adolescents

Cytologic screening is an important diagnostic tool used to detect precancerous and cancerous lesions of the cervix. We studied the prevalence of cervical abnormalities, based on Pap smear results, in patients at the Outpatient Adolescent Clinic at West Virginia University. We found a high incidence of overall intraepithelial cell pathology (24%) in this group with 2.4% high grade and 9.9% low-grade lesions. These findings show that major cervical pathology is present in this age group. Furthermore, repeat smears at intervals of < one year were performed on 317 patients. Of these repeat smears, 7% changed from normal to abnormal in this period. Sexually active adolescent females should have Pap smears at least annually to detect abnormalities that may otherwise not be detected until they are more advanced and difficult to manage. Higher risk adolescents may need semiannual screening.     

高危HPV检测对不能明确意义的非典型鳞状细胞分流的作用

目的:探讨高危人乳头状病毒16/18(HPV16/18)DNA检测对不能明确意义的非典型鳞状细胞(ASCUS)进一步分流诊断的意义.方法:对80例薄层液基细胞学(LCT)检查结果为ASC-US的患者进行HPV16/18DNA检测,同时所有患者均进行阴道镜检查及组织病理学检查.结果:80例患者中,HPV16/18阳性者4...     

液基细胞学和HPV—DNA检测在宫颈病变筛查中的应用研究

目的：探讨液基细胞薄层涂片（TCT）和肿瘤相关人乳头瘤病毒（HPV）检测与阴道镜合用对子宫颈癌及癌前病变筛查的可行性。方法：1376例育龄非孕妇女,采用TCT、HC-Ⅱ（杂交捕获二代）定量检测宫颈HPV—DNA含量。对宫颈细胞学异常和HPV—DNA阳性者行阴道镜下宫颈多点活检和颈管诊刮术,以病理组织学诊断为金标准,比较3种方法阳性检出率,评价TCT、HC-Ⅱ的诊断价值。结果：1376例受检者中,TCT阳性82例（6．0％1,HPV—DNA阳性74例（5．4％1,96例行阴道镜下宫颈多点活检,诊断鳞状上皮内低度病变（LSL）28例、高度病变（HSL）21例、鳞状细胞癌（SCC）2例。阴道镜活检对CIN（宫颈上皮内瘤变1诊断符合率为85．4％,TCT检测率,HPV检测与组织学级别基本一致。结论：本组患病人群符合子宫颈癌及癌前病变的流行病特点：TCT和宫颈HPV—DNA检测可作为子宫颈癌及癌前病变常规筛查的方法,配合阴道镜及病理检验,能明显提高诊断的准确性和早发现癌前病变。     

Detection of human papillomavirus in women attending Pap?cervical screening camp at a peripheral hospital of North-Eastern India

Human papillomavirus (HPV) associated cervical cancer is the leading cause of deaths in India. However, cytological/HPV screening may result in early detection of cervical cancer, resulting in early treatment and reduced mortality. Although reports related to general population is available, data on HPV prevalence among women attending AFMS health care facilities is scarce. Cervical samples were collected for cytological staining by Pap test and molecular detection by PCR, genotyping by HPV specific primers and sequencing. Apart from finding of atypical cells of undetermined significance (ASCUS) in one subject, no evidence of malignancy was observed. A high prevalence of HPV was found in this study group, which was intermediate between previous reports from general population and cervical cancer patients. All the subjects had infection of high risk HPV type16. HPV prevalence was found similar between different age groups. Although, none of the study subjects had malignant changes, but due to high prevalence of high risk HPV infection and other associated risk factors, these subjects might be at an elevated risk of developing cervical cancer. Regular follow-up of these patients who were detected HPV positive are required to screen for cervical malignancy.     

Cytologic manifestations of cervical and vaginal infections. II. Confirmation of Chlamydia trachomatis infection by direct immunofluorescence using monoclonal antibodies

We found inflammatory patterns of transparent lymphocytes on increased numbers of histiocytes suggestive of chlamydial infection in 68 (56%) of 121 cervical cytologic smears. Chlamydia trachomatis was isolated from 36 (53%) of those with and only two (4%) of those without such inflammatory patterns. Direct stain with fluorescein-conjugated monoclonal antibodies demonstrated elementary bodies of C trachomatis in 30 (79%) of the 38 culture-positive patients, including 29 of the culture-positive patients who had an inflammatory cytologic pattern suggestive of C trachomatis infection. Thus, Papanicolaou smears can be screened for inflammatory pattern, and separate endocervical smears from patients with a pattern suggestive of chlamydial infection can then be stained by immunofluorescence to confirm the presence of C trachomatis infection. This two-step approach detected 29 of 38 infections confirmed by culture in the present study, giving a sensitivity of 76%, a specificity of 100%, and a positive predictive value of 100% in a population having a 31% prevalence of C trachomatis infection.     

宫颈刮片细胞学检测与TCT在宫颈病变筛查中的应用对比

目的:比较宫颈刮片细胞学检查与液基薄层细胞学检查(TCT)对宫颈早期病变的检出率。方法:分别采用宫颈刮片细胞学检查与TCT,对妇科门诊体检或就诊的患者进行筛查,以病理检查结果作为评价标准。结果:TCT组的检出率明显高于宫颈刮片组(宫颈刮片组为0.57%,TCT组为1.73%,P<0.01)。结论:作为一种高检出率的检测手段,TCT对宫颈病变的筛查具有重要作用,值得推广。     

Prevalence of hepatitis C virus antibodies in Sydney blood donors.

OBJECTIVE: To determine the prevalence of hepatitis C virus (HCV) antibodies in the Sydney blood donor population. DESIGN: All blood donations collected from Red Cross blood donors in Sydney from February 1990 until April 1991 were tested for HCV antibodies. For those samples found reactive in an anti-HCV screening test, a confirmatory test was carried out for the presence of HCV antibodies and the alanine aminotransferase level was measured. RESULTS: The prevalence of repeated reactivity to the screening test was 0.45% among blood donations overall, and 1.02% in donors giving blood for the first time in the study period. The confirmatory test result was positive for 30.8% of donations found to be repeatedly reactive in the screening test. There was little change over the study period in the HCV antibody prevalence of donors giving blood for the first time, but there was a clear decrease in the prevalence among all donations. Prevalence in males was nearly twice the prevalence in females--a difference which was consistent across age groups. The highest prevalence in both sexes was in the age group 30-34 years. Among samples for which the screening test results was positive, there was a strong correlation between the reactivity recorded for the screening test and both the proportion found positive by the confirmatory test and the proportion with an elevated alanine aminotransferase level. CONCLUSION: The small proportion of blood donations found to be repeatedly reactive by anti-HCV screening and the relatively good correlation with the confirmatory test and liver function assay indicate that a policy of discarding these donations will decrease the risk of transfusion-transmitted HCV infection without materially affecting the supply of blood.     

HPV分型检测对不能明确意义的非典型鳞状细胞的分流作用

目的：评估人乳头瘤病毒（HPV）分型检测对不能明确意义的非典型鳞状细胞（ASC-US）分流监测的临床价值。方法：对60例子宫颈超柏氏薄层液基细胞学（LCT）检查结果为ASC—US的患者进行HPV核酸扩增分型检测,所有患者均同时进行阴道镜检查及组织病理学检查。结果：在60例ASC—US患者中,高危型HPV阳性者37例。子宫颈高度病变在高危型HPV阳性组和阴性组的发生率分别为35．14％和8．70％,差异有统计学意义俨〈0．05）。以组织病理学检查结果作为诊断的金标准,计算出HPV DNA分型检测高危型HPV阳性对诊断子宫颈高度病变的灵敏度为86．67％,阴性预测值为91．30％。结论：HPV DNA分型检测对子宫颈细胞学结果为ASC-US的患者可有效地进行分流监测,提高筛查效力。     

124例宫颈上皮内瘤样病变病例5年随访分析

目的探讨宫颈细胞学检查和人乳头状瘤病毒（HPV）检测在宫颈上皮内瘤变（CIN）的筛查及随访中的临床应用。方法回顾性分析我院2006年收治的124例CIN患者的临床资料,并采用液基细胞学技术（TCT）、HPV检测等进行5年随访。结果 124例患者中,TCT检查结果与病理结果的符合率为41.9%,Spearman秩相关结果显示,TBS分级与病理等级呈显著负相关（r=-0.22,P〈0.05）。高危型HPV（＋）占84.7%,其中,HPV16型占58.1%,HPV58型占17.2%,HPV52型占15.2%和HPV51型占9.5%。5年随访中均未见宫颈病变复发或升级。结论 TCT联合HPV检测可应用于CIN的筛查及随访。     

福州地区健康体检女性HPV-DNA检测联合宫颈液基细胞学检查对宫颈病变筛查的结果分析

目的 分析健康体检女性宫颈癌筛查人群HPV感染情况及与宫颈病变的关系,筛查并识别目标人群。方法 选取2018年1月～2020年1月福建省立医院9355例行HPV-DNA检测联合宫颈液基细胞学检查(Thinprep cytologic test,TCT)的健康体检女性为研究对象。结果 9355例受检者中,HPV感染1366例,感染率为14.60%,检出全部27种HPV亚型;高危型HPV前5位的亚型依次是HPV 52、HPV 58、HPV 53、HPV 56、HPV 39;单一感染1057例(77.38%),多重感染中二重感染最常见(17.42%)。宫颈改变219例(2.34%),165例合并HPV感染,感染率为74.43%;在LSIL、HSIL、SCC中,高危型HPV感染率分别为80.00%、96.00%、100.00%,单一感染率分别为62.50%、84.00%、100.00%,HPV16占比分别为7.50%、28.00%、100.00%(P0.05)。46～50岁高危型HPV、单一感染和多重感染人数最多;AGO、ASC-US、LSIL在此组最多。LSIL及以上级别宫颈病变以51～55岁最多。结论 福州地区宫颈癌筛查的目标人群是46～55岁女性,加强对此年龄段宫颈癌筛查女性健康管理、转诊、随访有重要意义。     

液基细胞学检测在宫颈癌筛查中的作用研究

目的寻找提高子宫颈癌前病变及宫颈癌筛查的检出率最有效的途径。方法随机抽取我院门诊就诊病人行TCT检查。细胞学诊断采用TBS分级系统。细胞学诊断阳性者,全部在阴道镜下取活组织检查,所有检查均在双盲下进行。结果除12例不满意标本外,TCT异常者检出率为8.43%（191/2267）;其中ASCUS占5.03%（114/2267）,鳞状上皮内病变（SIL）及鳞状细胞癌（SCC）占3.40%（77/2267）;低度鳞状上皮内病变（LSIL）占1.72%（39/2267）,高度鳞状上皮内病变（HSIL）占1.59%（36/2267）;宫颈鳞状细胞癌（SCC）占0.09%（2/2267）。结论细胞学筛查配合阴道镜下活检,能提高子宫颈癌前病变和宫颈早期浸润癌检出率。     

宫颈液基薄层细胞学检查联合DNA倍体细胞检测筛查宫颈疾病的临床价值

目的:探讨液基薄层细胞学检查(TCT)联合DNA倍体细胞检测在普查宫颈疾病中的临床价值。方法:分析2010年5月-2011年5月在我院妇女保健科完成宫颈TCT联合DNA倍体细胞检测的已婚妇女6 747例,对347例宫颈TCT检查阳性患者及262例DNA倍体细胞检测阳性(扫描结果3个以上>5C非整倍体细胞)患者行阴道镜检查,依据病理结果分析符合率。结果:未明确意义的不典型鳞状细胞(AS-CUS)177例,低度鳞状上皮内病变(L-SIL)106例,高度鳞状上皮内病变(H-SIL)64例,同时接受DNA倍体细胞检测阳性率分别为61.0%,84.9%,100%。AS-CUS组的DNA倍体细胞检测阳性率与L-SIL、H-SIL之间的差异有统计学意义(P<0.05)。TCT阳性347人,病理学检查(病检)阳性74人,符合率21.3%,TCT及DNA倍体细胞检测均阳性262人,病检阳性92人,阳性符合率35.1%。两组与病检符合率比较,差异有统计学意义(P<0.05)。且随着病理级别升高,TCT及DNA倍体细胞均阳性检出率也越来越高。结论:宫颈TCT检测联合DNA倍体细胞检测,能有效提高宫颈疾病的检出率,结合病理检查,可早期发现宫颈癌前病变,是普查宫颈疾病的可靠方法。     

安徽省73239例宫颈液基细胞学的Bethesda系统报告结果分析

目的 分析宫颈液基细胞学的Bethesda系统(TBS)报告结果,评估安徽省妇女宫颈病变发病的年龄分布特点及地区特点,通过计算液基细胞学高级别病变的阳性预测值,评估其在宫颈癌筛查中的作用,为安徽省的宫颈癌筛查提供数据参考.方法 2015年1月至2015年12月对合肥金域医学检验所有限公司病理科检测的73 239例宫颈液基细胞学TBS报告结果进行数据分析,以及分析宫颈液基细胞学筛查高级别及以上病变对应组织学诊断的符合率.采用x2检验,计算阳性率及宫颈病变的年龄发病率、地区发病率差异.计算高级别病变的阳性预测值.结果 73 239例标本中筛查出7 102例宫颈癌及癌前病变(阳性率9.70%);各年龄组宫颈病变检出率:≤20岁9.72%,20岁<年龄≤30岁8.21%,30<年龄≤40岁9.41%,40<年龄≤50岁10.65%,50岁<年龄<60岁10.17%,≥60岁9.53%(65岁以上10.2%);高级别及以上病变检出率:≤20岁0.22%,20岁<年龄≤30岁0.80%,30<年龄≤40岁1.51%,40<年龄≤50岁2.13%,50岁<年龄<60岁2.30%,≥60岁2.58%(65岁以上2.94%),高级别病变的检出率随着年龄的增加而逐渐增加.皖南地区阳性率为9.9%,皖北为9.5%,差异有统计学意义(P<0.05).其中安庆、蚌埠、池州地区的高级别及以上病变检出率分别为2.26%,2.26%,2.15%,高于其他地区.288例高级别及以上病变中有组织学活检/锥切报告结果,234例为高级别及以上病变(阳性预测值为81.25%),癌或疑癌19例病例中18例为高级别及以上病变(阳性预测值为94.74%).结论 宫颈细胞学可作为宫颈癌筛查的手段,建议安徽省宫颈癌筛查可以从30岁开始,重点在40岁及以上年龄段,40岁以下可以适当延长筛查间隔;终止年龄应放宽至65岁以上;同时应加大对皖南山区及偏远地区的宫颈癌筛查力度.     

宫颈癌早期筛查不同方法的优劣性分析

目的比较宫颈细胞涂片与液基细胞学检查在宫颈癌筛查上的应用效果,探求宫颈癌早期最佳筛查方法。方法回顾我院疑似宫颈病变的240例临床资料,根据患者筛查方法不同将其分为宫颈细胞涂片组和液基细胞学检查组各120例,并以病理检查为金标准进行两组诊断效果比较。结果液基细胞学检查与病理结果的阳性符合率较宫颈细胞涂片明显提高（X2=30．17,P〈0．01）。结论与宫颈细胞涂片比较,液基细胞学检查为更有效的宫颈癌早期筛查方法。     

Population screening for cervical cancer in Jamaica. Results of two separate surveys

Cervical cytology screening was carried out among 652 low-income Jamaican women. The investigation was intended as a pilot survey aimed at defining a high-risk population in a developing country with a high incidence of cervical cancer. A high percentage of the women participated in the program. The prevalence of preclinical carcinoma was 18/1000, much higher than in North America and Europe but similar to the Cayman Islands and Barbados. These results were compared with those from a cytology screening of women who were practicing family planning. The prevalence of preclinical carcinoma among the family planning women was one third that of the general population - 5.7/1000. The variance seemed to be related to differences in socioeconomic factors as the women were similar in race and age. The conclusion is drawn that effective control of clinical carcinoma of the cervix in Jamaica may best be achieved by defining and screening other high-risk areas within the general population.     

宫颈细胞学涂片联合阴道镜检查对宫颈病变的诊断价值

目的评价宫颈细胞学涂片联合阴道镜检查对宫颈病变的诊断价值。方法对2005-01~2006-12在哈尔滨医科大学附属第四医院妇科门诊检查的1 160例患者行宫颈细胞学涂片检查,对其中186例细胞学提示阳性或临床高度可疑的患者行阴道镜下活组织病理检查,以病理诊断为金标准,对结果进行分析。结果宫颈涂片检查1 160例中,异常涂片146例(12.59%),临床高度可疑的患者40例行阴道镜检查下活检。病理结果显示:CINⅠ38例,CINⅡ8例,CINⅢ2例,子宫颈鳞癌2例。宫颈涂片细胞学检查诊断宫颈病变符合率为84.0%,阴道镜检查对宫颈病变的诊断符合率为88.0%,两者比较差异具有显著性(P<0.05),两者联合病变检出率为98.0%。结论采用宫颈细胞学检查配合阴道镜下病理检查,可明显提高对宫颈病变诊断的准确率,能满足早期发现癌前病变。     

鳞状上皮细胞癌抗原联合液基薄层细胞检测在宫颈病变筛查中的价值

目的：探讨鳞状上皮细胞癌抗原（SCC-Ag）联合液基薄层细胞检测（TCT）在宫颈病变筛查中的应用价值。方法TCT检测提示异常的58例患者,行病理活检,同时进行血清SCC-Ag检测,以病理活检为诊断标准,计算TCT与SCC-Ag联合检测筛查宫颈病变的敏感度、特异度,评价两者联合检测的诊断价值。结果 TCT检测的敏感度和特异度分别为75％和65.8％;SCC-Ag检测的敏感度和特异度分别为60％和86.9％;两者联合检测的敏感度和特异度分别为55％和89.4％。 TCT检测与SCC-Ag检测差异有统计学意义（ P ＜0.05）,两者联合检测与单一TCT检测差异有统计学意义（ P ＜0.05）。结论TCT与SCC-Ag联合检测可提高宫颈检测的特异度,在宫颈病变筛查中具有一定的临床应用价值。     

The prevalence of Chlamydia trachomatis in a young, sexually-active population

A prospective study was carried out to determine the prevalence of Chlamydia trachomatis among 1000 sexually-active women at the Family Planning Association Clinic in Melbourne. This organism was isolated from the cervices of 5.1% of screened women. The women were surveyed about their sexual and gynaecological history, and symptoms of discharge or pain. It was found that women who gave positive results for the presence of Chlamydia were younger, and had commenced intercourse at an earlier age. Risk factors of multiple sexual partners, cervical ectopy and symptoms of urethritis were identified. We recommend that women who have more than one sexual partner should ask their partners to use condoms or, failing this, undergo annual screening for Chlamydia by immunofluorescent staining.