Tobacco smoking and acute myocardial infarction in young adults: a population-based case-control study

OBJECTIVE: To evaluate the effect of tobacco smoking on the risk of non-fatal acute myocardial infarction in young adults (< or = 45 years), and whether there is modification of this effect by sex. METHODS: We conducted a population-based case-control study with 329 incident acute myocardial infarction cases (42 women; 287 men), consecutively admitted to the Cardiology department of hospitals in Porto, Portugal, and 778 controls (486 women; 292 men), selected within the non-institutionalized Porto population, during 2001-2003. Odds ratios and 95% confidence intervals (OR, 95%CI) were calculated using unconditional logistic regression. RESULTS: The prevalence of current smoking was 80.8% in male cases and 53.8% in male controls (OR=3.63, 95%CI: 2.50, 5.27) and 59.5% of female cases were smokers compared to 35.8% of controls (OR=2.64, 95%CI: 1.39, 5.02). No interaction was found between current smoking and sex on myocardial infarction risk (p=0.401). A dose-effect response was present, the odds favoring myocardial infarction reaching an eight-fold increase for those that smoked > 25 cigarettes/day compared to never smokers. The risk estimate for former smokers was similar to never smokers. CONCLUSIONS: Tobacco smoking is an important independent risk factor for acute myocardial infarction in young adults, with similar strength of association for both sexes.     

高危型人乳头瘤病毒载量与子宫颈病变的关系

目的 研究妇女生殖道感染高危型人乳头瘤病毒(HR-HPV)的载量与各级子宫颈上皮内瘤变(CIN)的关系.方法 汇总1999-2008年间在我国14 6个城市地区和8个农村地区开展的以人群为基础的子宫颈癌筛查横断面研究的数据.共有18 186名17～59岁的妇女参加了筛查,并收集子宫颈脱落细胞用于HR-HPV DNA检测.采用第2代杂交捕获试验(he2),病毒载量由样本的相对光单位与标准阳性对照之比(RLU/PC)来衡量.根据HR-HPV载量,除阴性组[0,1.00)以外,将阳性对象分为3组:低度载量[1.0,10.00),中度载量[10.00,100.00)和高度载量≥100.00.子宫颈病变按照病理诊断分为正常、轻度宫颈上皮内瘤变(CIN 1)、中度宫颈上皮内瘤变(CIN 2)、重度宫颈上皮内瘤变(CIN 3)和子宫颈癌(SCC).采用非条件多项式logistic回归分析病毒载量与子宫颈病变级别的关系.结果 HR-HPV感染率为14.51%(2515/17 334),其中100.00%(29/29)的SCC、97.63%(206/211)的CIN 3、93.43%(199/213)的CIN 2、75.04%(421/561)的CIN 1和10.17%(1660/16 320)的正常妇女HR-HPV DNA检测阳性.HR-HPV感染阳性的SCC、CIN 3、CIN 2、CIN 1和官颈正常妇女的病毒载量中位数分别是320.85、158.05、143.70、125.34和9.64.各级病变中病毒载量的分布差异有统计学意义(X2=6190.40,P<0.01);病毒载虽越高,CIN程度越高(X2=5493.35,P<0.01).低、中和高度载量组与阴性组相比,发生各级CIN的危险性均增加[OR(95%C/):CIN 1为9.01(6.31～12.87)、24.96(18.23～34.17)和68.42(51.40～91.08),CIN 2为26.44(12.07～57.95)、98.53(49.54～195.98)和322.88(168.62-618.27),CIN 3+为72.89(24.02～221.18)、343.58(121.81～969.09)和>999.99(473.38～>999.99)],有明显的剂量反应关系(X趋势2势分别为3115.05、2413.95和3098.57,P值均<0.01).HR-HPV阳性人群各年龄组内,HR-HPV中、高度载量组患CIN 2+的危险性高于低载量组[OR值(95%CI):<35岁组为4.71(1.23～18.09)和15.06(4.40～51.49),35岁～组为4.01(1.62～9.90)和14.09(6.15～32.28),40岁～组为3.06(1.52～6.16)和7.78(4.05～14.95),≥45岁组为3.50(1.36～9.01)和7.57(3.13～18.30)],且随病毒载量升高,危险性升高(X趋势2分别为51.33、66.28、53.64和51.00,P值均<0.01);高载量40岁～组患CIN 2+的风险最大[OR值(95%CI)为2.02(1.15～3.52)].结论 子宫颈HR-HPV病毒载量与子宫颈癌及癌前病变级别、CIN 2+患病率高度相关;中、高度病毒载量是SCC、CIN 2和CIN 3的主要危险因素,其对于35岁以上女性的致病风险更大.综合考虑年龄和病毒载量将有助于医生有效地分类管理患者或筛查妇女.     

Lower red blood cell folate enhances the HPV-16-associated risk of cervical intraepithelial neoplasia

OBJECTIVE: We previously reported that higher circulating concentrations of folate are independently associated with a lower likelihood of becoming positive for high-risk human papillomaviruses (HR-HPVs) and of having a persistent HR-HPV infection and a greater likelihood of becoming HR-HPV negative (Cancer Res 2004;64:8788-93). In the present study conducted in the same study population, we tested whether circulating folate concentrations modify the risk of cervical intraepithelial neoplasia (CIN) > or =2 associated with specific types of HR-HPV. METHODS: Multiple logistic regression models were used to assess associations (odds ratio with 95% confidence intervals) across HR-HPV, folate, and rigorously reviewed cervical histology of each subject. RESULTS: HPV-16-positive women with low red blood cell folate were significantly more likely to be diagnosed with CIN > or =2 than were HPV-16-negative women with higher red blood cell folate (odds ratio 9, 95% confidence interval 3.3-24.8). CONCLUSION: To our knowledge, this is the first study reporting an independent association of folate with risk of having CIN > or =2 in a population tested extensively for HR-HPV and CIN that also adequately controlled for several other micronutrients and known risk factors for CIN. Our findings suggest that improving the folate status in HR-HPV-infected women may reduce the risk of CIN and thus the risk of cervical cancer. Folate supplementation should be tested as a means of reducing the risk of developing CIN > or =2 in women exposed to HR-HPV, especially HPV-16.     

基于诺模图模型预测脊柱术后手术部位感染风险的研究

目的 建立预测脊柱术后手术部位感染(surgical site infection,SSI)发生风险的诺模图模型,以帮助医务人员制定预防策略,降低SSI的发生率.方法 回顾性选择2012年5月至2019年5月在温州市人民医院接受脊柱手术的患者2348例.采用单因素和多因素回归模型确定脊柱手术后SSI的独立预测因素,并根...     

中国三城市男性吸烟者的社会规范与戒烟行为的关系

【目的】了解中国男性戒烟相关社会规范的现状及其与戒烟意愿、戒烟尝试等戒烟行为之间的关系。【方法】基于横断面研究,于2013年8-11月在上海、南宁、牡丹江三个地区抽取成年男性现在吸烟者进行问卷调查,收集基本信息、每日吸烟量、戒烟意愿、戒烟尝试和戒烟相关社会规范等资料。建立单因素、多因素logistic回归模型分别分析戒烟相关社会规范与戒烟意愿、戒烟尝试的关系。共获得有效问卷3621份,总有效率95.8%。【结果】吸烟者感知到的戒烟相关社会规范较低,很少能从家人、朋友及其他身边的人获得戒烟的劝谏与建议。社会规范得分每提高1分,则吸烟者的戒烟意愿可能性增加69%(OR为1.69,95%CI为1.48~1.94),吸烟者戒烟尝试的可能性增加86%(OR为1.86,95%CI为1.66~2.08)。【结论】戒烟相关社会规范是吸烟者产生戒烟意愿、戒烟尝试的独立预测因子。今后的控烟干预策略应该致力于创建鼓励戒烟的社会规范。     

HPV单一与多重型别感染子宫颈病变风险比较

目的 对比HPV单一与多重型别感染者子宫颈病变风险,探索相应的管理模式.方法 回顾性总结2010年至2012年在北京大学第一医院妇产科同时行子宫颈细胞学与HPV检测且高危型HPV阳性妇女7 192例的临床资料,分析HPV高危型单一与多重型别感染者子宫颈癌前病变及浸润癌的相关性.结果 7 192例HPV高危型感染者中单一及多重型别感染率分别占75.88%及24.12%.在单一及多重型别感染者中,最常检出的型别均为16型,其次为58型、52型、53型.单一与多重型别感染者中细胞学高级别异常及以上占比分别7.81%及8.24%,两者无统计学差异(χ2=0.343,P=0.574),Logistic回归分析发现HPV16、31、33型别感染与细胞学高级别及以上异常具有相关性[OR分别为3.700(95%CI:3.048~4.492)、2.038(95%CI:1.568~2.647)、1.563(95%CI:1.110~2.201)].单一与多重型别感染者中CIN2+检出率分别为22.29%及23.04%,CIN3+检出率分别为11.72%及8.73%,两组感染者CIN2+检出无统计学差异(χ2=0.226,P=0.653),CIN3+检出有统计学差异(χ2=0.622,P=0.011),在HPV16、HPV16/18单一与多重型别感染者CIN2+检出均无统计学差异(χ2值分别为2.215、2.680,均P>0.05),CIN3+检出均有统计学差异(χ2值分别为0.622、11.112,均P<0.05),在非HPV16/18型单一及多重型别感染者CIN2+、CIN3+检出均无统计学差异(χ2值分别为2.747、0.199,均P>0.05).Logistic回归分析发现HPV 16型、单一型感染、细胞学异常及高级别异常与子宫颈病变CIN2+具有相关性[OR值分别为2.358(95%CI:1.934~2.874)、1.264(95%CI:1.020~1.566)、2.216(95%CI:1.779~2.761)、9.599(95%CI:7.728~112.575);HPV16、33型别感染、细胞学异常及高级别异常与CIN3+具有相关性[OR值分别为4.192(95%CI:3.102~5.665)、1.806(95%CI:1.183~2.757)、2.919(95%CI:1.360~2.708)、10.357(95%CI:7.545~14.215).结论 HPV多重型感染虽可导致更多的细胞学异常,但尚未导致更多的高级别细胞学异常;HPV单一型别、HPV16型别、16/18型别感染者的CIN3+风险增高,临床上应重视对这一人群的管理.     

电子阴道镜用于HR-HPV阳性患者分流管理的可行性研究

目的:探讨电子阴道镜用于高危型人乳头瘤病毒(high risk human papillomavirus,HR-HPV)阳性患者分流管理的可行性。方法:对1 984例19～63岁要求防癌筛查的女性,同时给予液基薄层细胞学(TCT)及HR-HPV检测,1周后对细胞学及HR-HPV阳性者给予电子阴道镜检查及活检组织病理学检查。以组织病理学诊断为"金标准",比较液基细胞学及电子阴道镜对HR HPV阳性病例检出高级别CINⅡ及其以上病变(≥CINⅡ,即CINⅡ+)的敏感性及特异性。结果:1 984例中,HR-HPV阳性366例,阳性率18.44%。其中350例同时具有TCT、阴道镜检查结果,阴道镜及TCT同时异常者132例,占49.62%(132/266)。CINⅠ+检出率44.00%(154/350),CINⅡ+及浸润癌检出率34.00%(119/350)。细胞学异常率58.85%(206/350),以≥ASCUS为阳性标准时,其敏感性77.19%,而特异性只有50.00%。以≥LSIL为标准时,CINⅡ+检出敏感性降低(43.86%),特异性则明显提高(82.63%)。阴道镜异常率52.86%(185/350),CINⅡ+检出敏感性、特异性分别为91.23%,65.68%。浸润癌检出率100.00%。以检出CINⅡ+为终点,两组比较具有统计学差异(P<0.05)。结论:电子阴道镜对于HR-HPV阳性者进行分流具有较高的敏感性和阴性预测值。单独采用HR-HPV进行防癌初筛者,HR-HPV阳性首选电子阴道镜检查,可更早发现更多的高级别CIN及癌。     

Smoking in Aborigines and persons of European descent in southeastern Australia: prevalence and associations with food habits,body fat distribution and other cardiovascular risk factors

Abstract: As part of a population-base study of risk factors for heart disease, we aimed to establish the prevalence of smoking and to indentify associations between smoking and other risk factors in Australian Aborigines (n = 306) and persons of European descent (n = 553) in two country towns. Smoking prevalence was first analysed as a dichotomy (current smokers compared with nonsmokers), and according to three levels of exposure (< 10, 10—20 and > 20 cigarettes per day), and two levels of nonexposure (never and former smoker). Other behavioural, biochemical and physical variables were included in multivariable analyses. Of the Aborigines, 64.4 per cent (95 per cent confidence interval (CI) 59.0 per cent to 69.8 per cent) were current cigarette smokers, compared with 22.8 per cent of non-Aborigines (CI 19.3 per cent to 26.3 per cent). For persons aged 13 to 54 years, using the five categories of exposure, smoking in Aborigines again far exceeded that in non-Aborigines in all age groups (for males χ² = 72.8, for females χ² = 94.6, 4 df, P = < 0.0001 for both sexes). In non-Aboriginal females, the highest prevalence was in the youngest group (56 per cent of those aged 13 to 17 years). Food habit was associated with smoking. Subjects who ate meat without trimming the fat were more likely to smoke. In Australian country towns, Aborigines and all young women need smoking cessation programs. The nutritional status of smokers requires further study.     

Plasma uric acid levels in women with cervical intraepithelial neoplasia

The objective of this study was to determine the association of plasma levels of uric acid, an endogenous antioxidant, in women with cervical intraepithelial neoplasia (CIN), while controlling for the confounding effects of human papillomavirus (HPV) infection, age, smoking, and use of oral contraception. Plasma-reduced and oxidized uric acid levels were determined in 650 women by high-performance liquid chromatography, employing electrochemical technique. The findings demonstrated that 1) plasma-reduced uric acid (PRUA) levels in women with CIN (n = 311) were significantly lower (P < 0.05) compared with women in a control group (n = 339); 2) according to multiple logistic regression analysis, PRUA levels were negatively (P = 0.0113) and HPV infection were positively associated (P < 0.0001) with CIN, after controlling for the confounding effects of the studied factors; 3) according to multiple regression analysis, there was a 31% decrease in CIN risk for each incremental increase of 1mg/dl of PRUA; and 4) according to polychotomous logistic regression analysis, independent of HPV infection, PRUA level was inversely associated with the histopathological graded severity of CIN. We have previously reported decreased plasma levels of exogenous antioxidants, for example, vitamins C and E, in women with CIN independent of HPV infection. The data suggest that plasma deficiencies of several antioxidants in HPV-infected uterine cervical tissue may create an oxidative environment that renders the tissue susceptible to free radical damage. It may be speculated that chronic free radical-induced tissue damage in the context of persistent HPV infection may be involved in the pathogenesis of CIN.     

HC2检测高危型HPV-DNA载量与子宫颈病变的关系

目的:探讨采用杂交捕获2代试验(HC2)检测妇女生殖道感染高危型人乳头瘤病毒(HR-HPVDNA)的载量与各级别宫颈病变的关系。方法:回顾性分析2009年2～12月在石河子大学医学院第一附属医院妇科就诊妇女963例,均实施医生取材收集子宫颈脱落细胞,进行细胞学检查及HC2检测HR-HPVDNA,细胞学检查包括薄层液基细胞学(TCT)或传统宫颈刮片检查。HR-HPVDNA载量由样本的相对光单位与标准阳性对照之比(RLU/PC)来衡量,载量1.00为阴性,载量≥1.00为阳性,将阳性分为3组:低度载量组(1.00,10.00),中度载量组(10.00,100.00)和高度载量组(≥100.00)。有244例行宫颈活检,依据病理结果分为慢性宫颈炎105例、轻度宫颈上皮内瘤变(CIN1)35例、中度宫颈上皮内瘤变(CIN2)29例、重度宫颈上皮内瘤变(CIN3)40例和子官颈癌35例。对实施宫颈病理检查的244例,采用非条件多项式Logistic回归分析病毒载量、年龄与子宫颈病变级别的关系。结果:HR-HPV感染率为74.6%(182/244),其中88.6%(31/35)的宫颈癌、97.5%(39/40)的CIN3、96.6%(28/29)的CIN2、74.3%(26/35)的CIN1和55.2%(58/105)的慢性宫颈炎病毒载量中位数分别是宫颈癌:197.13、CIN3:77.78、CIN2:47.63、CIN1:15.11、慢性宫颈炎:1.13。各级病变中病毒载量的分布差异有统计学意义(χ2=42.82,P0.05);病毒载量越高,CIN程度越高(χ2=66.49,P0.05),低、中和高度载量组与阴性组相比,发生CIN2～3的危险性增加[OR(95%CI):18.11(1.60～205.28)、36.49(2.72～490.09)和39.35(3.91～396.16)],且有明显的剂量反应关系;高病毒载量的35岁～组、45～岁组患CIN2+风险较大,[OR(95%CI):4.5(1.52～13.30)、7.75(2.74～21.96)]。结论:采用HC2检测子宫颈HR-HPVDNA结果显示,病毒载量与子宫颈病变程度高度相关,高病毒载量是宫颈癌、CIN3和CIN2的主要危险因素,其对45岁以上女性的致病风险更大。综合HC2检测HR-HPVDNA定性及定量结果以及患者年龄指导临床筛查更具意义。     

农村少数民族已婚妇女高危型宫颈人乳头状瘤病毒感染调查及危险因素分析

目的:了解贵州省农村少数民族妇女宫颈高危型人乳头状瘤病毒(HR-HPV)感染率和亚型分布及与HR-HPV感染相关的危险因素。方法:于2009年1月~2010年2月,采用分层整群随机抽样的方法对贵州省黔南地区农村少数民族妇女2 786例进行流行病学问卷调查和HR-HPVDNA分型检测,并对与HR-HPV感染相关的因素进行单因素及多因素分析。结果:2 786例妇女中,HR-HPV感染患者为316例,总感染率为11.34%。水族妇女HR-HPV感染率与布依族、苗族、毛南族妇女之间相互比较,差异均有统计学意义(P0.05)。HPV感染的亚型中,HPV16(2.010%)最常见,其次为HPV33(1.759%)、58(1.364%)、52(1.256%)和31(1.149%)。单因素分析显示,婚姻状况、初次性生活年龄和妊娠次数为HR-HPV感染的危险因素(P0.05)。多因素分析表明,吸烟(P=0.003)、性伴侣数(P=0.023)、初次性生活年龄(P=0.198)和民族(P=0.235)为影响HR-HPV感染的独立危险因素。结论:贵州省农村少数民族妇女宫颈HR-HPV感染率低于国内平均水平,其最常见的亚型为HPV16;影响HPV感染的独立危险因素为吸烟、性伴侣数、初次性生活年龄和民族。     

Smoking and respiratory disease symptoms inrural Bangladesh

Respiratory disease (excluding tuberculosis) is a largely untargetted health problem in Bangladesh. This study emphasises both that existing morbidity is considerable and that it is sure to increase if smoking spreads further. In two poor village populations 71% of men though only 1% of women were current smokers (one or more cigarettes or bidi per day); about one in five had begun smoking before the age of 10 years. Most heavy smokers and all women smoked bidi (hand-rolled coarse tobacco sticks). Expenditure on smoking absorbed up to 5% of household income but, seemingly paradoxically, one of the lowest socio-economic groups had the heaviest consumption.For men the striking effect of smoking in increasing respiratory disease symptom prevalence at all ages is clear. Nearly all male smokers reported “cough” but so did four out of five men and women who had never smoked. There were too few women smokers for meaningful analysis. However, “morning phlegm”, “an episode of increased phlegm” and “wheezing” as well as being common for non-smokers of both sexes, were two to three times more frequent among women than men who had never smoked. In women there must certainly be other causal factors for respiratory symptoms apart from smoking, the most important are likely to be smoke from cooking fires and respiratory infections in childhood. Improving immunization coverage and the treatment of respiratory infections in childhood would be useful preventive strategies for both men and women. The most urgent public health measure is to reduce the prevalence of smoking.     

Peer Reviewed: Smoking Status as a Predictor of Hip Fracture Risk in Postmenopausal Women of Northwest Texas

Introduction

The purpose of this study was to determine the effect of cigarette smoking on the risk of hip fracture for postmenopausal women living in rural and urban areas of Northwest Texas.

Methods

Using an unmatched case-control design, we compared postmenopausal women who had recently experienced osteoporotic hip fracture with women who had not. Both study groups completed a questionnaire on demographic, clinical, and behavioral risk factors for osteoporotic hip fracture. We categorized smoking status as never smoked, former smoker, and current smoker. Covariates included age, weight, age at menopause, physical activity, estrogen replacement, calcium supplementation, and rurality. We used univariate and multivariate logistic regressions to test the associations between hip fracture and the independent variables of interest.

Results

We found an increased risk of hip fracture for former smokers (adjusted odds ratio [OR], 2.27; 95% confidence interval [CI], 1.22–4.21) and current smokers (adjusted OR, 3.72; 95% CI, 1.59–8.70). Residence in a rural county (population <100,000) also was associated with increased risk (adjusted OR, 2.71; 95% CI, 1.48–4.95).

Conclusion

Former and current smoking increased the risk of hip fracture in this population of postmenopausal women.     

北京地区已婚妇女生殖道高危型人乳头状瘤病毒感染与宫颈病变相关性研究

目的 探讨北京地区已婚妇女生殖道高危型人乳头状瘤病毒(HR-HPV)感染与宫颈上皮内瘤变(CrN)的现患状况及其相关性.方法 于2007年3月至2008年9月采用多阶段整群随机抽样的方法,在北京地区抽取12个区县137个社区25～54岁已婚妇女6185名,进行妇科体检、宫颈HR-HPV及细胞学检测,并进行问卷调查.对出现不典型鳞状上皮细胞及以上细胞学异常改变的妇女进行宫颈病理学检查.应用EpiData 3.0软件双次录入、审核数据后,使用SPSS 15.0软件进行统计分析.结果 (1)北京地区25～54岁已婚妇女生殖道HR-HPV感染率为9.9%,宫颈病变患病率为6.0%;(2)HR-HPV感染及宫颈病变患病高峰年龄均为30～34岁组;(3)HR-HPV感染者的宫颈细胞学异常率(40.3%)、宫颈病变患病率(30.4%)均明显高于未感染者;(4)多元logistic同归分析显示,与正常人群相比,HR-HPV感染对宫颈上皮内低度病变(CIN Ⅰ)组和高度病变及癌症(≥CIN Ⅱ)组的OR值分别为8.385和97.416,归因危险度百分比分别为88.1%和99.0%.结论 HR-HPV感染为宫颈病变的主要因素;30～34岁的已婚妇女是生殖道HR-HPV感染和宫颈病变的高发人群.     

Facial wrinkling in men and women, by smoking status.

OBJECTIVES. This study examined the association of smoking status and pack-years of smoking with facial wrinkling in men and women. METHODS. We conducted a cross-sectional study of 299 never smokers, 551 former smokers and 286 current smokers, aged 30 through 69 years, drawn from a health maintenance organization. Smoking status, pack-years of smoking, and potential confounding variables were assessed by questionnaire. Facial wrinkle category, a dichotomous variable, and facial wrinkle score, a computed continuous variable, were assessed by blinded standardized visual assessment. Wrinkling was so uncommon among 30- through 39-year-old subjects that analyses were restricted to subjects aged 40 and over (227 never smokers, 456 former smokers, and 228 current smokers). RESULTS. With age, average sun exposure, and body mass index controlled, the estimated relative risk of moderate/severe wrinkling for current smokers compared to never smokers was 2.3 (95% confidence interval [CI] = 1.2, 4.2) among men and 3.1 (95% CI = 1.6, 5.9) among women. Pack-years was positively associated with facial wrinkle score in women aged 40 through 69 years and in men aged 40 through 59 years. In both groups, the increased risk of wrinkling was equivalent to about 1.4 years of aging. CONCLUSIONS. Our results support earlier findings that risk of facial wrinkling is greater in cigarette smokers than in never smokers.     

p16/mcm2双染在宫颈上皮内瘤变的诊断价值及其与高危型HPV感染的关系

目的 研究p16/mcm2免疫细胞化学双染在宫颈病变中的表达及其与HPV感染的关联,并探讨其在宫颈癌筛查中的应用价值。方法 将2015年5-12月参加宫颈癌筛查并行高危型HPV（HR-HPV）检测和液基细胞学检查的1 127名女性纳入研究,对留存细胞学标本进行p16/mcm2免疫细胞化学双染检测,并与宫颈组织病理学结果进行比较。结果 p16/mcm2在HPV16/18阳性组和其他HR-HPV阳性组的表达风险均高于HPV阴性组,OR值分别为15.95（95%CI：9.59~26.51）、10.53（95%CI：7.41~14.98）;p16/mcm2阳性率随宫颈上皮内瘤变（CIN）级别的升高而升高,且在CIN2组、CIN3组中均高于良性病变组（P<0.05）;p16/mcm2阳性者中检出CIN2及以上（CIN2+）和CIN3及以上（CIN3+）病变的灵敏度分别为86.1%、92.0%,特异度分别为46.1%、44.4%;在细胞学诊断为非典型鳞状细胞和低度鳞状上皮内病变人群中检出CIN2+和CIN3+病变的灵敏度分别为85.7%、87.5%,特异度分别为45.5%、44.1%。结论 p16/mcm2双染灵敏度高于细胞学检查,特异度优于HPV检测,可识别宫颈高度病变和指导CIN的分级,有望成为新的宫颈癌筛查标志物。     

HPV分型检测对宫颈细胞学阴性妇女的诊断价值研究

目的探讨高危型HPV分型检测对宫颈细胞学阴性妇女的宫颈病变诊断价值。方法对宫颈细胞学阴性、HPV阳性的妇女436例进行阴道镜检查。根据不同年龄组及不同高危型HPV型别,分为HPV 16/18阳性组,其余HR-HPV阳性组,分析年龄和高危型HPV型别与重度宫颈病变的关系。结果 436例女性中,30～39岁、40～49岁和≥50岁年龄组CIN II+的患病风险分别是30岁年龄组妇女的2.1、1.5和1.7倍。HPV 16/18型阳性CIN II+患病风险是其余HR-HPV阳性的3.3倍,两组患病率分别为21.59%和7.62%,差异有统计学意义(P0.01)。结论 HPV分型检测对细胞学阴性妇女的宫颈病变有重要诊断价值。宫颈细胞学阴性、HPV 16/18阳性,建议行阴道镜检查,尤其是年龄≥30岁妇女,有更重要意义。     

Smoking cessation and lung cancer mortality in a cohort of middle-aged Canadian women

PURPOSE: To determine the impact of smoking cessation on lung cancer mortality among women. METHODS: Survival analysis is used to assess the effect of smoking cessation on lung cancer death in the dietary cohort of 49,165 women aged 40 to 59 years enrolled in the Canadian National Breast Screening Study. RESULTS: During an average of 10.3 years of follow-up, 106 women died of lung cancer. The risk of lung cancer mortality among women who quit before age 50 (HR=0.26; 95% CI, 0.13-0.55 among women who quit at ages 40-49) or quit in the previous 10 years (HR=0.39; 95% CI, 0.22-0.69) is substantially lower than the risk among current smokers. Women who quit after age 40 or have quit for less than 20 years are at substantially higher risk of lung cancer mortality compared with never smokers. Both duration of smoking cessation and age at quitting have independent effects on lung cancer mortality, after controlling for number of cigarettes smoked per day and number of years smoked, as well as other potential confounding variables. CONCLUSION: These findings suggest that programs and policies to promote early cessation of smoking and prevention of relapse should be a public health priority.     

Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies

BACKGROUND: Although smoking is the primary cause of lung cancer, much is unknown about lung cancer etiology, including risk determinants for nonsmokers and modifying factors for smokers. OBJECTIVE: We hypothesized that alcohol consumption contributes to lung cancer risk. DESIGN: We conducted a pooled analysis using standardized exposure and covariate data from 7 prospective studies with 399,767 participants and 3137 lung cancer cases. Study-specific relative risks (RRs) and CIs were estimated and then combined to calculate pooled multivariate RRs by using a random-effects model. RESULTS: We found a slightly greater risk for the consumption of > or = 30 g alcohol/d than for that of 0 g alcohol/d in men (RR: 1.21; 95% CI: 0.91, 1.61; P for trend = 0.03) and in women (RR: 1.16; 95% CI: 0.94, 1.43; P for trend = 0.03). In male never smokers, the RR for consumption of > or = 15 g alcohol/d rather than 0 g alcohol/d was 6.38 (95% CI: 2.74, 14.9; P for trend < 0.001). In women, there were few never-smoking cases and no evidence of greater risk (RR: 1.35; 95% CI: 0.64, 2.87). Because of possible residual confounding by smoking, we performed sensitivity analyses by reclassifying the never smokers in the highest drinking category as former smokers. Resulting associations for alcohol consumption were somewhat attenuated, but P for trend = 0.05 for men, which was near the original P = 0.03. CONCLUSIONS: A slightly greater risk of lung cancer was associated with the consumption of > or = 30 g alcohol/d than with no alcohol consumption. Alcohol consumption was strongly associated with greater risk in male never smokers. Residual confounding by smoking may explain part of the observed relation.