子宫内膜癌筛查进展

子宫内膜癌是女性生殖系统三大恶性肿瘤之一, 发病率已高居妇科肿瘤首位, 在全球范围内还在不断增长。我国也呈现逐年上升的趋势。子宫内膜癌作为可筛查的肿瘤, 其筛查策略尚存争议。子宫内膜癌筛查人群主要还是针对高危人群, 但对于中风险人群(或者风险增加人群)的筛查还在探索阶段。尝试综合子宫内膜癌的各种风险因素建立筛查模型, 将非常有助于确定合适的筛查人群。在经阴道超声检查的基础上, 微/无创取样技术及微量组织病理学的开展, 极大地推动了子宫内膜癌筛查的发展, 在此基础上联合分子生物学检测可能具有更好的筛查前景。     

我国消化道早癌筛查的挑战和展望

我国是消化道肿瘤高发国家，以胃癌、食管癌和结肠癌为代表的三大消化道肿瘤严重威胁着我国人民的健康水平，也造成了沉重的医疗负担。本文从近年来国家颁布的相关政策入手，分别针对胃癌、食管癌、结肠癌和胰腺癌的筛查流程加以评述，评估胃癌的血清胃蛋白酶原联合胃泌素检测、结肠癌的粪便和血液基因检测、胰腺癌的"血清液体活组织检查"等新技术对早癌的筛查效果，并提出消化道早癌筛查工作现阶段存在的困难和挑战。通过回顾和展望，进一步明确了推动消化道早癌筛查行动和研究对于降低我国消化道肿瘤病死率的重要意义。     

食管癌高危人群预警和早期发现液体活检技术指标研究进展

高危人群预警筛查和早期发现是降低食管癌发病率和死亡率的关键[1].筛查和甄别无症状人群中食管癌高危人群和早期癌患者是食管癌早期发现的主要内容.目前食管癌早期发现最佳方法是内镜筛查,包括食管内镜+碘染色(色素镜) +靶向活检(碘不染色区活检) [2].     

内窥镜在食管癌高发区高危人群筛查中的局限和对策

内窥镜和黏膜活检组织病理学检查是目前食管癌高发区无症状高危人群筛查最有效的方法之一.但无症状高危人群筛查中,近80%的居民食管上皮组织病理属于正常范围,也就是说,在无症状高危人群筛查中存在内窥镜应用过度的现象,加之内窥镜检查复杂的规范程序、昂贵的价格以及有经验的内窥镜医师的缺乏等,导致其成本较高而效率较低,不能满足大范围人群筛查的要求.作者提出食管癌普查的三级筛查制度,第一级筛查为无创的血清学检查,通过检测血液中有关肿瘤相关分子的水平间接了解食管上皮增生状态;第二级为脱落细胞学检查;内窥镜活检、组织病理学检查为第三级筛查.3者结合,可以降低内窥镜应用的频率,降低筛查成本,提高检出效率,适应于大范围人群筛查.三级筛查模式与现行农村(社区)合作医疗制度相结合是该模式推广应用的重要保证.     

营养风险筛查表-2002结合实验室营养指标检测对食管癌术前患者营养状况分析

目的:运用营养风险筛查表-2002对食管癌术前患者进行营养风险筛查, 并结合实验室营养指标检测综合分析患者营养状况及相关影响因素, 为临床营养支持提供依据。方法:对62例食管癌术前患者采用营养风险筛查表-2002进行术前营养风险调查, 并结合人体营养指标血清视黄醇结合蛋白(RBP)、前白蛋白(PAB)、白蛋白、血红蛋白、红细胞计数进行检测分析。结果:38例(61.29%)患者术前具有营养不良风险, 年龄≥60岁者营养不良风险发生率为79.49%;有吞咽困难者营养不良风险发生率为68.63%;logistic回归分析年龄、体质量指数和有无吞咽困难均为术前营养风险相关危险因素(P<0.01)。有营养风险患者RBP、PAB、白蛋白、血红蛋白均明显低于无营养风险患者(P<0.01);有营养风险患者红细胞计数与无营养风险患者比较差异无统计学意义(P>0.05)。结论:食管癌术前患者存在较高的营养不良风险, 医务人员应重点关注有吞咽困难、年龄≥60岁、体质下降、RBP和PAB早期改变者, 为患者采取及时有效的营养支持。     

多项肿瘤标志物在80例食管癌诊断中的应用分析

目的：探讨多项肿瘤标志物在食管癌诊断中的应用。方法：将80例食管癌定为肿瘤组，80例门诊就诊的一般疾病患者定为对照组，两组均进行多项肿瘤标志物检测（TSGF、CA19—9、CEA、CYFRA21—1）并进行比较分析。结果：两组检测结果比较，有非常显著差异性（P〈0．01）。结论：多种血清肿瘤标志物联合检测对食管癌的早期诊断有良好的指导作用，比单项检测更具有说服力，更能提高对食管癌早期筛查的阳性率。     

妊娠期阻塞性睡眠呼吸暂停筛查的研究进展

阻塞性睡眠呼吸暂停（OSA）是妊娠人群中常见的睡眠呼吸障碍性疾病,不仅与多种不良妊娠结局相关,也可能对母婴远期健康产生重要影响。目前诊断OSA的金标准多导睡眠监测在妊娠人群中难以大规模开展,导致绝大多数妊娠期OSA未能得到及时诊断。寻求其他筛查策略和筛查工具准确识别具有OSA风险的孕妇并进行及时诊治,对于改善不良妊娠结局具有重要意义。本文针对妊娠期OSA患病率、筛查现状、筛查时机、目标人群、筛查工具的研究进展进行综述,以期为妊娠期OSA的筛查提供参考和理论依据。     

中国卒中学会关于无症状性颈动脉狭窄筛查的科学声明

无症状性颈动脉狭窄（aCAS）是卒中发生的重要危险因素,但有关aCAS筛查的获益与风险意见不一。为进一步明确相关问题,中国卒中学会组织国内相关领域的专家展开讨论,结合了国内外研究进展、aCAS的循证证据和我国国情制定本科学声明。本声明提出对于普通人群不推荐常规开展颈动脉筛查,以期提高临床医生及相关人员开展aCAS人群评...     

运用核酸扩增技术对22326名献血者的检测情况分析

输血相关传染病的预防和控制已成为全球关注的焦点问题,如何有效地检测出病毒以及缩短窗口期,是当下血液筛查检测技术的发展趋势。由于国产酶联免疫吸附试验(ELISA)法检测试剂的灵敏度相对偏低,窗口期长,而核酸扩增检测技术(NAT)检测直接测定病毒RNA或DNA,可显著缩短窗口期,降低输血感染的风险,提高用血安全,已成为不少地区血站开展献血者血液筛查的必要手段。2010年我国部分血站开始试点核酸检测,2012版《血站技术操作规程》,将NAT纳入血液检测项目,开启了我国NAT检测时代。按照国务院《卫生事业发展“十二五”规划》等有关文件要求,全面开展血站筛查核酸检测(以下称核酸检测),缩短病毒检测“窗口期”,是进一步提高我国临床用血安全水平、降低经输血传播疾病风险的重要举措。笔者通过对我站2017年1至12月份NAT检测情况统计分析,探讨开展核酸检测对献血者血液筛查的重要性。     

不同类型社区大肠癌筛查模式的探讨

城市社区居民是我国大肠癌防治的重点人群,开展城市居民的大肠癌筛查是我国大肠癌预防控制的重要内容。本文参照北京市试点社区开展大肠癌筛查所采用的模式,根据国内外筛查工作的经验和不足,对我国不同类型城市社区大肠癌的筛查模式进行一些探讨。     

中国武安市食管癌高发区胃镜普查初步研究

目的在河北省武安市食管癌高发区建立普查基地,在大规模食管癌普查工作前,先进行预试验研究。方法对武安市上团城乡上团城村一街的居民进行逐个入户调查,对年龄40～65岁的居民登记,进行问卷调查;获取知情同意后,进行胃镜检查,筛查食管癌和癌前病变。结果共对92名居民进行了问卷调查,对88名居民进行了消化内镜检查。19例居民普通内镜或者色素内镜怀疑食管癌或癌前病变者进行内镜下活检,并送病理检查。发现7例为轻-中度异型增生,2例为高度异型增生/原位癌,1例为进展期癌,异型增生及癌变者碘染色不染或者淡染。结论本研究在食管癌高发区进行胃镜普查早期发现食管癌和癌前病变的可行性,为以后长期的研究摸索经验。     

色素内镜对食管癌手术切除范围的价值

目的能否通过色素内镜检查,降低残端癌的发生率。方法６９例食管癌病人,其中３６例进行术前色素内镜检查,并对病变范围做墨汁标记,以示手术切除部位,术后切除的病灶做病理检查,另３３例病人按常规做食管癌根治术,术后做病理检查。结果３６例色素内镜检查病人,残癌发生率为０。３３例未经色素内镜检查病人,有４例发生残端癌,占１２．１％（４／３３）。结论说明术前做色素内镜检查,可降低残端癌的发生率。     

Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review

CONTEXT: Gastroesophageal reflux disease (GERD) is a risk factor for adenocarcinoma of the esophagus, a rare cancer whose incidence is increasing. Adenocarcinoma may develop from Barrett esophagus, a metaplastic change of the esophageal epithelium from squamous to intestinalized columnar mucosa, which is associated with chronic reflux. Some have recommended that patients with chronic reflux symptoms undergo upper endoscopy to assess for Barrett esophagus and to screen for cancer. OBJECTIVES: To review the evidence linking GERD and Barrett esophagus to esophageal adenocarcinoma and to examine the utility of upper endoscopy as a screening tool in adenocarcinoma of the esophagus among individuals with GERD. DATA SOURCES: A MEDLINE search was performed to identify all pertinent English-language reports about GERD, adenocarcinoma, and Barrett esophagus from 1968 through 2001. Reports were of randomized controlled clinical trials if available, case-control data if trials were unavailable, and cohort studies if case-control data were unavailable. Pertinent bibliographies were also reviewed to find reports not otherwise identified. STUDY SELECTION AND DATA EXTRACTION: Studies were selected by using the search terms gastroesophageal reflux, adenocarcinoma, and Barrett's esophagus, with subheadings for classification, complications, drug therapy, economics, epidemiology, mortality, surgery, and prevention and control. Clinical guidelines for the care of subjects with GERD and Barrett esophagus were retrieved and abstracted. DATA SYNTHESIS: Cohort studies demonstrate that symptoms of GERD occur monthly in almost 50% of US adults and weekly in almost 20%. Three large case-control studies demonstrate a positive association between reflux symptoms and risk of adenocarcinoma of the esophagus, with more prolonged and severe symptoms accentuating this risk. However, because of the low incidence of adenocarcinoma of the esophagus and the ubiquity of reflux symptoms, the risk of cancer in any given individual with reflux symptoms is low. No randomized trial data are available to demonstrate either decreased cancer incidence or increased life expectancy in subjects with GERD who undergo screening endoscopy. CONCLUSIONS: Strong evidence supports the association of GERD and adenocarcinoma of the esophagus; however, the risk of cancer in any given individual with GERD is low. Barrett esophagus appears to be a common precursor lesion to this cancer. Given the low absolute risk of cancer in those with GERD and the lack of demonstrated efficacy of endoscopic screening, insufficient evidence exists to endorse routine endoscopic screening of patients with chronic GERD symptoms.     

基于“痰瘀毒结、因癌致虚”论治老年食管癌

食管癌是全球范围内的高发肿瘤之一,而我国人口老龄化是食管癌发生的一大危险因素。因老年食管癌患者的临床特点,使得其治疗手段较年轻患者相对受限。中医作为老年食管癌重要治疗手段之一,其不良反应相对较少,老年患者更能耐受。曾普华教授认为老年食管癌的关键病机为“痰瘀毒结、因癌致虚”,以“益气健脾、化瘀解毒、攻毒散结”之法治之,临床疗效显著。     

早期胃癌内镜诊断进展

在早期胃癌(EGC)的诊断中,内镜检查是最直接、准确、可靠的诊断方法。目前,有多种内镜检查方法用于临床:普通电子内镜、放大内镜、染色内镜、超声内镜、荧光内镜、近红外线电子内镜、窄谱成像技术、共聚焦激光显微内镜等。各种方法在EGC的诊断中各有其独特的价值,在临床中应结合实际情况选择合适的方法,制定相应的筛查方案,以提高EGC的诊断率。     

Narrow-band imaging in the diagnosis of early esophageal cancer and precancerous lesions

Background In the recent years, the incidence of esophageal cancer in China has increased. The key point for raising the survival rate is the diagnosis and treatment at an early stage. Narrow-band imaging （NBI） can enhance the contrast of the mucous membrane of the esophagus without staining. This study aimed to explore the value of NBI in the diagnosis of early esophageal cancer and precancerous lesions.
Methods The esophagus was examined with ordinary endoscopy and NBI endoscopy. Pit patterns and blood capillary forms were examined with routine magnifying endoscopy and NBI endoscopy. Finally, a 1.2% Lugoul＇s iodine solution was used to stain the esophageal mucosal surface and a biopsy was taken at all the sites where NBI or iodine staining was positive. NBI and iodine staining scales were compared with pathologic diagnosis, which was considered as the gold standard.
Results A total of 90 cases （138 lesions in total） were diagnosed as early esophageal cancer or precancerous lesions; 104 lesions （75.4%） were detected with ordinary endoscopy, 120 lesions （87.0%） were detected with NBI endoscopy, and 138 lesions （100%） were detected with iodine staining. The lesion detection rate of NBI was significantly lower than that of iodine staining （X2=17.176, P 〈0.01）. However, there was no significant difference between NBI and iodine staining for the diagnosis of high grade intraepithelial neoplasia （X2=1.362, P 〉0.05）, while the detection rate of NBI was significantly lower than that of iodine staining for the diagnosis of low grade intraepithelial neoplasia （X2=13.388, P 〈0.01）. The pit pattern and blood capillary form of early esophageal cancer and precancerous lesions could be demonstrated clearer with NBI than with ordinary endoscopy.
Conclusions NBI can enhance the contrast of the mucous membrane of the esophagus without staining. The combination of NBI and iodine staining can raise the diagnostic rate of early esophageal cancer and precancerous lesions.     

食管癌高发区高危人群食管癌筛查研究

目的通过内镜筛查了解食管癌高发区高危人群食管各级病变及食管癌的患病情况,为病因学研究提供科学依据。方法从2006～2011年在食管癌高发区四川省盐亭县,采取整群随机抽样的方法选择97个自然村作为筛查对象,对40～69岁的高危人群采取内镜下碘染色及指示性活检进技术行筛查,并经病理学诊断确诊。结果轻、中、重度食管增生的检出率分别为5.33%(803/15 065)、1.28%(193/15 065)、0.68%(102/15 065),原位癌、黏膜内癌、浸润性癌的检出率分别为0.15%(22/15 065)、0.06%(9/15 065)、0.29%(43/15 065);食管增生男性检出率高于女性;65岁之前轻、中、重度食管增生及浸润性癌的检出率随着年龄的增长而增加;时间分布上,轻、中、重度食管增生的检出率在不同年份之间差异具有统计学意义(P<0.01)。结论依托国家食管癌筛查项目,在食管癌高发区对高危人群进行癌症综合知识宣传,提高防癌意识,是保证早诊早治工作可持续发展的关键。     

加强结肠镜检查规范培训，提高结肠腺瘤检出率

我国结直肠癌发病率和死亡率逐年增加,针对其进行早防早筛早诊早治是遏制该趋势的有效措施,而结肠镜检查则是其筛查和检测的重要手段。腺瘤检出率是结肠镜检查的关键质控指标,提高腺瘤检出率不仅可以提高结肠镜的检查质量,更重要地是可以显著降低结直肠癌的发病率和致死率,具有重大临床意义。本团队从肠道准备质量、进镜操作技巧、退镜时间和质量、人工智能系统等不同层次寻找提高结肠镜学员腺瘤检出率的方法,力争在内镜医师的肠镜学习阶段为其打下坚实基础,从而切实改善我国结肠镜操作低腺瘤检出率的现状。     

216例内镜下碘染色诊断早期食管癌的临床对照研究

目的:探讨内镜下碘染色对早期食管癌的诊断价值。方法:将胃镜下有可疑食管病变的216例患者随机分为染色组和对照组各108例。用复方碘溶液对染色组进行食管粘膜染色检查,并于不染色或淡染色区进行病理活检。对照组不行碘染色,仅根据临床经验进行病理活检。结果:染色组不染色或淡染色60例(55.6%),发现食管癌12例(11.1%),其中早期食管癌2例,鳞状上皮异型增生6例(5.6%),其中中重度异型增生3例;对照组活检21例(19.4%),发现食管癌1例(0.9%),轻中度异型增生3例(2.8%)。两组食管癌诊断率的差异有统计学意义。结论:内镜下碘染色能减少食管粘膜活检误差,提高食管癌诊断率,有助于发现早期食管癌及其癌前病变,值得临床推广应用。     

Human papillomavirus (HPV) and cervical cancer

Epidemiologic studies have consistently shown that the most important risk factor for cervical cancer relates to sexual activity and a sexually transmitted agent, probably a virus, is the principal causative agent. In recent years, much attention has been focused on the human papillomavirus (HPV) as the causative agent. The compelling epidemiologic evidence of the role of HPV in cervical cancer is complemented by equally strong data on the role of oncoproteins E6 and E7 of high-risk HPV strains in the molecular pathogenesis of cervical cancer. Incidence and mortality from cervical cancer have been decreasing steadily in most developed countries, but is the leading female cancer in developing countries. This variation in incidence is explicable in terms of differing levels of risk behaviour and population screening facilities and uptake. With better understanding of the aetiopathogenesis, vaccination against HPV is becoming a reality. This may be particularly useful in developing countries, where it is proving difficult to implement effective screening programmes.