血清HE4、CA125联合检测鉴别盆腔肿块患者卵巢癌的诊断价值

目的:探讨新肿瘤标记物血清人附睾分泌蛋白4(HE4)和CA125联合检测鉴别妇科盆腔肿块患者卵巢癌的诊断价值。方法:将诊断为妇科盆腔肿块拟行手术的108例患者和40例健康体检妇女采用酶联免疫吸附法(ELISA法)测定HE4含量、电化学发光法测定CA125含量。结果:卵巢癌组患者血清HE4、CA125水平明显高于盆腔良性肿块组患者(良性组)及健康妇女(对照组),差异有统计学意义(P<0.05),良性组血清HE4水平与健康妇女(对照组)比较差异无统计学意义(P>0.05),而同组血清CA125水平与对照组比较差异有统计学意义(P<0.05);良性组和对照组血清HE4的阳性率均为0,而良性组血清CA125为30.1%,良性组中HE4的阳性率与同组血清CA125阳性率比较差异有统计学意义(P<0.01);HE4+CA125联合检测卵巢癌的敏感度、特异度分别为91.4%、80.5%,与单一指标检测敏感度进行比较差异有统计学意义(P<0.05)。结论:HE4是一种较理想的卵巢癌肿瘤标志物,其血清水平对妇科盆腔肿块良恶性疾病的鉴别诊断具有一定的应用价值,与CA125联合检测可以提高盆腔肿块患者中卵巢癌的鉴别诊断价值。     

血清MMP-7和MMP-10的水平在卵巢癌诊断中的意义

目的:探讨血清MMP-7和MMP-10的检测在卵巢癌诊断中的意义。方法:选取59例卵巢癌患者,52例卵巢良性肿瘤患者和40例健康体检妇女(正常对照组)为研究对象。采用ELISA方法测定血清中MMP-7和MMP-10的水平。结果:恶性组血清MMP-7和MMP-10的水平明显高于良性组和对照组(P<0.01)。良性组血清MMP-10水平高于对照组(P<0.01)。血清MMP-7和MMP-10的ROC曲线下面积分别为0.723和0.826。血清MMP-7和MMP-10的联合诊断灵敏度为95.2%,特异度为94.8%。结论:血清MMP-7和MMP-10的检测可以用于卵巢癌的诊断,两者联合诊断可大大提高卵巢癌的检出率。     

Women's Reactions to HPV Diagnosis: Insights from In-Depth Interviews

ABSTRACT

Research links certain types of the human papillomavirus (HPV) to subsequent development of cervical cancer. Women (n = 52) recently diagnosed with HPV following an abnormal Pap smear participated in in-depth interviews to explore their knowledge of HPV, their emotional responses to diagnosis, and the extent of their disclosure of their HPV diagnosis to others. Women had many knowledge deficits about HPV. Emotions related primarily to stigma, fear, self-blame, powerlessness, and anger. Most women disclosed their disease to significant others, usually to a sexual partner. Women's lack of accurate knowledge may contribute to the array of emotions they experience. Whereas education about HPV may reduce the potency of these emotions, information alone may be inadequate for achieving optimal patient care. Health care providers can be important in treating the emotional elements associated with diagnosis as well as the condition itself.     

Women's reactions to HPV diagnosis: insights from in-depth interviews

Research links certain types of the human papillomavirus (HPV) to subsequent development of cervical cancer. Women (n=52) recently diagnosed with HPV following an abnormal Pap smear participated in in-depth interviews to explore their knowledge of HPV, their emotional responses to diagnosis, and the extent of their disclosure of their HPV diagnosis to others. Women had many knowledge deficits about HPV. Emotions related primarily to stigma, fear, self-blame, powerlessness, and anger. Most women disclosed their disease to significant others, usually to a sexual partner. Women's lack of accurate knowledge may contribute to the array of emotions they experience. Whereas education about HPV may reduce the potency of these emotions, information alone may be inadequate for achieving optimal patient care. Health care providers can be important in treating the emotional elements associated with diagnosis as well as the condition itself.     

肿瘤特异性生长因子(TSGF)的测定及临床应用

目的探讨肿瘤特异性生长因子(TSGF)作为肿瘤标志物检测的效果,为群体肿瘤普查和恶性肿瘤的早期诊断提供简单、快速的检测手段。方法对210例恶性肿瘤、39例良性肿瘤和144例炎症患者进行血清学检测,同时与甲胎蛋白、癌胚抗原等7种标志物检查结果进行了比较。结果良性肿瘤组无1例阳性;恶性肿瘤组阳性率81·9%;炎症疾病组阳性率15·9%,但跟踪检测多数在一周后转阴;TSGF测定的阳性率高于其它7种肿瘤标志物。结论TSGF可作为首选的肿瘤标志物检测,对健康普查和恶性肿瘤的早期诊断及疗效观察具有重要意义。     

血清TSGF、CA15-3、CEA在乳腺癌中的表达及临床意义

目的:探讨联合检测乳腺癌患者血清中恶性肿瘤特异性生长因子(TSGF)、糖类抗原CA15-3及癌胚抗原CEA在乳腺癌诊断中的价值。方法:采集128例乳腺癌患者、64例乳腺良性疾病患者及30例健康人血液,利用生化比色法测定TSGF含量,利用化学发光免疫法检测CA15-3及CEA含量。结果:乳腺癌组TSGF、CA15-3、CEA含量明显高于乳腺良性疾病组和健康组(P0.05)。乳腺癌组TSGF、CA15-3、CEA阳性率分别为48.4%、36.7%、17.9%。联合检测乳腺癌阳性率为67.9%。结论:单独检测TSGF、CA15-3、CEA对乳腺癌有意义,联合检测提高乳腺癌的诊断率,提高诊断的敏感性和准确性。     

The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient,nurse and volunteer perspectives

Objective To qualitatively identify the concerns and needs of Australian women recently diagnosed with breast cancer. Background Breast cancer diagnosis can lead to impairment in multiple areas of psychosocial well‐being, including physical, social and emotional functioning. Research has therefore begun to focus on identifying and addressing survivors’ concerns and needs, with most research examining the time of treatment completion. However diagnosis and treatment are also key times of psychological need, and less is known about the psychosocial concerns and needs at these times. Research design Seven focus group interviews were conducted examining three categories of participants: (i) patients diagnosed with early‐stage breast cancer within the past 12 months, (ii) oncology nurses, and (iii) volunteers who work with cancer patients. Sampling was discontinued when informational redundancy was achieved. Setting and participants Thirty‐four participants took part in one of seven focus group meetings held in a hospital patient resource room. Results A wide variety of psychosocial concerns and needs were discussed, and five specific areas of concern were identified: (i) coping with side‐effects; (ii) dealing with self‐concept change; (iii) stress and adjustment reactions; (iv) having to manage others’ unhelpful beliefs, expectations and emotions; and (v) issues with survival and growth. There was a large degree of consistency in the concerns and needs identified by the different group categories. Conclusion In general, the concerns and needs expressed were consistent with survivorship issues previously identified in the literature; however, several new insights were obtained. Clinical implications of these findings are discussed.     

联合检测血清CA125、CA199、CA153和CA724对卵巢癌的诊断价值

目的:探讨肿瘤标志物CA125、CA199、CA153和CA724联合检测对卵巢癌的诊断价值。方法:采用电化学发光法测定45例卵巢癌患者、38例卵巢良性肿瘤患者和41例健康妇女血清中的CA125、CA199、CA153和CA724水平。结果:卵巢癌患者血清CA125、CA199和CA153水平显著高于正常对照组(P<0.05);卵巢癌患者血清CA125、CA199和CA153阳性率分别为66.6%、31.1%和42.2%,均显著高于正常对照组(P<0.05);联合检测CA125、CA199、CA153和CA724诊断卵巢癌的阳性率为86.6%,诊断卵巢良性肿瘤的阳性率为34.2%,均显著高于正常对照组(P<0.05),且显著高于单一肿瘤标志物检测的阳性率;联合检测的敏感性(86.6%)和准确性(91.5%)均高于单项检测结果。结论:联合检测CA125、CA199、CA153和CA724对卵巢恶性肿瘤的诊断和鉴别具有重要意义。     

血清CA125在妇科疾病诊断中的临床意义

目的:检测妇科住院患者血清癌抗原125(Cancer antigen 125,CA125)水平,探讨血清CA125在妇科疾病诊断中的临床意义。方法:采用电化学发光法测定232例妇科住院手术患者血清CA125水平,以门诊体检健康妇女15例作对照,分组分析血清CA125水平。结果:23.3%卵巢癌患者血清CA125在400～1000U/ml之间,55.8%血清CA125大于1000U/ml,51.7%卵巢子宫内膜异位囊肿、68.8%子宫腺肌病及54.5%输卵管卵巢脓肿患者血清CA125在35～199U/ml之间;卵巢癌患者血清CA125显著增高,阳性率为97.7%,与妇科其他良、恶性肿瘤比较差异有显著性(P<0.01);卵巢子宫内膜异位囊肿、子宫腺肌病、输卵管卵巢脓肿患者血清CA125阳性率分别为62.1%、68.8%及81.8%,显著高于正常对照组(P<0.01),但显著低于卵巢癌组(P<0.05)。结论:血清CA125在卵巢癌诊断中有重要意义;对卵巢子宫内膜异位囊肿、子宫腺肌病及输卵管卵巢脓肿有一定诊断意义。     

Exploring breast cancer screening barriers among Barbadian women: a focus group study of mammography in a resource-constrained setting

Breast cancer affects women worldwide. Early detection strategies, notably mammography, aim to reduce mortality from breast cancer. However, mammography is a costly screening tool, generates controversy in terms of its impact and adverse effects, and its uptake remains low among some populations. This qualitative study (12 focus groups with 110 participants) explored experiences with mammography among Barbadian women by investigating how barriers are negotiated in a setting of resource-constrained health care provision without a national screening programme. The study findings indicate that, firstly, Barbadian women have to actively seek understanding of both breast cancer and the mammography process. Women described how, with little public awareness and knowledge, they borrow from available public health information on diabetes and HIV/AIDS to give meaning to mammographic screening. Secondly, many women expressed their fear about mammography and its potential consequences, such as experiencing social stigma and losing a romantic relationship after diagnosis. Thirdly, the cost of screening for women who opted for the more reliable private facilities was discussed, along with the potential cost of health care following a diagnosis and the emotional cost of enduring the societal taboo of breast cancer. If breast cancer screening is to be acceptable for this or similar populations, there should be provision of additional services to ensure better access to free screening or alternative strategies, as well as post-diagnostic social and financial support. The policies to develop these services must also address women’s concerns about screening and breast cancer, and provide comprehensive information to allow informed decisions about screening.     

A prospective study of the development of breast cancer in 16,692 women with benign breast disease

The authors studied the relation between benign breast disease and subsequent breast cancer in 16,692 women with biopsy-diagnosed benign breast disease who had participated in the Breast Cancer Detection Demonstration Project throughout the United States. Women were classified into one of five benign breast disease categories: atypical hyperplasia, proliferative disease without atypia, nonproliferative disease, fibroadenoma, and other benign breast disease. A total of 485 incident cases of breast cancer were identified in the women from August 1973 to February 1986 after a median follow-up period of 8.3 years from the diagnosis of benign breast disease. Age-adjusted incidence rates were calculated for benign breast disease types stratified by family history and calcification status. Relative risk (RR) estimates of breast cancer for women in the five benign breast disease categories, compared with the screened women who did not develop recognizable breast disease (normal subjects), were computed using the proportional hazards model. Results indicated that risk was associated with the degree of epithelial atypia. Over all age groups, women with nonproliferative disease, proliferative disease without atypia, and atypical hyperplasia displayed progressively increasing risks of 1.5, 1.9, and 3.0, respectively, compared with normal subjects, with 95% confidence intervals (CI) exceeding unity. Particularly high risk was seen among women under age 46 years with atypical hyperplasia (RR = 5.7, 95% CI 3.0-10.6). Women with fibroadenoma as the only indication of their benign breast disease had a relative risk of 1.7, with a lower 95% confidence limit of 1.0. No increased risk was seen for women with other benign breast disease. Positive family history (RR = 1.8) and calcification (RR = 1.2) significantly increased a woman's risk proportionately over the risk associated with each benign breast disease subtype. The authors conclude that the risk of developing breast cancer varies by category of benign breast disease and is directly related to the degree of epithelial atypia.     

Real-time moment-to-moment emotional responses to narrative and informational breast cancer videos in African American women

In a randomized experiment using moment-to-moment audience analysis methods, we compared women's emotional responses with a narrative versus informational breast cancer video. Both videos communicated three key messages about breast cancer: (i) understand your breast cancer risk, (ii) talk openly about breast cancer and (iii) get regular mammograms. A community-based convenience sample of African American women (n = 59) used a hand-held audience response device to report the intensity of their emotional reaction while watching one of the two videos. Strong emotions were more likely to correspond to contextual information about characters in the video and less likely to correspond to health content among women who watched the narrative video compared with those who watched the informational video (P < 0.05). Women who watched the narrative video were more likely to report feeling attentive (41 versus 28%, respectively), inspired (54 versus 34%) and proud (30 versus 18%) and less likely to feel upset (8 versus 16%) (all P < 0.05). Women in the narrative group were more likely to mention women's personal stories than health information in open-ended recall questions, but this did not detract from obtaining health information. Findings suggest that stories can be used to communicate health information without distracting from core health content.     

人附睾蛋白的联合检测在肺癌诊断中的临床价值

目的探讨血清人附睾蛋白(HE4)与其他肿瘤标志物联合检测在肺癌诊断中的临床价值。方法选取本院初诊的肺癌患者52例作为恶性组、肺部良性疾病患者67例作为良性组、健康体检者60例作为对照组,同时检测血清HE4、CEA、CYFRA21-1、NSE水平。结果恶性组血清HE4、CEA、CYFRA21-1、NSE水平均高于良性组及对照组(P<0.05)。恶性组中四项联合检测阳性率明显高于单项检测。恶性组中HE4的敏感度和AUC均高于其他项目,四者联合检测的敏感度、阴性预测值及AUC均高于单项检测(P<0.05)。结论肺癌患者血清HE4、CEA、CYFRA21-1、NSE水平升高,联合检测有助于肺癌的诊断和对高危人群的筛查,HE4在肺癌诊断方面可能是更好的肿瘤标志物。     

One month after diagnosis: quality of life, coping and previous functioning in siblings of children with cancer

BACKGROUND: The aim of the present study is to describe the quality of life (QoL) of siblings of children with cancer and to predict it according to their health before the diagnosis of cancer in the ill child and their ways of coping with the illness. METHODS: Participants were 83 siblings from 56 families-46 girls and 37 boys, aged 7-18. The assessment took place 1 month to 8 weeks after the diagnosis of cancer in the ill child. The siblings' QoL was assessed with the TNO-AZL children's quality of life questionnaire (TACQOL). Coping strategies were assessed with the Cognitive Coping Strategies Scale for siblings (CCSS-s). Physical problems and eating and sleeping problems that existed before the ill child was diagnosed were determined in a structured interview with the parents. RESULTS: A substantial number of siblings reported impaired cognitive and emotional QoL compared to the reference group. School-aged siblings (7-11 years) reported more trouble with motor functioning than peers. The coping strategy 'predictive control' (maintaining positive expectations regarding the illness) positively predicted siblings' QoL. The presence of health problems before diagnosis was negatively associated with siblings' QoL. Older siblings reported more negative emotions, while girls reported lower social QoL and reliance on 'interpretative control' (trying to understand the illness) was associated with fewer positive emotions. CONCLUSIONS: During the first 2 months after the diagnosis of cancer in a brother or sister, siblings have relatively lower QoL than peers. Health problems that existed before diagnosis may be a predictor of later adjustment problems. Positive expectations about the course of the illness appear to protect siblings from distress. Information about the illness is a delicate issue that requires parental guidance.     

Risk factors for breast cancer according to age at diagnosis in a French case-control study

In a French case-control study of 1010 women with breast cancer and 1950 controls with nonmalignant disease, the variations of the effects of 8 risk factors for breast cancer as a function of age at diagnosis, were analysed by tests of homogeneity and trend. The risks associated with a late age at first full-term pregnancy and with nulliparity were different between age-groups (test of homogeneity: p = 0.03), and the highest risks for these two factors were observed in women 45-54 years old. The risks associated with Quetelet index were also found to vary with age at diagnosis (test for trend: p = 0.008). A high Quetelet index decreased the risk of breast cancer in the younger age-groups; this decrease of risk became progressively less important with advancing age, and no such effect was found in the oldest age-group. Inverse results were observed for a tall stature (test for trend: p = 0.04): a tall stature increased the risk of breast cancer in the younger age-groups, and the figures suggested a reverse effect in the oldest group. No large variation with age was found for the effects of age at menarche, history of breast cancer death in mother or sisters, prior biopsy for benign breast disease, and weight. In conclusion, the relative importance of certain risk factors for breast cancer is closely related to age at diagnosis. Nulliparity and a late age at first birth appear to be major risk factors only for middle-aged women, whereas a low Quetelet index and a tall stature appear to increase the risk of breast cancer only for younger women.     

糖类抗原CA72-4联合人附睾蛋白4对卵巢癌的诊断价值

目的探讨糖类抗原72-4(carbohydrate antigen72-4,CA72-4)联合人附睾蛋白4(human epididymis protein-4,HE4)对卵巢癌的诊断价值。方法选取我院收治的卵巢癌患者及卵巢良性疾病者各60例,分别作为卵巢癌组、良性组,并选取60例健康体检者为对照组;三组研究对象均分别行CA72-4、HE4水平检测,分析对比各组检测结果。结果卵巢癌组患者CA72-4、HE4水平及其阳性率均高于良性组及对照组(P<0.05);良性组患者HE4水平及CA72-4、HE4检测阳性率均高于对照组(P<0.05);CA72-4与HE4联合诊断对卵巢癌患者的敏感度明显高于两者单独诊断(P<0.05)。结论糖类抗原CA72-4、HE4联合诊断对卵巢癌有更高的敏感性,在临床诊断卵巢癌中可发挥积极作用。     

WOMEN LIVING WITH OVARIAN CANCER: DEALING WITH AN EARLY DEATH

Our intent to explore the emotion of anger in women living with ovarian cancer revealed a basic social concern of "dealing with an early death." The findings of this grounded theory study also identified the core variable of "finding meaning in life" as assisting the nine women in dealing with an early death. The categories of hope and physical wellness influenced the women's search for meaning after a diagnosis of ovarian cancer. Several action and interactional coping strategies were identified as positive coping behaviors. The consequences of finding meaning in life was a perception of well-being defined by the women as satisfaction with their lives. Conversely, an inability to find meaning in life resulted in feelings of despair. The women's perceptions of well-being were not static and could fluctuate as they lived with ovarian cancer. Implications for further research and practice are discussed.     

Delay in the presentation of breast symptoms for consultant investigation

Summary Women referred to hospital outpatients with breast symptoms were interviewed to ascertain the interval between first noticing a breast symptom and first consulting a doctor (patient delay). Later, the hospital notes of each patient were examined to determine the intervals between this first consultation and referral by a doctor (doctor delay) and between referral and outpatient attendance (hospital delay), as well as the diagnosis (benign or malignant). The study found that the largest component of delay between noticing symptoms and outpatient attendance was patient delay, with 20 per cent of the women delaying for more than 12 weeks. Analysis of this group revealed that long delays were related to both age and subsequent diagnosis, but that these two variables were not independent of each other. The findings that there were longer delays in older women and that symptoms other than lumps, which could indicate breast cancer, were associated with long delays, have implications for health education. Generally, doctors in the community distinguished between benign and malignant cases, with 86 per cent of the latter referred within a week. Most women waited 2 weeks or less for an outpatient appointment, with none of those subsequently found to have breast cancer waiting more than 4 weeks. This study was supported by a grant from the Department of Health and Social Security through the Wessex Regional Cancer Organisation.     

HE4对不同年龄段卵巢癌的诊断价值评估

目的:探讨血清人附睾分泌蛋白4(HE4)对不同年龄段卵巢癌的诊断差异和临床意义。方法:收集女性卵巢癌术前血清标本160例、女性盆腔良性疾病患者血清标本45例及女性健康人血清标本109例测定HE4浓度,分析HE4在不同年龄阶段的差异和诊断能力。结果:卵巢癌组血清HE4浓度高于良性组和健康对照组(P<0.001)。三组各年龄阶段的HE4浓度比较差异有统计学意义(P<0.001和P=0.005)。青中老年组的最佳诊断点分别为75、80、130pM。结论:血清HE4能够很好地诊断卵巢癌,但在老年人群中诊断能力稍差。