宫颈上皮内瘤变Ⅰ级的自然转归与随访观察

目的探讨CINⅠ患者的自然转归。方法以组织病理学检查诊断为CINⅠ患者74例作为观察对象,随访12个月后行HR-HPV、TCT检查;随访24个月后行HR-HPV、TCT、电子阴道镜及组织病理学检查。结果74例CINⅠ患者随访24个月后,自然消退42例（56.76%）,病变持续25例（33.78%）,进展7例（9.46%）,其中宫颈上皮内瘤变2级（CINⅡ）5例,宫颈上皮内瘤变3级（CINⅢ）2例。结论HR-HPV及TCT可以作为CINⅠ病变转归的监测方法。     

阴道镜联合HPV检测对宫颈癌及宫颈上皮内瘤变的诊断价值

目的探讨阴道镜联合高危型人乳头瘤病毒(HR-HPV)检测对宫颈癌及宫颈上皮内瘤变的诊断价值。方法对644例行宫颈癌筛查的妇女行阴道镜和HR-HPV检测,并应用阴道镜取宫颈多点活组织进行病理检查。结果HR-HPV诊断结果阳性率为17.70%,阴道镜诊断结果阳性率为18.01%,HR-HPV+阴道镜诊断结果阳性率为18.79%;HR-HPV+阴道镜检测灵敏度和符合率与单一使用阴道镜或HR-HPV检测比较,P<0.05,差异具有统计学意义;HRHPV检测低危病变阳性率和高危病变阳性率比较,P<0.05,差异具有统计学意义。结论阴道镜联合HR-HPV检测可提高宫颈癌及宫颈上皮内瘤变的诊断灵敏度和符合率,高危病变HR-HPV检测阳性率更高。     

50例阴道上皮内瘤变临床治疗分析

目的 探讨阴道上皮内瘤变(VAIN)的临床特征及治疗方法。方法 回顾分析50例VAIN患者的临床资料,其中VAINⅠ、Ⅱ、Ⅲ级分别为16、5、29例,年龄33~76岁。结果 多数患者无临床症状,少数表现为阴道分泌物增多,82%患者病变位于阴道穹窿或上1/3,18%位于阴道中、下1/3,VAINⅠ级患者观察随访,VAIN Ⅱ级患者阴道局部用药,VAIN Ⅲ级患者行三维高剂量率腔内后装放疗。HPV感染与VAIN级别呈正相关(P=0.028)。结论 VAIN级别与高危型HPV感染呈正相关,腔内后装放疗对VAIN Ⅲ级患者起到有效治疗作用,副反应小治愈率高。     

宫颈电圈切除术对重度宫颈上皮内瘤变的诊疗价值及高危型HPV检测的临床意义

目的探讨宫颈电圈切除术(LEEP)对重度宫颈上皮内瘤变(CINⅡ～Ⅲ)的诊疗价值,研究高危型人乳头瘤病毒(HPV)在重度CIN中的感染情况及对LEEP术预后的影响.方法对112例重度CIN患者行阴道镜活检及LEEP术治疗,并同时行高危型HPV的PCR检测,对其疗效及预后进行分析.结果在112例重度CIN患者中,CIN Ⅱ级67例,CIN Ⅲ级(包括原位癌)45例.LEEP术后随访,治愈98例,治愈率达87.5%;发现病变残留者14例(12.5%),复发者4例(3.6%).在所有患者中,92例高危型HPV检测阳性,总感染率为82.1%.CIN Ⅲ级患者HPV阳性率(93.3%)较CIN Ⅱ级患者(74.6%)显著升高(P<0.05).高危型HPV阳性组LEEP术后病变残留率或复发率与HPV阴性组比较,差异无显著性(10.9%比20.0%,或4.3%比0;P>0.05).因CIN残留或复发而再次行LEEP术的13例患者中,检测到12例(92.3%)仍有高危型HPV感染.结论 LEEP术是诊断和治疗重度CIN的有效且理想的方法.高危型HPV与重度CIN的发生有关.术前高危型HPV阳性与否似乎与LEEP术预后无关.     

液基细胞学联合HPV分型检测在妊娠合并宫颈上皮内瘤变患者的应用

  目的  应用液基细胞学联合HPV分型方法检测妊娠合并宫颈上皮内瘤变(Cervical intraepithelial neoplasia, CIN), 初步了解此类患者中TCT及HPV感染情况与妊娠宫颈病变的关系。  方法  对象为2006年1月至2012年1月确诊为妊娠合并宫颈上皮内瘤变的72例患者, 初次孕期保健均进行细胞学、HPV检测, 对这些临床资料进行回顾性分析研究。  结果  妊娠合并CIN发生率为2.1%。72例患者中全部产前行宫颈TCT检测, HSIL为32例, LSIL为40例, 56例于产前保健时检测HPV, 其中48例(85.7%)为阳性结果, 32例为HPV16型单独或混合感染。72例孕期保健时行阴道镜活检病理诊断CINⅠ16例、CINⅡ16例、CINⅢ40例。  结论  液基细胞学联合HPV分型检测在妊娠合并宫颈上皮内瘤变患者的应用是安全而且有效的。在妊娠期CIN患者中HPV感染率高, 且HPV16型与CIN高等级病变关系密切。      

310例宫颈上皮内瘤变(CIN)术后随访的临床分析

目的:分析310例CIN术后随访资料。方法:比较手术前后3月、6月、12月液基细胞术(TCT)阳性率、HPV感染率的改变。分析其与不同年龄,不同病变程度间的关系。结果:310例标本中,术后3月TCT阳性率由术前89.68%降至30.00%,术后6月、12月TCT的阳性率分别为6.77%、1.61%;术后3月HPV的感染率由术前93.55%降至56.77%,术后6月、12月分别为14.19%、5.48%。随年龄增加,术后3月、6月,不同年龄组TCT阳性率及HPV感染率分别逐渐增加,且各组间的差异分别具有显著性(P<0.05)。术后12月,51-60岁年龄组TCT阳性率及HPV感染率均显著高于其余各组,差异具有显著性(P<0.05),而其它各组间差异无显著性(P>0.05);随CIN级别增加,术后3月、6月、12月TCT的阳性率及HPV的感染率分别增加,在同一随访时限内不同级别间TCT阳性率及HPV感染率差异分别具有显著性(P<0.05)。结论:宫颈环形电切术(LEEP)能显著减低TCT、HPV的阳性率。术后3月复查HPV阳性率下降不明显,术后6月HPV阳性率明显降低。对于年龄较大、病变程度高的CIN术后患者,应加强随访。     

宫颈上皮内瘤变管理的进展

宫颈上皮内瘤变（CIN）是一组宫颈癌的癌前病变,它能反应宫颈癌发生发展的连续过程。宫颈癌早诊早治工作的广泛开展,使其预防和治疗关口明显前移。因此,如何规范CIN的管理已成为宫颈癌防治工作的关键。该文针对CIN各级的特性及其管理的新进展进行综述。     

射频治疗宫颈上皮内瘤变的初步研究

目的探讨射频治疗宫颈CIN的疗效、特点及安全性。方法对2001年至2005年应用阴道镜、细胞学涂片、活检门诊筛查出的年轻妇女宫颈上皮内瘤变(CIN)患者52例,进行射频治疗并随访。结果本组CINⅠ级24例,CINⅡ级16例,CINⅢ级12例,应用射频治疗52例,其中5例CINⅢ级者射频后行子宫切除术,术后病理未见癌前病变及癌性病变。本组宫颈CIN治疗有效率为100%。结论射频治疗宫颈CIN是一种较好的物理治疗方法,与其他方法比较具有方法简单、效果确切、时间短、见效快、能保留年轻妇女的宫颈等特点,值得进一步探索和推广。     

宫颈上皮内瘤变的阴道镜检查

目的总结我院阴道镜检查400例患者中宫颈上皮内瘤变(CIN)50例的阴道镜下特征.方法采用TZ-YDJ数字电子阴道镜检查.结果 CIN1级阴道镜下主要表现为边界模糊的平坦醋酸白色上皮,可有细镶嵌;CIN2级镜下为边界清楚的稍突起白色上皮,合并细镶嵌或点状血管;CIN3级可见边界明显的突起白色上皮,镶嵌、点状血管及多种构图.结论 阴道镜检查是早期发现宫颈癌前病变的重要检查方法之一,结合镜下定位活检可提高CIN的诊断准确率.     

宫颈上皮内瘤变自然史转移概率的研究

[目的]探讨1级宫颈上皮内瘤变(CIN1)进展、退化或保持不变的转移概率,为使用基于转移概率为基本参数的Markov模型进行卫生经济学评价提供参数。[方法]利用前瞻性的宫颈癌自然史随访6年队列(SPOCCS-I)的宫颈癌自然史的数据,使用指数分布模型和微积分方法对CIN1进展和退化的年转移概率进行了估计。[结果]SPOCCS-I人群中CIN1患者的疾病保持不变的、发生进展和退化的年转移概率分别为0.658、0.020和0.322,相应的6年累积转移概率分别为0.081、0.054和0.865。[结论]SPOCCS-I人群中CIN1的患者在1年内发生进展的可能性为2%,该人群中有32.2%的CIN1患者会在1年内发生退化。根据中国宫颈癌自然史队列SPOCCS-I计算出的CIN1的转移概率符合卫生经济学评价中使用的Markov模型需要的参数,可以为之提供参数的参考依据。     

HR-HPV对CIN冷刀锥切后的随访价值

探讨HR-HPV监测CIN冷刀锥切后病变残余或复发的价值。方法：118例冷刀锥切后患者第3、6、12、18、24个月均检测HR-HPV和细胞学及阴道镜,病理证实存在CIN视为残留或复发。结果：术后病理切缘阳性10例（8.5%）;术后24个月残留或复发18例（15.3%）。术后第6个月HR-HPV转阴率较术后第3个月升高,差异有统计学意义,较6个月后的转阴率无统计学意义。术后第6个月HR-HPV阳性者28例（23.7%）,阳性者发病18例（64.3%）,阴性患者无发病。术后第6个月HR-HPV诊断病变残留或复发的敏感度和特异度分别为100.0%和90.0%,阳性预测价值和阴性预测价值分别为64.3%和100.0%。HR-HPV与TCT正确诊断率为91.5%和81.4%,Youden's指数为0.900和0.598,HR-HPV优于TCT。切缘阳性者残留或复发率（40.0%）较阴性患者（13.0%）高（P=0.045）,切缘阳性者发病风险是阴性者4.5倍（95% CI=1.121～17.866）。结论：术后第6个月HR-HPV检测是监测冷刀锥切后病变残留或复发的早期敏感指标,阳性者密切监测,阴性者常规监测不增加发病风险。此外,切缘阳性是病变残留或复发的一个重要危险因素。     

bcl-2蛋白在宫颈上皮内瘤样变及宫颈癌中的表达和意义

目的　探讨bcl-2在宫颈上皮内瘤样变及宫颈浸润癌中过度表达的意义。方法　采用免疫组织化学SP法检测了 10例宫颈上皮内瘤样变 (CIN)及 5 7例宫颈癌中bcl-2蛋白的表达 ,并以 11例正常宫颈组织作对照。结果　bcl-2蛋白在CIN中的表达强度明显高于正常对照 (P <0 0 5 ) ;bcl-2蛋白在宫颈癌中的表达 ,不仅表达阳性率 ( 94 7% )明显高于正常对照 ( 5 4 5 % ) (P <0 0 1) ,而且表达强度亦明显高于正常对照 (P <0 0 1) ;bcl -2蛋白在宫颈癌临床Ⅲ期中的过表达 ( 6 4 3 % )明显高于临床Ⅱ期 ( 2 2 2 % ) (P <0 0 5 )。结论　bcl-2蛋白的过度表达不仅与宫颈癌的发生有关 ,而且与宫颈癌的发展有关。     

宫颈冷刀锥切术诊治宫颈上皮内瘤变的价值

[目的]探讨宫颈冷刀锥切术对宫颈上皮内瘤变(CIN)的诊断及治疗作用.[方法]对比126例行宫颈冷刀锥切术和阴道镜下多点活检的CIN患者的病理检查结果,分析CIN患者行宫颈冷刀锥切术的临床疗效和并发症.[结果]阴道镜下多点活检和宫颈冷刀锥切术后病理完全符合83例(占65.9％).14例(11.1％)患者锥切边缘受累;发现早期浸润癌5例,其中2例早期浸润癌仅行宫颈锥切,随访无复发.宫颈冷刀锥切术的主要并发症为出血和宫颈管狭窄,发生率分别为6.3％ (8/126)和3.9％ (5/126).[结论]宫颈锥切术比阴道镜下多点活检对宫颈上皮内瘤变的诊断更准确,并具有重要治疗作用.     

Comparison of Cervical Levels of Interleukins-6 and -8 in Patients with and without Cervical Intraepithelial Neoplasia

Introduction: Interleukins-6 and -8 are two pro-inflammatory cytokines increasing in serum and local levels under malignant conditions. There are limited evidences on the association between cervical level of these two factors and cervical intraepithelial neoplasia (CIN). So, this study aimed to explore the association between cervical levels of IL-6 and IL-8 with cervical premalignant lesions. Methods: The present case-control study was conducted on married women undergone Pap smear for routine screening in two groups as the group with CIN (n=100) and the healthy control group (n=100). Cervical secretions were collected using sterile swab and the levels of IL-8 and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA). The obtained data were analyzed by SPSS software. Results: The mean cervical IL-6 level was 568.66±594.62 pg/ml in the patients with CIN and 212.7±213.9 pg/ml in the controls (P <0.001). The cervical IL-8 levels in the case and control groups were measured to be 1320.43±876.5 pg/ml and 1053.59±747.64 pg/ml, respectively (p=0.02). By modifying the confounding size effect of the age and marital duration, it was determined that cervical levels of IL-6 and IL-8 were both associated with CIN. Conclusion: Our results showed that the cervical levels of IL-6 and IL-8 are associated with CIN independent of age and marital dura     

宫颈上皮内瘤变相关危险因素102例分析

[目的]研究宫颈鳞状上皮内瘤变（CIN）的发病相关危险因素及诊疗方法。[方法]102例CIN患者行阴道镜下活检和高频电波刀宫颈环状电圈切除术（LEEP），并同时行高危型HPV检测（HCU）。[结果]102例患者中CINⅠ54例，CINⅡ29例，CINⅢ19例。LEEP术后治愈率为96．1％（98／102），发现病灶残留4例，复发8例（7．8％）。63例高危型HPV阳性，总感染率为61．76％。CINⅡ、Ⅲ组较CINⅠ感染率显著升高（P〈0．05）。术后HPV持续感染率25％。多因素非条件Logistic回归分析显示，年龄、近5年性传播疾病（STD）感染、无性生活防护和性伴的多性是CIN的独立危险因素。[结论]CIN与性行为和下生殖道感染等因素相关。LEEP是CIN诊断和治疗的有效方法。高危型HPV与重度CIN的发生有关，术后高危型HPV检测对预测残留或复发有指导意义。     

Diagnostic and Therapeutic Cold Knife Conization for Cervical Intraepithelial Neoplasia

OBJECTIVE To evaluate the diagnostic and therapeutic efficacy of using cold knife conization for cervical intraepithelial neoplasia (CIN).METHODS We retrospectively analyzed 186 cases with CIN diagnosed and treated in our hospital; compared the histologic diagnoses from cervical conization and from colposcopic multiple punch biopsies, and then evaluated their postoperative histologic findings and clinical outcomes.RESULTS Of the 186 cases, there was a correlation in histologic findings between cervical conization and colposcopic multiple punch biopsies in 138 cases (74.2%), and there was no correlation in the other 48 cases (25.8%). Incomplete excision was performed in 8 cases (4.3%), but the failure rate was only 1.1%; the cure rate was 98.9%. Five cases with early invasive cancer were found.Eleven patients underwent subsequent hysterectomy. The main complications associated with conization were hemorrhage and cervical stenosis. Bleeding occurred in 8 (4.3%) of the patients, and cervical stenosis occurred in 3 (1.6%).CONCLUSION Cervical intraepithelial neoplasia was diagnosed more accurately using conization than by colposcopic multiple punch biopsies. Conization can also play an important role in the treatment for CIN. If properly performed, the procedure has a low risk of complications. It can provide an accurate histologic representation of the disease process, and be curative in most cases.     

宫颈上皮内瘤变150例临床分析

目的：探讨宫颈上皮内瘤变（CIN）的诊断及治疗方法。方法：回顾分析1984年1月至1998年12月住院治疗的150例CIN的临床资料。结果宫颈细胞学检查诊断的阳性率为76．65,与宫颈管细胞学检查联合应用诊断的阳性率为78．8％,两者比较无显著性差异。细胞检查结合阴道镜下活检诊断CIN阳性率为95．3％,与单一细胞学诊断相比较,有显著性差异。阴道镜下活检与病理诊断的符合率为91．6％,镜下活检与宫颈管刮术结合诊断的阳性率明显高于单纯阴道镜下活检。141例采用手术治疗,无1例切缘阳性;9例原位癌采用腔内放疗,全组无1例复发或死亡。结论宫颈细胞学检查结合阴道镜检是诊断CIN的有效方法,对绝经后妇女应同时行宫颈管刮术,对不宜手术的原位癌患者可行单纯腔内放疗。     

Distribution of HPV-16 Intratypic Variants among Women with Cervical Intraepithelial Neoplasia and Invasive Cervical Cancer in Mongolia

Objectives. Infection with high-risk human papillomavirus (HPV) is a critical factor associated withcarcinogenesis of the uterine cervix. HPV-16 is most frequently found, and is further subclassified into intratypicvariants based on the nucleotide sequences of the viral genes. Although certain HPV-16 variants are reported tobe associated with the progression of cervical lesions, these relationships remain controversial with differentresults for different populations. To provide data for another population, we investigated the prevalence ofHPV-16 and distributions of its intratypic variants among Mongolian women with cervical intraepithelialneoplasia (CIN) and invasive cervical cancer. Materials and Methods. We analyzed samples from 374 randomlyselected women who attended the National Cancer Center of Mongolia between January 2002 and July 2007,including 147 invasive cervical cancer patients, 127 CIN patients and 100 age-matched controls who werecytologically normal. HPV genotyping was initially conducted, followed by variant analysis for HPV-16-positivesamples by nucleotide sequencing of the E6 gene. The HPV data were evaluated statistically for correlationswith the patients’ clinical data. Results. HPV genotyping detected 101 HPV-16-positive samples. Among thesesamples, 92 were available for subsequent variant analysis, including 66 invasive cervical cancer samples, 25CIN samples and 1 cytologically normal sample. A total of 14 different variants were identified. All 14 variantsbelonged to the European lineage, and the European prototype was detected in 66% (61/92) of the samples.Among the remaining 31 variants, variants with the T350G nucleotide change were predominant (13/31, 42%),followed by variants containing G94A (11/31, 35%), G176A (4/31, 13%) and G274T (2/31, 7%) . There were nosignificant differences among all the variants regarding their distributions in CIN and invasive cervical cancers.Conclusions. HPV-16 variants of the European lineage were exclusively distributed among the Mongolian womenexamined, and the European prototype was overwhelmingly predominant. Since no significant differences werefound between the types of variants and severities of the cervical lesions, it is possible that racial or geographicfactors may have some influences on these relationships.