阴道镜配合病理活检应用于宫颈疾病的诊断价值

目的 评价电子阴道镜及宫颈病理活检对宫颈疾病的诊断价值.方法 收集我院妇科门诊2003年至2006年宫颈疾病患者行阴道镜检查病行宫颈活检的病理结果进行对照分析.结果 电子阴道镜检查后行宫颈活检1060例,病理结果显示:宫颈癌16例,宫颈上皮内瘤样变342例,宫颈炎性病变702例,阴道镜诊断宫颈上皮内瘤样变及宫颈癌的符合率分别为:93.44%和93.75%.结论 阴道镜检查配合病理活检诊断宫颈疾病结果及时可靠,尤其对宫颈上皮内瘤样变的早诊断及降低宫颈癌的发生率有重要价值.     

2500例阴道镜检查结果分析

目的 探讨阴道镜检查对宫颈病变的诊断价值.方法 对2006年7月至2007年6月在我院妇科门诊进行阴道镜检查2500例妇女的阴道镜图象及560例阴道镜下定位活检的病理学结果进行回顾性分析.结果 病理确诊早期宫颈癌18例,宫颈上皮内瘤变68例,其中CIN Ⅰ 42例,CIN Ⅱ 16例,CIN Ⅲ 10例,宫颈湿疣5例.宫颈癌检出率0.72%,宫颈上皮内瘤变检出率2.72%.结论 阴道镜检查联合病理组织学检查是诊断CIN及早期宫颈癌的一个可靠方法.     

335例阴道镜图像异常病理诊断结果临床分析

电子阴道镜检查通过观察宫颈表面形态和终末血管网的变化来估计癌瘤的发生和发展,已成为妇科防癌检查的常用手段。在阴道镜下选择异常图像的部位准确取活检,打破了传统的固定点取活检的方式,减少了盲目性,提高了诊断的准确率,是早期诊断宫颈非典型增生和早期浸润癌的辅助方法之一。     

阴道镜检查在宫颈疾病诊断中的应用价值

目的 探讨电子阴道镜在宫颈疾病诊断中的应用价值.方法 对2007-2008年岳阳市三人民医院妇产科180例宫颈疾病患者进行阴道镜检查并行宫颈细胞学检查,进行回顾性分析和比较.结果 ①阴道镜在诊断宫颈病变中的诊断符合率为83.0%,灵敏度为80.4%,特异度为87.7%,漏诊率为5.1%;②阴道镜图像与组织学结果相比:二联征符合率为77.8%,三联征符合率为100%,可疑宫颈癌符合率为100%.醋白上皮符合66.7%;③宫颈疾病中30～40岁年龄段发病所占比例最大46.5%,50～60岁为宫颈癌发病高峰.结论 阴道镜检查诊断宫颈疾病结果准确可靠,减少漏诊,尤其对CIN的早期诊断、治疗及降低宫颈癌的发生率有重要意义.     

809例阴道镜下活检结果分析

目的 检查阴道镜下诊断宫颈疾病的价值.方法 对2009年1月至10月在安阳市妇幼保健院妇科门诊就诊并接受阴道镜下活检者资料进行分析.结果 检查共809人,慢性宫颈炎占 726人,宫颈上皮内瘤变Ⅰ级49人,Ⅰ-Ⅱ级13人,Ⅱ-Ⅲ级4人,宫颈原位癌2人,鳞癌Ⅰ-Ⅱ级14人,浸润癌1例.结论 阴道镜下活检准确率更高,明显提高上皮内瘤变的诊断率.     

TCT联合阴道镜在宫颈疾病中的诊断价值

目的 探讨液基薄层细胞检测系统（TCT）联合阴道镜及阴道镜下宫颈活检在宫颈疾病中的诊断价值。方法 回顾性分析2006年1月至2007年12月来我院门诊主诉白带增多、性交出血及妇检宫颈糜烂的756例患者行TCT筛查，其中125例阳性患者进行阴道镜下宫颈活检情况。结果 TCT异常率为16．53％，TCT检查CINI及以上病例诊断与病理活检诊断符合率为83．10％、灵敏度为86．44％（51459）、特异性为88．10％（74／84）、阳性预测值83．61％（51／61）、阴性预测值90．24％（74／82）；阴道镜检查CINI及以上病例诊断与病理活检诊断符合率为71．43％、灵敏度为95．45％（63／66）、特异性为86．05％（74／86）、阳性预测值84．00％（63／75）、阴性预测值96．10％（74／77）；TCT检查2例宫颈癌，而阴道镜和病理活检均诊断3例宫颈癌，提示阴道镜检查宫颈癌的诊断价值高于TCT。结论 TCT细胞涂片联合阴道镜下活检病理组织学检查可明显提高CIN的阳性检出率，是发现宫颈疾病安全、方便、准确、可靠的检查方法，适合作为CIN的筛查方法。     

阴道镜在诊治宫颈疾病中的临床价值研究

目的研究分析采用阴道镜诊断宫颈疾病的临床方法和价值。方法回顾性分析2008年5月~2012年5月期间,赴我院进行妇科检查的480例宫颈病变患者的临床资料,所有患者入院后均经过严格的阴道镜检查,并送检病理科进行病理分析,分析患者的临床诊断结果并评估阴道镜在诊治宫颈疾病中的临床价值。结果本研究中发现300例宫颈炎患者,其中CINⅠ+CINⅡ患者142例,CINⅢ患者22例,宫颈湿疣患者10例,宫颈浸润癌患者6例。结论阴道镜在宫颈病变患者的早期诊断中具有重要的指导作用,对患者后期的诊断和治疗提供一定的依据,有助于患者的治疗和恢复颇具临床价值。     

阴道镜下活检诊断宫颈上皮内瘤样病变225例浅析

目的 通过阴道镜活检探讨宫颈上皮内瘤样变的检出率、图像特征及诊断价值.方法 对2005年1月～2007年7月阴道镜检查的患者共有1058例中225例CIN的阴道镜结果 进行分析.结果 CIN栓出率为21.27%,异常阴道镜图像主要为醋白上皮、血管异常、镶嵌.结论 阴道镜是临床辅助诊断CIN的一个重要手段.     

210例阴道镜下活检诊断宫颈病变回顾分析

目的探讨阴道镜下活检诊断宫颈病变的临床价值。方法选取我院妇科在2010~2012年收治的宫颈病变患者210例,根据患者的阴道镜图像定位取活组织进行病理检查。结果阴道镜诊断与阴道镜腺癌活检病理组织学诊断的完全符合率为77.6%,其中宫颈炎诊断复合率为93.3%;CIN诊断符合率为64.0%;侵润癌诊断符合率为100%。结论阴道镜检查对宫颈病变,尤其是宫颈癌前期病变具有较高的诊断价值,经阴道镜下定位活检可以提高宫颈病变诊断的准确率。     

儿科疾病诊断中影像学检查的重要性分析

目的分析影像学检查在儿科疾病诊断中的重要性。方法选取217例患儿,均接受影像学检查,回顾性分析、总结不同检查方式在不同类型疾病中的准确率。结果经统计,X线、CT扫描、MRI、USG以及联合检查(X线与CT)所占的比例分别为16.59%、10.60%、26.27%、25.35%和21.20%,其中以MRI和联合检查为主。结论 X线、CT扫描、MRI、以及USG是儿科疾病诊断中的主要影像学检查方式,根据疾病的类型选择合适的影像学检查方式,可以提高疾病的诊断准确率,为临床治疗提供依据,促进疾病预后,具有重要作用。     

Cervical Acid Phosphatase: A Biomarker of Cervical Dysplasia and a Potential Surrogate Endpoint for Colposcopy

Background: In 2000, cervical acid phosphatase (CAP) has been recently described as a biomarker labeling abnormal squamous cells on Pap smears (USPTO #6,143,512). The enzyme activity is presented as a red, granular deposit on a modified Papanicolaou background. This unique property was utilized for development of MarkPap® technology intended for cervical cancer screening. Material/patients & methods: We conduct a multicenter, random assignment, assessor blinded, 2-group (test and control), split-sample designed clinical trial on 1,500 subject/specimens to assess safety and efficacy of the new test, in comparison with the control, for cervical cancer screening in standard Pap test environment. Safety is measured with frequency, severity and relation of adverse events. Efficacy is measured with primary endpoints (portion of positive/abnormal specimens detected, and the false negative rate). At the end of the follow-up period (two years) when the study will be completed, other efficacy endpoints such as accuracy (sensitivity/specificity) and predictive values will be added to the method evaluation. Here we present in interim analysis. Results: In April 2003, the recruitment was completed and the first twelve hundred cases have been evaluated. There was no serious or related adverse event in both groups. Minor, unrelated adverse events were rare and insignificantly distributed in both groups. Primary endpoints: A: Portion of positive/abnormal specimens detected: Pe (new test) = 0.166, Ps (Pap control): 0.082; Ps’ (ACS reported value for US in year 2000): 0.07. Pe ≥ Ps + δ, for δ; = 0.5Ps. B. False negative rate: Pe = 0.05, Ps’ = 0.10. Confidence intervals: 95% CI: Test [0.148–0.193], Pap control [0.068–0.098]. OR = 2.26. χ² = 40.69101 is greater than the critical value of 3.841 (P < 0.01). Conclusion: We concluded that CAP had added to visibility of Pap test and has enabled cytoscreeners to significantly improve the detection of positive/abnormal specimens and reduce false negative rate. We discuss this unique property of CAP with emphasis on using it as a surrogate endpoint for colposcopy and eventual removal of a cervical lesion that, if untreated, could progress into cancer.     

抗核抗体检测在自身免疫性疾病中的应用评价

目的 探讨抗核抗体（ANA）检测对自身免疫性疾病诊断的指导意义.方法 回顾性分析2010年1月~2010年12月间在我院就诊的患者血清自身抗体的检测结果,599例患者,其中自身免疫性疾病患者313例,非自身免疫性疾病286例,所有患者血清检测ANA,以Hep-2细胞/肝组织为基质的间接免疫荧光法检测ANA.结果 在自身免疫性疾病中,干燥综合征（SS）、类风湿性关节炎（RA）、混合型结缔组织病（MCTD）和系统性红斑狼疮（SLE）中的阳性率分别为73.43%、53.66%、61.04%和90.63%;在非自身免疫性疾病中的阳性率为21.68%,阳性率明显低于自身免疫性疾病组（P〈0.01）;在自身免疫性疾病组,荧光核型以颗粒型最多见,占47.22%~63.84%.结论 ANA的检测有助于自身免疫性疾病的诊断和筛查.     

Evaluation of Recombinant Antigen-Based Assays for Diagnosis of Bullous Autoimmune Diseases

The diagnosis of autoimmune bullous diseases is based on clinical observation and on the presence of autoantibodies directed to molecules involved in the adhesion systems of the skin. Immunofluorescence assays are the currently accepted method for detection of autoantibodies; such assays depend greatly on the skill of operators and are difficult to standardize. Recombinant desmoglein-1 (Dsg1), Dsg3, and BP180 peptides, the main autoantigens in pemphigus or bullous pemphigoid, have been used to develop new quantitative enzyme immunoassays (EIA) for the detection of specific antibodies. The present study was undertaken to evaluate the sensitivity and specificity of these immunoassays and to determine the correlation between the results and the clinical aspects of diseases. Serum samples from patients with pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, or mucous membrane pemphigoid, from healthy individuals, and from patients with unrelated autoimmune conditions were tested. Anti-desmoglein reactivity was detected in all the patients with pemphigus and in none of the controls. Patients with the more benign form of cutaneous disease had anti-Dsg1 antibodies, while patients with deeper cutaneous lesions or with mucosal involvement had anti-Dsg3 reactivity also, or exclusively. The BP180-based assay was positive for 66.6% of patients with bullous pemphigoid and for none of the patients with mucous membrane pemphigoid, and no reactivity was detected in the control sera. In conclusion, the anti-Dsg1 and anti-Dsg3 assays are useful in the diagnosis of pemphigus and provide information on the clinical phenotype of the disease. However, the sensitivity of EIA for detection of autoantibodies in bullous pemphigoid should be improved by the use of additional antigens or epitopes.     

Clinical Evaluation of the Cartridge-Based GeneXpert Human Papillomavirus Assay in Women Referred for Colposcopy

High-risk human papillomavirus (hrHPV) testing is now being introduced as a potential primary screening test for improved detection of cervical precancer and cancer. Current U.S. Food and Drug Administration-approved tests are batch tests that take several hours to complete. A rapid, non-batch test might permit point-of-care (POC) testing, which can facilitate same-day screen and management strategies. For a non-batch, random-access platform (GeneXpert; Cepheid, Sunnyvale, CA), a prototype hrHPV assay (Xpert) has been developed where testing for 14 hrHPV types can be completed in 1 h. In the first clinical evaluation, Xpert was compared to two validated hrHPV tests, the cobas HPV test (cobas, Roche Molecular Systems) and Hybrid Capture 2 (hc2, Qiagen), and to histologic outcomes using specimens from colposcopy referral populations at 7 clinical sites in the United States (n = 697). The sensitivity of Xpert for cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) (n = 141) was equal to that of cobas (90.8% versus 90.8%, P = 1) and greater than that of hc2 (90.8% versus 81.6%, P = 0.004). Xpert was more specific than cobas (42.6% versus 39.6%, P = 0.02) and less specific than hc2 (42.6% versus 47.7%, P < 0.001). Similar results were observed for cervical intraepithelial neoplasia grade 3 or higher (CIN3+) (n = 91). HPV16 detection by Xpert identified 41.8% of the CIN2+ specimens with a positive predictive value (PPV) of 54.6%. By comparison, HPV16 detection by cobas identified 42.6% of the CIN2+ specimens with a PPV of 55.0%. hrHPV detection by the Xpert demonstrated excellent clinical performance for identifying women with CIN2+ and CIN3+ that was comparable to that of currently available clinically validated tests.     

HPV mRNA检测在宫颈癌诊断中的研究

根据国际癌症研究机构(IARC)报道,仅在2012年全世界就有超过25万女性死于宫颈癌,这是女性相关癌症的第四大死因[1].不管是生物学研究还是流行病学研究都已经证实宫颈癌与人乳头瘤病毒(HPV)感染息息相关[2]l.单独的HPV感染可能会引起大约5％的病毒相关的癌症发生,但是却是宫颈癌发病的全部因素[3].目前已经有120多种不同基因型的HPV,根据其临床表现可分为低风险型和高风险型,然而只有少数的HPV能够导致癌症的发生[4].本文就HPV致宫颈癌的发生和HPV的实验室检查以及HPV mRNA的相关进展做一些简要论述.     

Evaluation of the Clinical Performance of the cobas 4800 HPV Test in Patients Referred for Colposcopy

The clinical performance of the cobas human papillomavirus (HPV) test for detection of high-grade disease in a colposcopy-referred population was compared with that of Hybrid Capture 2 (HC2). The overall agreement between the tests was 92.3%. Clinical sensitivity and specificity for detection of cervical intraepithelial neoplasia grade 2 or greater (CIN2+) were 90.0% and 55.5% for cobas and 90.5% and 50.2% for HC2, respectively. In conclusion, both tests showed comparable performance for detection of CIN2+.