醋白肉眼观察试验在宫颈病变筛查中的价值

目的以宫颈细胞学、阴道镜检查及活检的诊断结果为标准，评价宫颈醋白肉眼观察试验（vision inspection with acetic acid，VIA）在宫颈病变筛查中的价值。方法2006年6月～7月对北京市展览路社区的790位20～54岁有性生活妇女进行宫颈病变筛查。采取每名妇女的宫颈脱落细胞，留做薄层液基细胞学（LCT）检测，然后应用5％醋酸涂抹法，进行宫颈醋白肉眼观察试验（VIA），VIA阳性者行阴道镜检查及活检病理检查；VIA阴性者若宫颈细胞学检测结果异常，再行阴道镜检查及活检病理检查。结果最终有783人纳入试验诊断效果评价分析，总共取了71例活检，病理组织学检查结果显示，宫颈早期浸润癌1例，CINⅢ4例，CINⅡ3例，CINⅠ12例。VIA方法筛查CINⅡ及以上宫颈病变和宫颈癌的灵敏度为62．5％，特异度为95．9％，阳性预测值为13．5％，阴性预测值为99．6％。结论醋白肉眼观察试验筛查宫颈病变的效率接近传统巴氏涂片，但因其方便快捷、价格低廉，在经济不发达地区或低收入人群中有一定应用价值，但是需要注意漏诊和过度治疗问题。     

宫颈癌筛查方法与我国宫颈癌筛查面临的新问题

宫颈癌的发病率居女性生殖道恶性肿瘤的首位.全球每年有近50万宫颈癌新发病例,其中83%发生在发展中国家,我国年新发病例13.15万,占28.8%[1].全世界每年约有29万人死于宫颈癌,我国约有3万人.因此,宫颈癌防治已成为全球性的公共卫生问题.近年来,我国政府采取了一系列有效举措,宫颈癌的预防已从医生行为转向政府或社会与医生的共同行为.值得关注的是宫颈癌发病不仅有上升趋势,而且有明显的年轻化倾向,因而宫颈癌的防治任务仍十分艰巨[2-3].     

胸腔积液细胞块切片免疫组化染色在鉴别肺腺癌与间皮病变 中的价值

目的 探讨胸腔积液细胞块切片免疫组化染色技术在鉴别肺腺癌与间皮病变中的临床价值。 方法 收集具有细胞 异型性的胸腔积液标本共 112 例,每例均制备细胞涂片与细胞块切片行 HE 染色,再选用细胞角蛋白 7（CK7）、癌胚抗原（CEA）、甲状 腺转录因子 -1（TTF-1）、细胞角蛋白 5/6（CK5/6）、钙结合蛋白（CR）等 5 种免疫标记对细胞块切片行免疫组化染色,比较 3 种检测方 法的阳性检出率及不同免疫标记诊断肺腺癌与间皮病变的灵敏度与特异度。 结果 对恶性胸腔积液的阳性检出率,细胞涂片 HE 染 色仅 49.3%,细胞块切片 HE 染色为 69.9%,细胞块切片免疫组化染色达 95.9%。CK7、CEA、TTF-1 在肺腺癌中高表达,CK5/6、CR 在 间皮病变中高表达。TTF-1、CK7、CEA 三者中任意两者（+）且 CK5/6 或 CR（-）对肺腺癌诊断的灵敏度达 100.0%,特异度达 96.8%。 CK5/6 或 CR（+）且 CK7、CEA、TTF-1 三者中任意两者（-）对间皮病变诊断的灵敏度达 100.0%,特异度达 98.6%。 结论 细胞块切 片免疫组化染色与细胞涂片 HE 染色相比可明显提高胸腔积液标本的阳性检出率,选择特异性免疫标记并将其合理搭配,利用不同标 记的互补与反证作用可有效鉴别肺腺癌与间皮病变,临床价值显著。     

人乳头状瘤病毒DNA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状瘤病毒(HR-HPV)的载量与子宫颈上皮内瘤变(CIN)的关系。方法 收集参加横断面普查研究的1997名35～45岁已婚妇女的子宫颈脱落细胞,采用第二代杂交捕获试验(HC2)进行HPV DNA检测,病毒载量由样本的相对光单位(RLU)与标准阳性对照(PC)之比(RLU/PC)来衡量,按照log_(10)RLU/PC分为阴性(<0)、低度载量(0～1.12)、中度载量(1.13～2.23)和高度载量(2.24～3.37)。子宫颈病变按照病理诊断分为正常、CIN1、CIN2～3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 100％(12/12)的SCC、97.3％(72/74)的CIN2-3、58.3％(74/127)的CIN1、11.5％(205/1784)的正常对象HR-HPV DNA检测阳性,各组阳性对象的中位log_(10)RLU/PC分别为2.60、2.32、2.18和1.18。从低度病毒载量与CIN1的危险比值比(OR)为3.8(1.9～7.3)至高度病毒载量与CIN2～3的OR值为865.9(200.1～3738.0),显示出感染病毒载量与子宫颈病变程度呈正相关(P<0.001)。结论 子宫颈HR-HPV病毒载量是影响SCC及癌前病变的重要危险因素。     

高危型人乳头瘤病毒载量与子宫颈病变的关系

Objective To determine the association between viral load of high risk human papillomavirus (HR-HPV) and cervical intraepithelial neoplasia (CIN). Methods Cervical exfoliated cells were collected from 18 186 women aged 17 -59 from six urban areas and eight rural areas when they were screened in the cross-sectional population-based studies from 1999 to 2008. HR-HPV was detected by the Hybrid Capture 2 (hc2) system, and viral load was measured by the ratio of relative light units to standard positive control (RLU/PC). RLU/PC was categorized for analysis into four groups: negative [0, 1.00),low viral load [1.0, 10.00), moderate viral load [10.00, 100.00), and high viral load 100. 00. Cervical lesions were diagnosed by biopsies as normal, CIN 1, CIN 2, CIN 3 and squamous cervical cancer (SCC). Association between HR-HPV viral load and CIN was evaluated by unconditional multinomial logistic regression. Results The HR-HPV infection rate of the population was 14. 51% (2515/17 334). 100. 00% (29/29) of SCC,97. 63% (206/211) of CIN 3,93.43% (199/213) of CIN 2,75.04% (421/ 561) of CIN 1 and 10. 17% (1660/16 320) of normal women were positive for HR-HPV DNA. The median RLUs for the HR-HPV positive women with SCC,CIN 3,CIN 2,CIN I and normal were 320. 85,158. 05, 143. 70,125.34 and 9. 64, respectively. There were significant differences among the distributions of viral loads in each lesion (X2=6190. 40,P<0. 01). The severity of CIN increased with the viral load (X2=5493. 35 ,P<0. 01). Compared with the risks of CINs in HR-HPV negative population,the risks of CINs in low,moderate and high viral loads were increased gradually [OR(95% CI) : CIN 1 : 9. 01 (6. 31 -12. 87), 24.96(18.23 -34. 17) and 68.42(51.40 -91.08); CIN 2:26.44(12.07 -57.95),98. 53 (49. 54 -195.98) and 322. 88(168.62 -618. 27) ; CIN 3 + : 72. 89(24.02 -221.18) ; 343. 58(121.81 -969.09) Was 3115.05,2413.95 and 3098.57, respectively. P<0.01) . In each age group of the HR-HPV positive population,the risks of CIN 2 + in the women with moderate or high viral load were higher than the one with low viral load [OR(95%CI):<35: 4. 71(1.23-18.09) and 15.06(4.40-51.49); 35-: 4.01 (1.62-9.90) and 14.09(6. 15 -32.28); 40-: 3.06(1.52 -6. 16) and 7.78(4.05 -14.95); ≥45: 3. 50(1.36 -9. 01) and 7. 57 (3. 13 -18. 30)], and there was a positive correlation between the risk of CIN 2 + and the viral load (Xtrend2was 51. 33,66. 28,53. 64 and 51.00,respectively. P<0. 01). The risk of CIN 2 + was highest among the women aged 40 -with high viral load [0R(95% CI):2.02 (1.15 -3. 52)]. Conclusion There is strong correlation between the HR-HPV viral load and the severity of CIN, and so is the correlation between the HR-HPV viral load and the risk of CIN 2 +. A moderate to high viral load of HR-HPV should be the major risk factor for the cervical cancer and CIN 2 and CIN 3,and there is a higher risk in the women aged 35 or older than the younger ones. Considering both the age and viral load could help the doctors to manage the screening women more effectively.