被动吸烟和宫颈疾病的相关研究

目的:探讨被动吸烟与宫颈癌、宫颈上皮内瘤变(CIN Ⅰ~Ⅱ)发病的相关性。方法:回顾性研究被确诊并收治的原发性浸润性宫颈癌新发病例192例(宫颈癌组),CIN Ⅰ~Ⅱ 142例(CIN组),正常对照组254例(对照组),进行一对一的问卷调查,运用χ2检验和Logistic回归分析对被动吸烟与宫颈疾病发病的相关性进行分析。结果:无论是距诊断或就诊前近10年内还是10年以前,患病组和对照组是否被动吸烟、被动吸烟的持续时间、接触强度都有显著差别(P<0.01)。Logistic回归分析结果显示10年内被动吸烟时间是宫颈癌和CIN Ⅰ~Ⅱ发病危险因素,分娩次数和肿瘤家族史是CIN Ⅰ~Ⅱ的危险因素,高教育程度和年龄低是保护因素。结论:被动吸烟及接触时间、强度是宫颈疾病发病的相关危险因素。     

Can we increase the cervical cancer screening interval with an HPV test for women living with HIV? Results of a cohort study from Maharashtra,India

We are reporting (a) updated incidence of cervical intraepithelial neoplasia (CIN) among women who did not have colposcopic or histopathological disease at baseline and (b) disease outcomes among women treated for CIN and their follow-up HPV status; in a cohort of women living with HIV (WHIV). The median overall follow-up was 3.5 years (IQR 2.8-4.3). The incidence of any CIN and that of CIN 2 or worse disease was 16.7 and 7.0 per 1000 person-years of observation (PYO), respectively. Compared with women who were HPV negative at baseline, women who cleared HPV infection had 23.95 times increased risk of incident CIN 2 or worse lesions (95% CI 2.40-661.07). Women with persistent HPV infection had 138.18 times increased risk of CIN 2 or worse lesions (95% CI 20.30-3300.22). Complete disease regression was observed in 65.6% of the HPV positive women with high-grade CIN and were treated with thermal ablation but HPV persistence was seen in 44.8% of those with high-grade disease. Among those who did not have any disease at baseline and were also HPV negative, about 87% (95% CI 83.79-89.48) women remained HPV negative during consecutive HPV test/s with the median interval of 3.5 years. Long-term surveillance of WHIV treated for any CIN is necessary for the prevention of cervical cancer among them. Our study provides an early indication that the currently recommended screening interval of 3 to 5 years among WHIV may be extended to at least 5 years among HPV negative women. Increasing the screening interval can be cost saving and improve scalability among WHIV to support WHO's cervical cancer elimination initiative.     

妊娠期宫颈上皮内瘤变的监测及治疗

目的研究妊娠期宫颈上皮内瘤变（CIN）的转归,评估细胞学和阴道镜检查用于监测妊娠妇女CIN的安全性。方法对19例妊娠前通过细胞学和/或阴道镜检查诊断为CIN的妇女妊娠期间每3个月进行一次细胞学和阴道镜检查进行随访,并于产后两个月进行细胞学和阴道镜检查的再评估,必要时产后给予宫颈环形电切术（loop electrosurgical excisionp rocedure,LEEP）,如果怀疑微灶浸润,则给予局部活组织检查。结果 8例产前诊断为CINⅠ的妇女中有3例产后病变消退（37.5%）,10例产前诊断为CINⅡ～Ⅲ的妇女中有5例产后病变消退（50%）,有1例妇女发现可疑微管浸润,于妊娠期行局部活组织检查,为早期间质浸润（〈1mm）,无一例产前诊断为CINⅢ的病例产后发现微管浸润（1.5mm）。87.5%的消退病例和60%的病变稳定病例经阴道分娩（P=0.057）。结论经过妊娠有87.5%的CIN消退率,这可能归因于宫颈成熟和阴道分娩过程中发育不良宫颈上皮丢失所致,细胞学和阴道镜检查评估是安全的,局部小面积的活组织检查在可能发生的微管浸润时被推荐使用。     

派特灵治疗宫颈高危型人乳头瘤病毒感染的临床观察

目的探讨派特灵在高危型人乳头瘤病毒（HPV）感染的宫颈病变患者中的临床价值。方法2009年6月至2011年6月在南通市妇幼保健院宫颈门诊行宫颈高频电刀电圈切除术治疗，病理学诊断为宫颈上皮内瘤变Ⅱ-Ⅲ级，术后6个月细胞学、阴道镜检查正常而高危型HPV检测阳性未自然转阴患者40例，随机分为治疗组及对照组；治疗组给予派特灵局部上药，对照组不再进行任何干预治疗。停药3、6个月后再次进行细胞学及高危型HPV—DNA检测。结果治疗组停药3、6个月后抗HPV感染的总有效率为90．0％、90．0％，对照组总有效率分别为30．0％、35．0％，治疗组的疗效明显高于对照组（∥分别为3．779、3．751，均P〈0．01），3个月及6个月后治疗组HPV—DNA负荷量均较治疗前明显下降（‰分别为3．606、4．365，均P〈0．01），对照组无明显疗效（U0分别为0．947、1．407，均P0〉0．05），治疗HPV负荷的改善率明显高于对照组（U。=3．653，U2=3．147，均P〈0．01）。结论派特灵可用以治疗高危型HPV感染。     

Spectrum of HPV types before and after treatment of cervical intraepithelial neoplasia grade 2 and 3

BackgroundTo monitor residual disease after treatment of high grade cervical intraepithelial neoplasia (CIN), cytology together with human papillomavirus (HPV) testing are commonly performed.ObjectivesTo analyse the spectrum of HPV types before and after treatment.Study designThis register-based study included 446 women treated for CIN2 or 3, where cytology samples had been HPV-tested before and after treatment by the use of the MGP-PCR Luminex HPV L1-DNA-assay identifying 39 HPV types, including 12 high risk (HR) HPV types.ResultsBefore and after treatment, 706 and 248 HPV isolates were detected of 36 and 34 different HPV types, respectively. Among all the HR HPV isolates, type-specific persistency was observed among 14% (76/542) after treatment, compared to 34% (31/92) of low-risk (LR) HPV isolates (p < 0.001). Among the potential high risk (PHR) HPV isolates, 8.3% (6/72) persisted. Totally, 99% (440/446) and 40% (179/446) of the women were HPV-positive before and after treatment, respectively. At least one of the 12 HR HPV types was present in 91% (404/446) and 24% (109/446) of the women before and after treatment, respectively (p < 0.0001). HR HPV types were present both before and after treatment among 23% (102/446) of the women, and 16% (71/446) manifested at least one persistent HR HPV type. The sensitivity, specificity and negative predictive value of HR HPV testing for detection of residual high grade squamous intraepithelial lesion (HSIL) was based on the first cytology after treatment, and was 91.7% (95% CI: 61.5%–99.8%), 84.1% (95% CI: 80.0%–87.7%) and 99.7% (95% CI: 98.2%–100.0%), respectively.ConclusionsAbout one out six treated women (16%) manifested at least one persistent HR HPV type, that was associated with recurrent or residual HSIL disease (odds ratio 58.1, 95% CI 7.4–457) (p = 0.0001). Testing for HR HPV demonstrated high sensitivity (92%) for residual HSIL. The higher persistency rate of LR HPV types suggests that they are more likely to be outside the treated area.     

LCT及HR-HPV诊断宫颈病变的临床价值

目的探讨LCT和HR-HPV对宫颈病变的诊断价值。方法对20479例患者行LCT检查,LCT阳性者行HR-HPV检测及电子阴道镜下宫颈活检组织病理检查,以组织病理学结果作为诊断的金标准,比较LCT阳性结果、HR-HPV检测结果与阴道镜下宫颈活检病理结果的符合率。结果1)LCT结果为ASCUS、LSIL、ASCH、HSIL与阴道镜下宫颈活检病理结果的符合率分别为54.55%、62.65%)、88.24%、92.99%。其HR-HPV阳性率分别为71.64%、80.56%、88.24%、92.86%。差异有显著性(P<0.001)。2)HR-HPV阳性组与阴性组比较,高级别宫颈病变的检出率分别为48.14%、17.39%,经卡方检验,P<0.001,差异有显著性。结论高危型人乳头瘤病毒检测对于细胞学诊断为非典型鳞状细胞的患者有重要的分流价值。     

HIF-1α survivin在宫颈上皮内瘤变及宫颈鳞癌中的表达和临床意义

目的：研究缺氧诱导因子-1α（HIF-1α）和生存素蛋白（survivin）在正常宫颈组织、宫颈上皮内瘤变组织（CIN）及宫颈鳞癌组织中的表达及意义。方法应用免疫组化的方法检测HIF-1α、survivin在宫颈鳞癌标本74例、CIN标本40例、正常宫颈标本24例中的表达情况。分析了两者与宫颈鳞癌病理学分级、临床分期及淋巴结转移的关系。结果 HIF-1α、survivin两种蛋白在正常宫颈组织中不表达,但在CIN组和宫颈鳞癌组中阳性表达率逐渐升高;HIF-1α、survivin阳性表达率与宫颈鳞状细胞癌的病理分级,临床分期,淋巴结转移呈正相关;在宫颈癌组织中HIF-1α与survivin的表达程度呈正相关。结论缺氧诱导因子-1α与survivin的阳性表达对恶性肿瘤的发展起着重要作用,对两个指标的联合检测有助于评估肿瘤的恶性程度及判断预后。