目的 评价分析宫腔镜应用于计划生育手术并发症诊治中的效果.方法 方便选择2018年7月-2019年7月深圳市妇幼保健院妇科收治的120例计划生育手术并发症患者,随机分为常规组(n=60例)和观察组(n=60例),常规组采用B超诊治,观察组采用宫腔镜诊治.对比两组患者治疗效果以及各项手术指标.结果 观察组治疗有效率(95.00％)高于常规组(80.00％),组间差异有统计学意义(χ2=6.171,P=0.013).观察组患者的术中出血量(20.11±5.42)mL低于常规组,组间差异有统计学意义(t=16.585,P<0.05).观察组手术时间(32.46±7.19)min及住院时间(2.29±0.73)d比常规组短,组间差异有统计学意义(t=15.309、4.253,P<0.05).结论 在计划生育手术并发症的诊治中应用宫腔镜技术,能提高患者的治疗效果,减少患者的术中出血量,缩短手术时间及住院时间,在临床推广使用中具有较高的价值.

目的 探讨不同性别、年龄及营养状态儿童体成分的差异,为儿童健康评价提供线索.方法 选取2019年1-12月在深圳市妇幼保健院儿童健康科体检的儿童1 185例,年龄3～8岁.所有研究对象均进行身高、体重测量;应用多频生物电阻抗分析仪测量人体成分各指标;分析不同性别、年龄、营养状态与儿童体成分之间的关系.结果 男童的体重、BMI、去脂体重、身体水分及基础代谢率均高于女童,体脂率低于女童(t=2.94、5.05、5.21、4.67、2.88、5.27,P＜0.05);而身高和体脂含量在不同性别组间变化小,差异无统计学意义(P＞0.05).男、女童的体脂含量、去脂体重均随年龄增长而增加,而BMI随年龄增加呈现先降低后(至6～岁)增加的趋势(P＜0.05),按BMI变化趋势,儿童脂肪重聚年龄约5岁.男、女童体脂含量、体脂百分比、去脂体重、均随BMI增加而逐渐递增(男:F=33.28、29.81、33.02,女:F= 28.57、13.38、24.55,P＜0.05).PBF与BMI评价儿童超重和肥胖有较高的一致性(x2= 143.28、99.02,P＜0.05),但PBF的超重及肥胖检出率更高(P＜0.05).结论 不同性别、年龄及营养状态儿童的人体成分存在明显差异,体成分对于儿童超重和肥胖的发生有较好的预警作用,是对儿童健康评价的有益补充.

目的 探讨营养指导对儿童生长发育状况和营养水平的影响.方法 纳入130例2016年3月-2019年3月到深圳市妇幼保健院体检的儿童,按照随机数字表法将130例入组研究对象分为对照组和研究组,每组各65例.对照组儿童给予常规营养指导干预,研究组儿童给予个体化营养指导干预,比较两组生长发育指标、血红蛋白与血清铁、锌水平,以及肥胖与营养不良情况.结果 ①两组干预前胸围、身高及体重等生长发育指标差异无统计学意义(P＞0.05);干预后研究组胸围、身高及体重等生长发育指标均高于对照组,差异有统计学意义(P＜0.05).②两组干预前血红蛋白及血清铁、锌水平比较差异无统计学意义(P＞0.05);干预后研究组血红蛋白及血清铁、锌水平均高于对照组,差异有统计学意义(P＜0.05).③两组干预前后肥胖及营养不良发生率差异均无统计学意义(P＞0.05).结论 个体化营养指导有利于儿童营养状况的改善,促进其生长发育,具有推广价值.

Objective To investigate the effect of combination of histone deacetylase inhibitor (HDACI) Suberoylanilide Hydroxamic Acid (SAHA) combined with human papilloma virus 16 E7-DNA (HPV16E7-DNA) vaccine in the treatment of cervical cancer and its immunological mechanism.Methods The model of mice with TC-1 cervical cancer was made,then on the 5th day after tumor bearing,the mice were randomly divided into HPV16E7-DNA group,SAHA group,SAHA and HPV16E7-DNA group,control group by random number table method.The therapeutic regimen was as followed:HPV16E7-DNA group was given vaccine 5 μg/kg,SAHA group was given SAHA 20 mg/kg,SAHA and HPV16E7-DNA group was given vaccine 5 μg/kg+SAHA 20 mg/kg,the control group was given 100 μL phosphate solutions (PBS).Once every 3 days,total for 4 times.The tumor growth curve was drawn;the amount of CD8+T cells in peripheral blood of mice in each group was detected by flow cytometry;the effects of different doses of SAHA (25.0,12.5 nmol/L) for the expression of H-2Kb of MHC class Ⅰ in TC-1 cells were detected by experiment in vitro.Results Compared with the other three groups,the tumor growth rate in SAHA and HPV16E7-DNA group was significantly slowed down,the amount of HPVE7 specific CD8+T cells in peripheral blood of mice was significantly increased (P ＜0.05).In-vitro experiment showed that compared with control group,the expression of H-2Kb of MHC class Ⅰ in SAHA group was increased significantly (P ＜ 0.05),while there was no significant difference between low dose of SAHA group and high dose of SAHA group (P ＞ 0.05).Conclusion HDACI combined with HPV16E7-DNA vaccine comes into significant anti-tumor effects may be through up-regulating expression of MHC class Ⅰ of the tumor cells and activating the immune response of CD8+T cells,which is expected to be used in the immunotherapy of cervical cancer.

[Purpose] To investigate the effectiveness of HPV16E7-HSP90 DNA vaccine in the treatment of cervical cancer in mice and its immunological mechanism.[Methods] On d5 after challenge of mouse cervical cancer TC-1 cells,mice were divided into two groups:HPV16E7-HSP90 DNA vaccine was intramuscularly injected to tumor-bearing mice in DNA vaccine group (5μ g/mice,q3d ×4),while PBS was injected to mice in control group (100μl/mice,q3d ×4).The tumor volume was measured every 3d after tumor challenge and the tumor growth curve was drawn.The expression of CD8+ T cells in tumor tissue and FAS protein in tumor cells were detected by immunohistochemical method at d8 after the completion of treatment.At the same time,the rate of apoptotic tumor cells was detected by TUNEL method.[Results] The tumor growth rate of the mice in DNA vaccine group was consistently lower than that in the control group (P＜0.05).The expression of CD8+ T cells in the tumor tissues and the expression of FAS in the tumor cells in the DNA vaccine group were significantly higher than those in the control group [(8.76±1.27) vs (5.70±1.40);(8.73±-0.99) vs (5.74+1.47);P＜0.05].The expressions of CD8+T cells in tumor tissues was positively correlated with the expression of FAS in tumor cells (P＜0.01).Meanwhile,the rate of apoptotic tumor cells in DNA vaccine group was significantly higher than that in the control group (57.59％ vs 13.11％,P＜0.05).[Conclusion] HPV16E7-HSP90 DNA vaccine shows a significant anti-tumor effect in tumor-bearing mice,which is associated with up-regulating of the expression of FAS,inducing the apoptosis of the tumor cells and improving the tumor specific immune responses of CD8+T cells.

Objective To investigate the vaginal microbilme characterization in women with human papillomavirus(HPV)16 and 18 infection and high-grade cervical intraepithelial neoplasia(CIN).Methods Three groups were set,including control group(without HPV infection and with colpitis),low-grade CIN group(with HPV 16 or/and 18 infection),and high-grade CIN group(with HPV 16 or/and 18 infection).Virginal microbial composition was determined by using 16S rRNA amplication sequencing and hierarchical clustering analysis among three groups was applied.Rank sum test was used to determine statistical significance.Results Diversity and complexity of bacteria was significantly elevated in high-grade group.Compared with the control,the growth of Lactobacillus crispatus(L.crispatus) and Lactobacillus casei(L.casei) was significantly decreased,while Lactobacillus iners(L.iners) was significantly increased in low-grade CIN group and high-grade CIN group,and both were proportionally correlated to the grade of the disease.Brucella canis(B.canis),as colonized bacteria,was significantly decreased in both low-grade and high-grade CIN groups,and the changes were proportional to the grade of disease.The growth of Dialistersuccinatiphilus(D.succinatiphilus),Gardnerella vaginalis(G.vaginalis) and Prevotellabivia(P.bivia) were significantly elevated and proportional to the grade of disease.Conclusion The diversity and complexity of virginal microbial composition could be significantly expanded in women with HPV infection and high-grade CIN.In contrast to the important role of lactobacillus in virginal health,L.inners could be pathogenic.The colonization of B.canis,D.succinatiphilus,G.vaginalis and P.bivia might be highly correlated with HPV chronic infection and further development of CIN.

目的：：研究宫颈上皮内瘤变( CIN)治疗后随访的手段和方法,包括随访时间、间隔时间和评估手段。方法：2011~2012年在我院进行CIN手术治疗并规律随访的患者685例,随访18~42个月,采用间隔4~6个月进行HPV检测、宫颈液基细胞学检查和阴道镜检查等评估手段,将其结果与设定的3个临床结局[痊愈、HPV持续感染、CIN残留(复发)]比较,分析其相关性并进行统计学分析。结果：术后6月, HPV检测的阴性预测值为97.9％,阳性预测值为42.6％；HPV(-)+TCT(-)的阴性预测值为98.2％,阳性预测值为73.1％；HPV(-)+Colp.(-)的阴性预测值为98.4％,阳性预测值为54.5％。3者检测结果的阴性预测值比较,差异无统计学意义( P>0.05)；阳性预测值以HPV+TCT方法更准确。术后12月复诊患者中,HPV、HPV+TCT和HPV+Colp.检测的阳性预测值分别为69.7％,77.8％,77.8％,均高于术后6个月；而阴性预测值者低于术后6个月。结论：HPV检测是CIN手术治疗后随访和评估较好的手段；6个月内HPV检测阴性对CIN临床预后的阴性预测更准确；HPV阳性预测值与临床结局的关系,HPV与TCT联合检查最准确；12个月的随访阳性结果比术后6个月的结果对残留/复发病例的预测更准确。

Objective To investigate the expression of human papillomavirus E2 mRNA in cervical cytologi-cal specimens as well as the role of that in cervical carcinogenesis and its clinical significance in screening and evalat-ing prognosis of cervical lesions.Methods The expression of E2 mRNA in 582 cases of cervical cytological speci-mens with high risk human papillomavirus infection and cytological diagnosis of NILM,ASCUS and LSIL,was detected by RT -PCR.Thereafter,all cases were divided into the four groups by colposcopy and histopathological confirmation, including 414 cases of cervicitis,95 cases of CINⅠ,51 cases of CINⅡ,20 cases of CINⅢ and 2 cases of invasive cervical carcinoma as well.Results The expression of HPV -E2 mRNA decreased dramatically corresponding with pathological upgrading from groups of cervicitis to invasive cervical carcinoma (χ2 =132.72,P <0.05).The sensitiv-ity,specificity,positive predictive value and negative predictive value of HPV -E2 mRNA for screening potential cervical lesions in group of NILM,ASCUS and LSIL were 77.2%,96.8%,75.6%,96.0% and 81.0%,91.7%, 79.1%,92.6% as well as 95.9%,93.4%,94.7%,95.0% respectively.Conclusion Deletion of HPV -E2 induced by genetic disruption played an important role in the early stage of malignant transformation of cervical epithe-lial cells.Therefore,detection of the levels of HPV -E2 mRNA expression might be clinically valuable for the screen-ing and evaluating of prognosis in cervical lesions.

[目的]总结宫颈高级别CIN术后残留、复发特点,探讨CIN病例术后临床复诊的重要性.[方法]宫颈高级别CIN行锥切手术治疗595例,术后病理诊断残留58例,术后第4个月开始定期随访,随访手段为HPV检测、阴道镜检查、细胞学检查,必要时进行活检及ECC.[结果]595例手术后病灶残留58例,残留阳性率9.75％,其中CIN2残留阳性率1.46％,实际残留率0,HPV持续阳性率0;CIN3残留阳性率14.10％,实际残留率2.05％,HPV持续阳性率1.03％.[结论]高级别CIN术后病理诊断边缘或/和基底有病灶残留,需要在随访中进一步明确,对实际残留病例应把握处理时机及恰当的处理方法.

一、病案摘要<br>　　患者32岁，因大量白色粘稠分泌物伴外阴不适8年，加重1年，于2011年6月10日在深圳市妇幼保健院子宫颈疾病诊治中心就诊。1993年行人工流产时首次妇科检查，发现阴道口两侧、阴道壁、宫颈表面等部位粘膜增厚，呈白色猪油状，弥漫无边界；阴道分泌物检查未见异常；阴道局部药物治疗后，无明显改善及变化。此后，多次因分泌物较多，自觉瘙痒不适去多家医院诊治，均未给予明确诊断，治疗多以冲洗及阴道上药为主。结婚10年，孕1产0，否认家族病史。

[目的]探讨对宫颈细胞ASC-US进行HPV-DNA检测的分层筛查的临床价值.[方法]对2007年5月至2010年1月宫颈细胞学描述为ASC-US,经HPV-DNA检测、阴道镜检查和宫颈组织病理诊断,随访半年以上的资料相对完整的486例病例进行分析.[结果]ASC-US病例中306例为宫颈的一般性感染和湿疣样病变,占62.96％;180例为宫颈上皮内瘤变(CIN Ⅰ～Ⅲ),占37.04％.486例ASC-US中HPV阳性300例.HPV阳性组300例中宫颈上皮内瘤变(CIN) 156例,占61.73％.HPV阴性组186例中CIN 24例,占12.9％,两组比较有显著性差异(P＜0.01).经过6～9个月的追踪观察,HPV阳性组再发CIN 4例,HPV阴性组未出现新CIN病例.[结论]ASC-US与下生殖道HPV感染有关,HPV感染的ASC-US病例有较高的风险伴有CIN.ASC-US病例可根据HPV-DNA检测结果选择临床治疗及处理方法.

目的:评价宫颈局部外用红色诺卡氏菌细胞壁骨架制剂(Nocardia rubra Cell Wall Skeleton,Nr-CWS) 治疗宫颈人乳头状瘤病毒(human papilloma virus,HPV)亚临床感染的疗效.方法:采用双盲随机对照试验设计,将宫颈HPV亚临床感染患者随机分入:实验组36 例,安慰剂组12 例,分别使用Nr-CWS和赋形剂.在治疗前、治疗后4 个月及8 个月,对患者进行宫颈HPV检测,细胞学检查和阴道镜评估,分析Nr-CWS对宫颈HPV亚临床感染的治疗效果.结果:4 个月:治疗组有效率48.57%,对照组有效率25%,两者比较差异有统计学意义(P＜0.05).8 个月:治疗组有效率为65.71%,对照组有效率41.67%,两者比较差异具有统计学意义(P＜0.05).结论:Nr-CWS对宫颈HPV亚临床感染有一定的清除作用.

特应性皮炎(AD)是一种与遗传过敏体质有关的皮肤炎症性疾病.其特征是皮肤干燥,瘙痒剧烈,反复发作,在不同年龄阶段有不同的临床表现,多见于儿童及青少年.成年后亦常伴有哮喘、过敏性鼻炎、过敏性结膜炎及血清总IgE的升高.现分析特应性皮炎患者的血清检测总IgE和特异性IgE,并分析其与疾病严重程度的相关性.

为了解妊娠期出现妊娠多形疹的相关发病因素,调查2005年11月1日至2007年10月30日门诊皮肤科治疗的妊娠多形疹患者53例,与同期产科门诊产检正常中晚期孕妇90例作对照,应用SPSS 13.0中的卡方检验、Fisher确切概率法和Logistic回归进行统计分析.妊娠多形疹相关发病危险因素与孕周、妊娠纹、直接胆红素、总胆汁酸相关,且两组间差异有统计学意义;与年龄、产次、血压、血糖、总胆红素、间接胆红素、乙肝放免、丙酸转氨酶、血钙无相关性.了解妊娠多形疹相关发病因素,有利于孕妇在孕期尤其是孕中期开始注意营养的均衡摄入,减少摄取含糖分高的食物,适当控制体重,减少妊娠纹,及时补充钙剂等,才可能降低妊娠多形疹的发病率.

目的:探讨社区居民妇女进行子宫颈癌筛查的必要性。方法:在街道计划生育服务站每年一度的妇科普查普治中,根据自愿原则,使用液基薄层细胞学(TCT)方法进行子宫颈癌筛查,标本送广州金域医学检验中心检验。对≥不能明确意义的非典型鳞状细胞(ASC-US)者进一步行人乳头瘤病毒(HPV)检测,必要时转诊阴道镜检查,对后续的检查结果进行随访追踪。结果:参加普通妇科检查的社区居民6630人中,有672人进行了TCT的初筛,发现≥ASC-US8.63%;HPV检测了67人,发现异常的有28人;70例转诊阴道镜或行病理检查,共筛查出≥宫颈上皮内瘤变(CIN)Ⅱ级8例,人群CIN现患率1.19%,其中1例为宫颈癌1b期。结论:为保障社区妇女的生殖健康,对社区育龄妇女开展子宫颈癌的筛查十分必要。建议政府在每年一度的妇科普查普治中,加入宫颈癌的筛查项目,想方设法采取措施降低检查费用,将会有更多的社区妇女接受检查而受益。

Objective:To investigate the distribution of human papillomavirus(HPV) infection and the cervical cancer or its precursor(cervical intraepithelial neoplsia,CIN) in different age women,providing evidence for the prevention of cervical cancer.Methods:By cluster sampling,the women who employed at the education system in Futian district of Shenzhen were selected to detect the HPV infection state and cervical cancer or cervical intraepithelial neoplasia(CIN) to evaluate the incidence of HPV infection and cervical cancer or CIN at different age.Results:Of the 2 052 cases,247 were tested HPV positive(12.03%),35 were found CIN I or greater lesion with histology.HPV infection had two peak prevalence at the age between 40 to 44(14.7%) and younger than 30(13.40%).The incidence(2.28%) of CIN I or greater lesion in the group aged between 35 to 44 were obviously higher than others and had significant difference.Conclusion:It is transient for the women aged below 30 years old to have high risk HPV infection.We don't recommend HPV test in women aged below 30 years old as a screening program for cervical cancer and its precursor.The prevention of cervical cancer should emphasize on women aged beyond 35 years old.

[目的]探讨电子阴道镜技术网络化(网络阴道镜)在宫颈癌筛查中的应用。[方法]利用网络技术,建立市区两级电子阴道镜筛查网络以及筛查网络信息系统,开展社区人群宫颈癌的筛查。[结果]观澜社区人群宫颈癌筛查的顺应性由基线的31.11%逐年升高至58.77%;葵涌社区由36.14%上升到51.01%。2009年诊断及治疗时效达标率两个社区分别为75.00%和87.50%。[结论]网络阴道镜在宫颈癌筛查中的应用,可以提高筛查人群的顺应性,可以拓展优质医疗服务的范围,在具有宽带网络的地区可以推荐使用。

目的:探讨妊娠期妊娠多形疹(polymorphic eruption of pregnancy,PEP)的相关发病因素。方法:调查皮肤科门诊PEP患病组43例及同期产科门诊产检晚孕妇无PEP 90例相关发病因素。结果:PEP相关发病危险因素与孕周、妊娠纹、血糖、直接胆红素、总胆汁酸相关(P<0.05);与年龄、产次、乙型肝炎表面抗原、ALT、血钙无相关性(P>0.05)。结论:妊娠多形疹发病趋势随孕妇孕周、妊娠纹增加而增加,与血糖、总胆汁酸数值异常相关。

宫颈癌防治现已成为评价一个国家或地区公共卫生实施情况的重要指标.中国每年有近10万新发病例,并有5万妇女死于宫颈癌[1].宫颈癌是致病因素相对明确的肿瘤,有确切的筛查方法,现仍有很多方法在探索中.医疗资源相对缺乏的发展中国家,如何利用有限资源防治宫颈癌,是一个急待解决的问题.目前,发展中国家用肉眼醋酸/碘试验(VIA/VILI)作为初筛宫颈痛的方法是一项可行的技术.而网络阴道镜技术则足将VIA/VILI与电子阴道镜和网络技术相结合的方法.本研究旨在探讨网络阴道镜技术在宫颈癌初筛中的应用,并对其效果进行评价.

[目的]对宫颈癌早诊早治工作实施有效的管理,探索城市宫颈癌的综合防治方法.[方法]建立"区域性子宫颈癌早诊早治中心",培训宫颈癌专业人员,建设宫颈癌防治队伍,建立宫颈癌筛查点,组建区域性宫颈癌筛查网络.建立阴道镜质量控制体系,对"区域性子宫颈癌早诊早治中心"防治宫颈癌进行效果观察.[结果]自建立"区域性子宫颈癌早诊早治中心"后,开展机会性筛查及早诊早治人数呈明显上升趋势,妇女健康体检进行宫颈癌筛查增加,筛查率提高到91.49%.网络单位宫颈癌筛查、诊断和治疗人数逐年上升,转诊我院治疗的病人占转诊单位应治病人的20.86%～00.00%.二级核查将初筛的阳性率由11.36%～13.91%降到4.83%～5.26%.[结论]建立"区域性子宫颈癌早诊早治中心"可为区域性宫颈癌防治提供技术保障,为本区域妇女提供宫颈癌诊治的优质服务.