目的:评价宫颈癌基因甲基化检测、高危型人乳头瘤病毒(HPV)检测对宫颈癌筛查的分流作用.方法:分析2020年3月～12月间中日友好医院宫颈病变诊疗中心门诊就诊的机会性筛查女性34例的临床资料.其均有进行阴道镜检查的指征,对她们进行性传播疾病(STD)十联检测、HPV分型(17型)检测、宿主基因SOX-1、PAX-1甲基化检测.根据组织病理学诊断,评价不同检测方案对高级别鳞状上皮内病变(HSIL)的筛查效果.结果:STD十联检测、甲基化检测与高危型HPV检测三者联合检测均为阳性的患者中,87.5％(7/8)的患者组织病理学为HSIL;具有阴道镜检查指征的入选病例中,55.9％(19/34)为HSIL.结论:STD十联检测、高危型HPV17分型检测和宿主基因SOX-1、PAX-1甲基化检测,三者联合可以短时间内、在阴道镜检查取得组织病理学诊断前预测患者罹患HSIL的风险.

目的:探讨人乳头瘤病毒(HPV)感染及抑癌基因甲基化检测在宫颈病变筛查中的作用.方法:分析2019年10月～2020年1月在中日友好医院门诊因HPV感染或液基细胞学检查(LBC)异常而就诊的机会性筛查女性494例,采用聚合酶链反应法(PCR)+导流杂交法测定HPV分型,定量甲基化-特异性PCR测定抑癌基因PAX-1、SOX-1甲基化水平,以组织病理学诊断为金标准,评价其筛查宫颈病变的效果.结果:(1)HPV感染增加≥高级别鳞状上皮内病变(HSIL)病变的发生风险(OR=1.949,95％CI: 1.321～2.875,P＜0.01).(2)HPV16型感染是甲基化阳性、HSIL和SCC的危险因素(均P＜0.01).(3)甲基化阳性的危险因素包括高危型HPV感染、HPV单一感染、HPV持续感染及具有HPV感染病史者(均P＜0.01).(4)联合HPV37分型和甲基化检测筛查≥HSIL病变的敏感性和阴性预测值分别为97.6％和96.3％.结论:抑癌基因甲基化与HPV感染密切相关,是≥HSIL病变的危险因素;甲基化检测作为HPV37分型检测的分流,可提高≥HSIL病变的筛查效果,有望成为宫颈癌筛查的潜在分子标志物.

目的 评估生殖道感染专病门诊性传播疾病(sexually transmitted disease,STD)的感染状况及其与高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)及以上病变的关系.方法 对2019年10月至2020年1月在中日友好医院妇科生殖道感染专病门诊就诊的494例机会性筛查女性子宫颈脱落细胞行STD10联检联合人乳头瘤病毒(human papillomavirus,HPV)37分型检测,采用SPSS 22.0软件对数据进行统计学分析.结果 494例机会性筛查女性人群中,STD10联检的总感染率为48.4％,且随着年龄段的增加,感染率呈下降趋势(x2=14.236,P=0.012).在≤低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)人群中,STD的感染率明显高于≥HSIL人群;在腺细胞相关病变人群中STD的感染率最高(Fisher确切概率法,P＜0.001).沙眼衣原体感染是HPV感染(x2=10.925,P=0.00 1)和高危型HPV感染(x2=11.802,P=0.001)的危险因素;HPV37种亚型的总感染率为63.4％,在55～64岁年龄组女性的感染率最高,为75.8％.子宫颈上皮病变的病程越重,HPV感染率越高,在鳞状细胞癌(squamous cell carcinoma,SCC)和腺细胞癌(adenocarcinoma,AC)人群中,HPV的感染率为100％(Fisher确切概率法,P=0.002).以组织病理学诊断≥HSIL作为子宫颈病变阳性的标准,高危型HPV感染会增加子宫颈病变的发生风险(x2=3.935,P=0.049).结论 成年女性罹患STD的风险高,沙眼衣原体感染可能会增加HPV尤其是高危型HPV感染的发病风险,进而增加HSIL发病的概率.因此,应该将STD的筛查纳入妇产科常规检查.

目的 探讨性传播疾病(sexually transmitted disease,STD) 10联检联合人乳头瘤病毒(human papillomavirus,HPV)分型和宿主基因SOX-1、PAX-1甲基化检测一次性试剂盒在子宫颈癌筛查中的联合应用,评价其对子宫颈病变的筛查效果.方法 对2019年10月至2020年1月在中日友好医院子宫颈病变诊疗中心门诊就诊的机会性筛查女性494例,行STD 10联检联合HPV分型和宿主基因SOX-1、PAX-1甲基化检测,根据其就诊情况获得液基细胞学(liquid-based cytologic test,LBC)及组织病理学诊断,以组织病理学诊断为金标准,评价不同筛查方案对组织病理学诊断阳性的筛查效果.结果 沙眼衣原体感染是HPV感染的危险因素(x2=10.925,P=0.001).HPV感染是甲基化(x2=29.893,P=o.ooo)、LBC (x2=6.607,P=0.012)和组织病理学阳性(x2=12.641,P=0.000)的危险因素.甲基化阳性与LBC (x2=33.647,P=0.000)和组织病理学阳性(x2=41.676,P=0.000)呈现高度的正相关性.HPV分型检测联合甲基化检测进行筛查,可显著提高子宫颈病变的敏感度和阴性预测值,分别为97.6％和96.3％.结论 HPV分型检测联合宿主基因SOX-1、PAX-1甲基化检测进行子宫颈病变筛查是可行的,可以在缺乏细胞学检测条件的地区,替代其对子宫颈癌筛查并起分流作用.

目的:研究配对盒基因1(pax1)在子宫颈组织中的蛋白表达及其临床意义,探讨pax1蛋白与子宫颈癌预后的关系.方法:采用免疫组化法检测中日友好医院2011年8月至2017年10月收治的101例子宫颈癌、120例子宫颈上皮内瘤变(CIN)及20例正常子宫颈组织(对照组)中pax1蛋白表达水平,分析其子宫颈癌临床病理参数,采用受试者工作曲线(ROC)评估其诊断效能并随访,探讨其与子宫颈鳞癌(Scc)及子宫颈腺癌(AC)预后的关系.结果:①对照组的pax1蛋白表达水平(90.0％)高于CIN(73.3％)及子宫颈癌(38.6％),SCC患者pax1蛋白阳性表达率(20.9％)明显低于AC (70.0％)及特殊类型子宫颈癌(100.0％),差异有统计学意义(P＜0.05).②ROC曲线显示,pax1蛋白曲线下面积(AUC)为0.829,诊断子宫颈癌的灵敏度90.0％,特异度61.3％.③pax1蛋白阳性表达率与子宫颈癌患者的HPV感染、分化程度、组织类型及脉管浸润有关(P＜0.05).④Scc患者中pax1蛋白阳性组的生存时间明显高于阴性组(P =0.040),AC患者中pax1蛋白阳性组的生存时间与阴性组比较,差异无统计学意义(P=0.589).结论:pax1蛋白的表达缺失与CIN及子宫颈癌进展密切相关,其诊断CINⅡ及以上的效能较高.pax1蛋白的表达缺失与SCC的发生发展及预后有一定的关系,pax1蛋白有望成为监测SCC患者预后的有效指标.

目的:研究含缬氨酸蛋白p97在宫颈病变中的表达水平,探讨p97蛋白与宫颈癌发生发展的相关性,并分析其对于宫颈癌远处转移及预后评估的临床价值.方法:收集中日友好医院201 1年8月～2017年10月妇科手术标本共259例,其中宫颈癌101例、上皮内病变(CIN)138例(其中CIN1 48例、CIN2 50例、CIN3 40例)、正常宫颈20例.采用免疫组化法检测p97蛋白表达,采用单因素Kaplan-Meier法分析p97蛋白对宫颈癌总生存率(OS)的影响.结果:p97蛋白表达在正常宫颈组、CIN组、宫颈癌组3组间差异均有统计学意义(均P＜0.05),p97蛋白与HPV感染、病理分化程度、肿瘤直径、淋巴转移及SCC值相关(P＜0.05).K-M生存分析结果显示,p97蛋白高表达组的总生存率显著低于p97蛋白低表达组(生存中位数34.27个月vs.51.55个月,P＜0.01).结论:p97蛋白与宫颈癌的发生发展及远处转移密切相关,它有望成为检测宫颈癌病情进展及评估预后的生物标记物.

目的:探索P16在宫颈上皮内瘤变Ⅱ级(CINⅡ)组织中的表达状态及其作为生物标记物对CINⅡ患者进行分流管理和预后判断的临床意义.方法:选取中日友好医院2008年1月～2017年12月宫颈锥切术后病理诊断为CINⅡ的组织学标本158例,应用免疫组织化学法检测P16的表达,取正常宫颈组织40例进行对照研究,并对CINⅡ患者进行术后随访统计.结果:CINⅡ患者宫颈组织中P16阳性表达率为55.7％,显著高于正常宫颈组织中P16阳性表达率(7.5％,P＜0.01).在CINⅡ患者中随机选取37例进行术后随访,P16阳性患者超薄细胞检测(LCT)阳性率72.72％,显著高于P16阴性患者LCT阳性率(15.79％,P＜0.05).P16阳性表达患者的HPV阳性率为75％,显著高于P16阴性表达患者的HPV阳性率(18％,P＜0.05).结论:P16在CINⅡ患者阳性表达提示病情进展风险更高,建议积极进行宫颈锥切诊断治疗,并加强术后随访;P16阴性患者建议暂时观察,避免不必要的手术创伤.

目的:分析妇科门诊就诊人群高危型人乳头瘤病毒(HR-HPV)感染情况及亚型分布特点,以及HR-HPV感染亚型与宫颈液基细胞学(TCT)改变的关系.方法:收集2017年1月～12月中日友好医院妇科6384例患者样本,进行共15种HPV亚型检测和TCT检查.结果:6384例患者标本中HPV阳性率24.11％.单一感染(74.14％)显著高于多重感染(25.86％)(P＜0.01),单一感染与多重感染前3位亚型均为52型、16型和58型.多重感染者TCT阳性率(31.66％)显著高于单一感染(24.45％)(P＜0.01).根据年龄分组后,17～30岁女性HPV阳性检出率最高.根据TBS分组后,HPV在HSIL组阳性率为91.67％,LSIL组为77.65％,ASC组为71.79％,NILM组为19.36％.结论:本研究中HPV感染以单一感染为主;多重感染人群TCT阳性率高于单一感染人群,HPV阳性率与TCT结果的严重程度相关.

目的:探讨HPV E6/E7蛋白在宫颈癌早期筛查方面的临床应用价值.方法:收集2015年11月～2017年11月间中日友好医院妇产科宫颈病变门诊就诊和住院的400例患者,选取其中53例HPV16/18型阳性患者检测E6和E7蛋白的表达,分析其表达水平与组织病理学符合情况.结果:HPV E6蛋白在炎症、CIN 1、CIN 2-3和宫颈癌中的阳性表达率为0、37.5％、64.0％和84.6％;HPV E7蛋白分别为14.3％、37.5％、80.0％和92.3％.随着病变级别增加,HPV E6/E7蛋白的阳性表达率显著增加(P＜0.01).HPV E6、E7蛋白检测的灵敏度(71.1％、84.2％)均高于LCT(63.2％),阳性预测值(90.0％、88.9％)均高于HPV-DNA检测(71.7％).结论:HPV E6/E7蛋白可能成为高度鳞状上皮内病变及宫颈癌的早期检测标志物,其检测可能提高筛查的准确性.

To sum up the diagnosis,etiology,classification,and surgical treatment of oblique vaginal septum syndrome(OVSS).The diversity of clinical manifestations of OVSS increases the difficulty of diagnosis and treatment.In younger patients with pelvic mass,primary dysmenorrheal,and one side renal agenesis,OVSS should be highly suspected.The basic treatment for OVSS is septum resection and drainage,and the correct pre-operative diagnosis is critical.

<正>1引言宫颈癌是一种感染性疾病,也是一种可治愈的疾病。其发病率居女性恶性肿瘤的第二位,生殖道恶性肿瘤的第一位。自从德国学者Harald(2008年诺贝尔奖获得者)在1970年发现HPV引发宫颈

<正>人乳头瘤病毒(human papillomavirus,HPV)感染已被证明是宫颈癌的直接病因[1],Woodman等[2]研究发现其归因危险性达到90%以上。有研究证明,

母乳是婴儿最理想的食品.近年来,我国的纯母乳喂养率却出现了下降的趋势[1],医务工作者母亲作为特殊的职业女性,既是医学知识的提供者,又是医疗行为的指导者,其母乳喂养情况更值得关注.

Objective:To investigate the expression of human telomerase RNA component(hTERC)gene in the cervical shedding cells and determine its value in diagnosis of cervical intraepithelial neoplasia(CIN)and carcinoma.Methods:Two hundred and four patients were examined with liquid-based cytology(LCT),high-risk human papilomavirus(HR-HPV)test by hyrid captureⅡ(HC-Ⅱ),pathological classification for the gold standard and hTERC gene detection by Fluorescence in situ Hybridization(FISH).Results:(1)The expression of hTERC gene were increased significantly in HSIL and above(P0.05).(2)The expression of hTERC gene were increased significantly in different grades of histopathology and significant rise in CINⅡ and above(all P0.01).(3)The more detection rate of HPV DNA,the higher grade in cytology and histology(all P0.01).(4)The detection rate of HPV-DNA was correlated with the expression of hTERC gene positively(P0.01).Conclusion:The hTERC gene expresses in cervical lesions were correlated with the HPV infection and the abnormality of cervical lesion histologically and cytologically.The rate increases positively with the progressive cervical lesions.The expression of hTERC gene may serve as a prognostic indicator to judge high grade lesion.

Objective To investigate the relationship of HR-HPV infection and cervical precancerous lesions.MethodsLiquid-based cytologic test(LCT)and HPV were performed in 948 women in China-Japan friendship hospital from July 2008 to April 2009.For the 367 patients with the abnormal cytological results or positive HR-HPV DNA,biopsy were done under colposcope.ResultsThere was significant difference in HR-HPV infection rates between women younger than 50 years(34.27%)and older than 50 years(18.98%)(P<0.01).Among positive HR-HPV women,there was no significant difference in the ratios of pkemalignancy ≥CIN2 in different age groups(<30、30～49 and ≥50 years old)(P>0.05).ConclusionsIt's important to under follow-up for women with positive HPV DNA of each age group.

The morphological change in the cervix during pregnancy is affected by the elevated level of sexual hormones. This paper described the physiological and pathological change in cervical morphology during pregnancy by use of cellular pathology, colposcopy and histopathology, put forward the main points of diagnosis and management for cervical in-traepithelial neoplasia during pregnancy.

Objective To observe the efficacy of Baofukang suppository for treatment of cervicitis combined with high-risk HPV infection.Methods The objects of observation were outpatients suffered from cervicitis with high-risk HPV infection persisted≥2 years,between January 2007 to August 2009 at China-Japan Friendship Hospital.137 cases of these patients were enrolled in test group,used Baofukang suppository vaginally for three courses (3 months).Additional 131 cases as control group didn't use any drug only given follow-up.1 month later after 3 months medication,all the patients came back accepted gynecological examination,LCT and HCⅡ test.Results 1 month later after 3 months medication,HCⅡ negative rate (38.0%),improved rate of HCⅡ RLU /CO ratio (37.2%) in test group were significantly higher than that in control group (22.1%,18.3%) (P0.01).As considered cervicitis index (LCT index and cervical erosion index),the cure rate (61.3%) and markedly effective rate (29.9%) in test group were significantly higher than that in control group (0,14.5%) (P0.01).Conclusion Baofukang suppository has anti-bacterial,anti-inflammatory and anti-HPV infection efficacy.

Objective To investigate the accordance of Hybrid Capture-Ⅱ(HC-Ⅱ) and real-time fluorescent PCR in detecting high-risk human papillomavirus(HR-HPV) DNA in cytological cervical samples and to investigate the sensitivity and negative predictive values of the two assays in screening high-grade cervical intraepithelial neoplasm.Methods HR-HPV DNA was in parallel detected with HC-Ⅱ and real-time PCR in 877 cytological samples from women underwent liquid-based cytological test.For the patients with the abnormal cytological results or positive HR-HPV DNA,biopsy was performed.Results The two HR-HPV DNA detection methods showed concordant results in 804 of 877 cervical samples(91.7%,Cohen′s Kappa=0.792).For the detection of the high-grade cervical intraepithelial neoplasia,the sensitivity of HC-Ⅱ and real-time PCR was 96.7% and 94.6%,respectively,and the negative predictive values were 99.5% and 99.2% respectively.Conclusions Real-time PCR has good accordance with HC-II for HR-HPV DNA detection and can been used in cervical cancer screening.

Objective:To evaluate the efficacy of liquid-based cytology test(LCT)for cervical cancer screening.Methods:LCT diagnosis of 336 cases with abnormal cervical cytologic results were compared with histopathol-ogy diagnosis.Results:LCT diagnosis of 336 cases included 135 cases of atypical squamous cells(ASC),156 cases of low-grade squamous cervical intraepithelial lesion(LSIL),39 cases of high-grade squamous cervical intraepithelial lesion(HSIL),3 cases of squamous cell carcinoma,2 case of atypical glandular cells and 1 case of adenocarcinoma.The conformity rate of LCT and histopathology diagnosis was 100% in cancer,92.31% in HSIL,69.87% in LSIL.Conclusion:LCT plays a major role for screening of cervical lesions.Comprehensive analysis of the clinical data is important for confirmation of LCT diagnosis.HPV-DNA test combined with LCT is benefit to improve the confirmation of histopathology.