目的探讨CT平扫联合临床特征对腹痛伴有附件肿块女性附件扭转的预测价值。方法回顾性选择2家三甲医院2018年1月至2023年9月因腹痛伴有附件肿块行手术的患者,按1∶1匹配扭转组与非扭转组,各53例。由2名放射科医师采用双盲法独立回顾性评...目的探讨CT平扫联合临床特征对腹痛伴有附件肿块女性附件扭转的预测价值。方法回顾性选择2家三甲医院2018年1月至2023年9月因腹痛伴有附件肿块行手术的患者,按1∶1匹配扭转组与非扭转组,各53例。由2名放射科医师采用双盲法独立回顾性评估附件肿块的15个CT征象。采用多因素logistic回归分析筛选高危因素。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估高危因素对附件扭转的预测价值。结果扭转组附件肿块以成熟囊性畸胎瘤最常见(32.1%),非扭转组附件肿块以附件脓肿最常见(20.8%)。两组间年龄、发热比例、白细胞计数、肿块位置、输卵管增厚水肿比例及盆腔积液比例差异均无统计学意义,恶心呕吐及余CT征象差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,恶心呕吐(OR=4.886)、脐凹征(OR=22.733)及漩涡征(OR=43.462)为附件扭转独立相关因素(P<0.05)。恶心呕吐、脐凹征及漩涡征预测附件扭转的曲线下面积(the area under the curve,AUC)分别为0.717、0.802、0.840;三者联合的AUC为0.877,灵敏度为92.45%、特异度84.91%、阳性预测值85.96%、阴性预测值91.84%、准确度88.68%。结论对于伴有附件肿块的女性腹痛患者,恶心呕吐、脐凹征及漩涡征有助于预测附件扭转,三者联合价值最大。展开更多
Background: Herpetic vesicles caused by herpes simplex virus and varicella zoster virus, and hydroa vacciniforme (HV) are characterized by umbilicated vesicule formation. Objectives: To understand the histogenesis of ...Background: Herpetic vesicles caused by herpes simplex virus and varicella zoster virus, and hydroa vacciniforme (HV) are characterized by umbilicated vesicule formation. Objectives: To understand the histogenesis of umbilicated vesicles in herpetic vesicles and HV, we demonstrated the presence of the virus- associated molecules in the lesions, and the pathogenic role of cytotoxic T- lymphocyte (CTL) immune responses. Methods: Phenotyping of infiltrating cells was carried out in biopsy specimens from herpes simplex, varicella, herpes zoster and HV, and compared with nonviral contact dermatitis. Viral antigens and Epstein- Barr virus- encoded small nuclear RNA (EBER) were detected by immunostaining and by in situ hybridization, respectively. Infiltrating CTLs expressing granzyme B and granulysin were determined by double immunostaining using confocal laser scanning microscopy. Results: In all herpetic vesicles, the corresponding viral antigens were observed in the cytopathic keratinocytes, and infiltration of lymphoid cells was present in the upper dermis and around the vessels. In all HV lesions studied, EBER+ T cells made up 5- 10% of the dermal infiltrates and the dermal infiltrates contained almost no CD56 cells. CTLs expressing granzyme B and granulysin were present in both herpetic and HV lesions, in which they made up 10- 30% of the total dermal infiltrates, whereas they comprised less than 5% of the infiltrates of biopsy specimens from nonviral contact dermatitis. Confocal laser microscopic examination demonstrated that both CD4+ and CD8+ T cells expressed granzyme B and granulysin. Conclusions: CD4+ and/or CD8+ CTLs reactive to the virus- infected cells might be responsible for the histogenesis of herpetic and HV lesions characterized by umbilicated vesicles.展开更多
文摘目的探讨CT平扫联合临床特征对腹痛伴有附件肿块女性附件扭转的预测价值。方法回顾性选择2家三甲医院2018年1月至2023年9月因腹痛伴有附件肿块行手术的患者,按1∶1匹配扭转组与非扭转组,各53例。由2名放射科医师采用双盲法独立回顾性评估附件肿块的15个CT征象。采用多因素logistic回归分析筛选高危因素。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估高危因素对附件扭转的预测价值。结果扭转组附件肿块以成熟囊性畸胎瘤最常见(32.1%),非扭转组附件肿块以附件脓肿最常见(20.8%)。两组间年龄、发热比例、白细胞计数、肿块位置、输卵管增厚水肿比例及盆腔积液比例差异均无统计学意义,恶心呕吐及余CT征象差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,恶心呕吐(OR=4.886)、脐凹征(OR=22.733)及漩涡征(OR=43.462)为附件扭转独立相关因素(P<0.05)。恶心呕吐、脐凹征及漩涡征预测附件扭转的曲线下面积(the area under the curve,AUC)分别为0.717、0.802、0.840;三者联合的AUC为0.877,灵敏度为92.45%、特异度84.91%、阳性预测值85.96%、阴性预测值91.84%、准确度88.68%。结论对于伴有附件肿块的女性腹痛患者,恶心呕吐、脐凹征及漩涡征有助于预测附件扭转,三者联合价值最大。
文摘Background: Herpetic vesicles caused by herpes simplex virus and varicella zoster virus, and hydroa vacciniforme (HV) are characterized by umbilicated vesicule formation. Objectives: To understand the histogenesis of umbilicated vesicles in herpetic vesicles and HV, we demonstrated the presence of the virus- associated molecules in the lesions, and the pathogenic role of cytotoxic T- lymphocyte (CTL) immune responses. Methods: Phenotyping of infiltrating cells was carried out in biopsy specimens from herpes simplex, varicella, herpes zoster and HV, and compared with nonviral contact dermatitis. Viral antigens and Epstein- Barr virus- encoded small nuclear RNA (EBER) were detected by immunostaining and by in situ hybridization, respectively. Infiltrating CTLs expressing granzyme B and granulysin were determined by double immunostaining using confocal laser scanning microscopy. Results: In all herpetic vesicles, the corresponding viral antigens were observed in the cytopathic keratinocytes, and infiltration of lymphoid cells was present in the upper dermis and around the vessels. In all HV lesions studied, EBER+ T cells made up 5- 10% of the dermal infiltrates and the dermal infiltrates contained almost no CD56 cells. CTLs expressing granzyme B and granulysin were present in both herpetic and HV lesions, in which they made up 10- 30% of the total dermal infiltrates, whereas they comprised less than 5% of the infiltrates of biopsy specimens from nonviral contact dermatitis. Confocal laser microscopic examination demonstrated that both CD4+ and CD8+ T cells expressed granzyme B and granulysin. Conclusions: CD4+ and/or CD8+ CTLs reactive to the virus- infected cells might be responsible for the histogenesis of herpetic and HV lesions characterized by umbilicated vesicles.
