<i>FAS</i>-670 Gene Promoter Region Polymorphism in Cervical Intraepithelial Neoplasia Grade 3 (CIN 3) and Invasive Cervical Cancer

The human papillomavirus (HPV) is the etiologic agent of genital cancer, but alone it is incapable of inducing oncogenesis. Rather, progression to invasive lesions is associated with host immunity and interference in the process of cellular apoptosis. Among the several genes involved in cell death, theFAS gene appears to be an important factor. The aim of this study was to evaluate whether there is an association between polymorphisms of the FAS-670 gene promoter region and preinvasive and invasive lesions of the cervix. The FAS gene was evaluated for the presence of polymorphisms using polymerase chain reaction and restriction fragment length polymorphism techniques in 225 blood samples for the control group, as well as cervical tissue from patients with cervical intraepithelial neoplasia grade 3 (CIN 3;75 cases) or invasive carcinoma (214 cases). The AG genotype of the FAS-670 gene promoter region was significantly more frequent in women with CIN 3, with an estimated risk of three times (OR = 3.0). No difference, however, was observed in the control group and women with cervical cancer. In women with cancer, the genotypes were similar in the different histological types and degree of tumor differentiation. Assessing allelic distribution (A or G), we observed no difference in frequency of genotypes in studied groups. These data suggest that polymorphism of the promoter region of the FAS-670 gene is associated with increased risk of CIN 3, but not for invasive cancer of the cervix.

Clinical significance of colposcopy on screening cervical intraepithelial neoplasia in cytological negative and smooth cervices

Objective： The aim of the study was to evaluate the clinical value of the video colposcopy in screening cervical intraepithelial neoplasia （CIN） in cytological negative and smooth cervices by optically gynecological examination. Methods： The 1050 women, whose cervices had been shown smooth and cytological negative by optical examine, were examined with electronic colposcopy in gynecological clinic, and biopsy was taken when the double abnormality of aceto-white epithelium and iodine negative, and other abnormal images were shown. A retrospective analysis of these cases was performed. Re. suits： （1） The 514 samples from 458 cases, including 458 samples of abnormal tissues under colposcopy and 56 samples of polyp or polypoid tumors by optically, were examined by biopsy. Among them, 68 samples were found to be CIN, including 11 cases of CINII/CINIII; （2） The 72 of 1050 cases showed the double-abnormality of aceto-white epithelium and iodine nega- tive. Among them, 64 cases were CIN determined by biopsy. And the positive predictive value of the double-abnormality of aceto-white epithelium and iodine negative under colposcopy was 88.9%, with a false negative rate of 3.3%; （3） Among 458 women examined by biopsy, only one of 350 samples from cervical polyp tissue was CIN （0.3%）, while 67 of 164 samples from the tissues with abnormal colposcopic images were found to be CIN （40.9%）, indicating the close relation between abnormal colposcopic findings and CIN; （4） The results of age-distribution analysis showed that, in the 164 cases with abnormal features under colposcopy, the incidence of double abnormality of aceto-white epithelium and iodine negative was higher in the age of sexual activity, just the same as the age distribution feature of CIN; while single abnormality of iodine negative appeared more in the age of over 50 years. Conclusion： Abnormal features displayed by colposcopy, especially the double abnormality of aceto-white epithelium and iodine negative, has an important significance for the screening of cervical precancerous lesions such as CIN. For this purpose, colposcopy examination is necessary even for the cases of cytological negative and smooth cervices.

The association between IgG1,IgG2 subclasses toward human papillomavirus 16-like particles in the serum and cervical intraepithelial neoplasia

Objective:The paper aimed to study the relationship between the expressions of immunoglobulin G(IgG) subclasses toward human papillomavirus 16-like particles(HPV16VLPs) in the serum of patients and different grades of cervical lesions.Methods:The expressions of IgG subclasses in 32 cases of human papillomavirus(HPV) infection,30 cervical intraepithelial neoplasia(CIN I),43 CIN Ⅱ-Ⅲ,and 24 hysteromyoma and chronic cervicitis were examined by ELISA.Results:The absorbance values of HPV16VLPs-IgG,IgG1 increased with the grade of CIN(P < 0.05).The IgG2 dominance(IgG2/IgG1 ratio > 1) from control group was 100%,87.50% for HPV infection group,75% for CIN I group,compared with that from CIN Ⅱ-Ⅲ patients(9.52%)(P < 0.05).The positive rates and absorbance values of HPV16VLPs-IgG,IgG1 and IgG2 from HPV16-DNA positive group were significantly higher than those from non-HPV16-DNA positive group(P < 0.05).There was a moderate correlation between the HPV16-DNA testing and detection of HPV16VLPs-IgG(r = 0.531,P < 0.05).Conclusion:An increase of the expressions of HPV16VLPs-IgG and its subclasses in the serum of the patients with cervical precancerous lesions,especially those with CIN II-III,might be associated with duration of HPV infection and severity of cervical lesions.An increase of the IgG2 dominance(IgG2/IgG1 > 1) in serum from low grade cervical lesions group and normal control group,might indicate the clearance of HPV infection and the regression of cervical lesions.

Relationship between Cell Proliferation and Apoptosis in Cervical Carcinoma

Objective To study the relationship between cell proliferation and apoptosis in cervical carcinoma and its clinical significance. Methods The cell proliferation and apoptosis of cervical epithelial cells in archival formalin-fixed, paraffin-embedded tissue sections of normal cervix, cervical intraepithelial neoplasms (GIN) and cervical squamous carcinoma were tested by using immunohistochemistry assay and DNA nick end-labeling technigue. The proliferation index (PI) and apoptosis index (AI) were calculated and their correlation with clinical and pathological data was analyzed.Results PI was gradually increased, but the AI and AI/PI ratio decreased from normal cervical epithelium, GIN to cervical carcinoma. There was no significant relationship among cell proliferation, apoptosis, clinical stages and pathological grades. High AI was always associated with a poor prognosis of the patients.Conclusion Cell proliferation and apoptosis allow to distinguish among normal epithelium, GIN and cervical carcinoma and are useful for the assessment of the malignant potential of tumor tissues.

Aberrant DNA methylation in cervical carcinogenesis

Persistent infection wit h high-risk types of human papillomavirus(HPV) is known to cause cervical cancer;however,additional genetic and epigenetic alterations are required for progression from precancerous disease to invasive cancer.DNA methylation is an early and frequent molecular alteration in cervical carcinogenesis.In this review,we summarize DNA methylation within the HPV genome and human genome and identify its clinical implications.Methylation of the HPV long control region(LCR) and L1 gene is common during cervical carcinogenesis and increases with the severity of the cervical neoplasm.The L1 gene of HPV16 and HPV18 is consistently hypermethylated in invasive cervical cancers and can potentially be used as a clinical marker of cancer progression.Moreover,promoters of tumor suppressor genes(TSGs) involved in many cellular pathways are methylated in cervical precursors and invasive cancers.Some are associated with squamous cell carcinomas,and others are associated with adenocarcinomas.Identification of methylated TSGs in Pap smear could be an adjuvant test in cervical cancer screening for triage of women with high-risk HPV,atypical squamous cells of undetermined significance,or low grade squamous intraepithelial lesion(LSIL).However,consistent panels must be validated for this approach to be translated to the clinic.Furthermore,reversion of methylated TSGs using demethylating drugs may be an alternative anticancer treatment,but demethylating drugs without toxic carcinogenic and mutagenic properties must be identified and validated.

Screening of premalignant and malignant cervical lesions in underdeveloped countries by using Pap smear as routine investigation in outpatient department

Objective: Papanicolou (Pap) smear screening has dramatically reduced the incidence of invasive cervical cancer worldwide. Pap smear screening is still not widely available in developing countries and therefore cannot be used as mass screening tool. This study was designed to establish the role of Pap smear as a routine investigation for females presented to gynecological department. Methods: It was a hospital based study. Patients attending with complaints including irregular vaginal bleeding, vagina discharge, dyspareunia, low backache or lower abdominal pain and primary or secondary infertility were included in the study. All these patients underwent pap smear. Results: Age of females was 25 to 60 years. Ninety females had dysplasia. Mild to moderate dysplasia was positive in 84 females. Six patients had severe dysplasia suspicious for squamous cell carcinoma (SCC) which was confirmed as invasive SCC on biopsy. All patients with mild to moderate dysplasia were regularly followed at 4 to 6 months. Thirty patients were lost during follow up. Forty had negative smear at 6 months, while fourteen having persistent dysplasia on repeated pap smears were referred for biopsies. Histopathology confirmed invasive SCC in five patients while chronic cervicitis was reported in nine patients. Only two of screened patients with high suspicion for cancer showed false negative results. Directed biopsies done in these confirmed invasive SCC. Conclusion: Pap smear is a useful, simple, non-invasive and reliable screening tool for cervical cancer. It may be practiced as a routine investigation in outpatients in developing countries, where mass screening is not available.

Improved Detection of Cervical Cancer and High Grade Neoplastic Lesions by a Combination of Conventional Cytology and DNA Automated Image Cytometer

OBJECTIVE: To reduce false-negative rates of population based cervical screening programs employing conventional cytology in combination with automated DNA image cytometer. METHODS: Involved cervical samples from a total of 3603 women were taken by a cervix brush and then placed into a fixative solution. The cells were separated from mucus by mechanical and chemical treatment after which they were deposited onto microscope slides by a cytospin. Two slides were prepared from each case;one slide was stained by Papanicolaou stain for conventional cytology examination, while the other slide was stained by a DNA specific and stoichiometric stain. The latter slide was used to determine the relative amount of DNA in the cell nuclei in order to assess the ploidy status of the epithelial cells. Enrolled in the study, 157 women were followed by colposcopy examination where punch biopsies were taken from the visible lesions or from suspicious areas. The results of the conventional cytology were then compared to the DNA image cytometer for all samples. RESULTS: Histopathology diagnosed 51 lesions from the 132 biopsied cases as CIN2 or higher, including 27 CIN2, 16 CIN3 and 8 invasive cancers. Conventional cytology correctly identified 29 of the 51 high grade CIN and in-vasive cancer, while DNA image cytometer correctly identified 38 high grade CIN and invasive cancer using the crite-rion that at least three cells were found on the slide that contained DNA amount in excess of 5c. 42 out of 51 high grade CIN and invasive cancer were found by conventional cytology in combination with DNA image cytometer. Sensitivities were 56.8%, 74.5% and 82.4%, while specificities were 86.2%, 81.5% and 81.5% in conventional cytology, DNA image cytometer and combination both cytology and DNA image cytometer respectively. CONCLUSION: The study demon-strated that screening for high grade neoplastic lesions and cervical cancer by DNA image cytometer or combination of conventional cytology and DNA image cytometer is more sensitive than conventional screening approach.

Correlative analysis between abnormal cervical cytology and pathology of vaginoscopic biopsy or conization

Objectives: To evaluate the predictive value of cervical intraepithelial neoplasia (CIN)III/ carcinoma in situ (CIS) by correlating analysis between abnormal cervical cytologic findings and pathological diagnosis of vaginoscopic biopsies or conization.Methods: Routine cervical cytology screening was performed in 31,634 cases by fluid-based thin-layer method (ThinPrep cytology test, TCT), 948 patients had both abnormal squamous cell appearance by TCT and pathological diagnosis of vaginoscopic biopsies and /or cervical conization. The predictive value of CINIII/CIS were studied retrospectively by correlating analysis of different cytology abnormalities and pathology diagnosis.Results: Cytologically, 1,260 out of 31,634 TCT tests showed abnormal squamous cells appearance, including atypical squamous cell of undetermined significance (ASCUS) 675 cases(2.13%), low squamous intraepithelial lesion (L-SIL) 379 cases(1.20%), high squamous intraepithelial lesion (H-SIL)176 cases(0.56%),cancer 30 cases (0.09%). Among 948 patients with pathological diagnosis, there were CINII-III in 70 cases(7.38%) and CINIII/CIS in 56 cases.(5.91%). The relative risks (RR) of different precancerous TCT results in predicting CIN III/CIS validated by pathology are as follow: AUSCUS 14.7% (95% confidence interval (CI) 8.0-27.0), Lsil 13.9% (95% CI 6.3-30.9), Hsil 126.1 (95% CI 60.6-218.6). The RR of AUSCUS group is not significantly different from that of L-SIL group(P =0.951). However, the RR of CINⅢ/CIS morbidity between the H-SIL or cancer group and the ASCUS or L-SIL group are significantly different (all P value <0.01).Conclusion: Vaginoscopic biopsy could verify pathological CINⅡ-Ⅲ and CINⅢ/CIS from cases with abnormal TCT results. There is significantly greater risk of being CINⅢ/CIS validated by vaginoscopic biopsy in the H-SILpatients,while ASCUS and L-SIL group have the coequal risk.

宫颈LEEP活检对阴道镜检诊断为CINⅠ的再评估

目的 评价阴道镜活检诊断轻度宫颈上皮内瘤样变（CINⅠ）的准确性和全面性。方法 对部分经阴道镜活检诊断为CINⅠ的患者进一步行宫颈环型电切术（LEEP），并根据病理组织学诊断分析最终确诊为中度和重度CIN（CINⅡ、CINⅢ）的机率，CIN的病灶多灶性分布以及CIN累及腺体的情况。结果 （1）153例CINⅠ患者接受LEEP宫颈锥切，术后病理组织学确诊为CINⅡ以上者51例（33．33％），其中CINⅡ25例，CINⅡ～CINⅢ18例，CINⅢ4例。另有4例（2．61％）病理组织学诊断为早期浸润癌。（2）同一宫颈锥切标本中存在2种以上病灶者共有41例，占26．80％（41／153）；其中存在2种病灶者27例，存在3种病灶者14例。（3）在病灶累及腺体的22例患者中，确诊为CINⅡ以上者20例（90．91％），包括CINⅡ9例，CINⅡ～CINⅢ8例，CINm3例。另1例为早期浸润癌。高级别（CINⅡ，CINⅢ）与低级别（CINⅠ）病灶共存于同一病例者有18例，占81．82％；其中9例为3种病灶共存，2种病灶共存者9例，仅4例为单一病灶。（4）宫颈锥切组织边缘病灶累及者7例（4．58％），最终全子宫切除2例（1．31％），均为切缘累及病灶为CINⅡ以上者。结论 CIN具有多病灶共存特点，阴道镜活检范围和深度有其局限性；阴道镜活检病理诊断为CINⅠ者应根据阴道镜检查图象满意度、随访可行性、患者年龄、生育要求等因素综合分析来决定进一步诊疗方案，必要时可行宫颈LEEP锥切或局部切除，以避免阴道镜活检对CINⅡ以上病变的漏诊。

B7-H6在宫颈上皮内瘤变、宫颈癌组织中表达差异及与肿瘤浸润T淋巴细胞、预后的相关性

目的探究宫颈上皮内瘤变、宫颈癌组织中B7同源体6(B7-H6)表达差异与肿瘤浸润T淋巴细胞、预后相关性。方法选取2019年6月—2021年3月60例经病理检查确诊为宫颈癌的手术患者作为研究组,另选同期同年龄段60例宫颈上皮内瘤变作为对照组。比较2组组织B7-H6表达情况(H-score评分)及血清B7-H6水平,并比较研究组不同肿瘤浸润T淋巴细胞浸润程度患者H-score评分、血清B7-H6水平,分析研究组H-score评分、血清B7-H6水平与肿瘤浸润T淋巴细胞浸润程度的相关性。研究组术后随访1年,比较不同预后患者一般资料、H-score评分、血清B7-H6水平,探讨预后影响因素,并分析H-score评分和血清B7-H6水平预测患者预后的价值。结果研究组H-score评分和血清B7-H6水平高于对照组(P<0.01)。研究组肿瘤浸润T淋巴细胞浸润程度0级患者H-score评分、血清B7-H6水平高于1级、2级患者,且1级患者高于2级患者(P<0.05)。研究组H-score评分、血清B7-H6水平与肿瘤浸润T淋巴细胞浸润程度呈负相关(P<0.01)。多因素Logistic回归分析显示,肿瘤直径、国际妇产科协会(FIGO)分期、淋巴结转移、间质浸润深度、H-score评分、血清B7-H6水平均为宫颈癌手术患者预后不良的独立危险因素(P<0.01)。肿瘤直径、FIGO分期、淋巴结转移、间质浸润深度、H-score评分和血清B7-H6水平预测宫颈癌手术患者预后不良的曲线下面积(AUC)分别为0.736、0.726、0.714、0.712、0.842和0.840,H-score评分和血清B7-H6水平预测的AUC分别大于肿瘤直径、FIGO分期、淋巴结转移、间质浸润深度预测的AUC(P<0.05)。H-score评分和血清B7-H6水平在预测宫颈癌手术患者预后不良方面拥有良好的临床效用。结论宫颈癌组织B7-H6表达高于宫颈上皮内瘤变,且宫颈癌组织B7-H6表达、血清B7-H6水平与肿瘤浸润T淋巴细胞浸润程度呈负相关,也是宫颈癌手术患者预后不良的独立危险因素,在预测预后方面具有一定临床价值。

宫颈锥切术后全子宫切除的CINⅢ患者病灶残留相关因素分析

目的 探讨宫颈锥切术后病灶残留的相关因素,为宫颈锥切术后的进一步诊疗提供依据。方法对90例宫颈锥切术后(LEEP术和CKC术)再行全子宫切除的CINⅢ患者进行回顾性分析,探讨患者年龄、HPV感染情况、切缘状态、切缘阳性病变级别以及宫颈锥切方式与病灶残留之间的关系。结果 全部病例治疗后随访42~66月,未发现复发;55例(55/90,61.11%)患者的全宫标本中存在病灶残留;年龄】40岁组(33/47例,70.2%)与≤40岁组(22/43,51.2%)、HPV-H感染组(32/52,61.5%)与HPV-H阴性组(1/2,50.0%)、LEEP术组(49/78,62.8%)与CKC术组(6/12,50.0%)的病灶残留率差异无统计学意义(P】0.05);切缘阳性患者病灶残留率(38/53,71.7%)明显高于切缘阴性患者(17/37,46.0%,P【0.01);切缘病变级别为CINⅡ-Ⅲ患者(27/33,81.8%)病灶残留率明显高于CINⅠ患者(11/20,55.0%,P【0.05)。结论 切缘阳性是CINⅢ病灶残留的危险因素,临床医师可以通过控制切缘阳性从而降低病灶残留,对于切缘阳性患者尤其是切缘高级别病变患者应考虑进一步的治疗及严密的随访。

CINⅡ~ⅢLEEP治疗后随访情况分析

目的：探讨宫颈上皮内瘤样病变（CIN）Ⅱ-Ⅲ患者高频电波刀宫颈电圈环切术（LEEP）治疗的有效性。方法：对CINⅡ-Ⅲ行LEEP手术的73例患者进行为期2—5年的随访，对手术后患者的病灶持续存在和复发等情况进行分析总结。结果：6个月总的治愈率为97．26％，病变持续存在率2．74％，术后1年复发率为2．78％，2年时复发率为1．41％，3年、4年、5年无复发。其中CINⅡ33例，6月治愈率96．97％，病变持续存在率3．03％，1年复发率为0.2年复发率为3．23％；CINⅢ40例，6月治愈率为97．50％，病变持续存在率2．50％，1年复发率5．00％；CINⅡ、CINⅢ在治愈率、病变持续存在率、复发率方面比较差异无显著性（P〉0．05）。结论：LEEP对于CINⅡ-Ⅲ患者的治疗是安全、有效的，但需长期随访，尤其是术后前2年。

中药二黄散对伴有HPV感染的CINⅠ患者宫颈局部微环境的影响

目的研究中药二黄散对伴有HPV感染的CINⅠ患者对宫颈局部免疫状态的影响及治疗效果。方法选取伴有HPV感染的CINⅠ患者100例,将其随机分为二黄治疗组(50例)和对照组1(不作任何治疗,50例),同期50例正常妇女为对照组2。观察不同时间宫颈病变及HPV转归情况,并应用酶联免疫吸附试验测定不同时间的阴道灌洗液辅助性T淋巴细胞(Th细胞)1、2细胞因子水平,其中Thl细胞因子以白细胞介素(IL)2、IFN-γ表示,Th2细胞因子以IL-4、10表示,并结合临床资料进行分析。结果治疗组CINⅠ及HPV不同时间转归率明显高于与对照组1,比较差异均有统计学意义(P<0.05,P<0.01),治疗组患者治疗后IL-2水平均有不同程度升高,与治疗前及对照组1比较,差异均无统计学意义(P>0.05);治疗组患者治疗后IL-4、IL-10水平均无明显变化,与治疗前及对照组1比较,差异也均无统计学意义(P>0.05)。治疗组患者治疗后IFN-γ水平均明显升高,与治疗前及对照组1比较,差异有统计学意义(P<0.01)。结论中药二黄散对伴有HPV感染的CINⅠ患者有较好的治疗作用,其治疗机制可能为:通过调节Th1/Th2的免疫平衡清除HPV病毒,且通过调节Th1细胞因子IFN-γ在宫颈病变发展过程中的作用较IL-2可能更为重要。

IL-23A和IL-17A在CIN及子宫颈癌中的表达及意义

目的探讨白细胞介素23A（interleukin-23A,IL-23A）和IL-17A在不同等级子宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）及子宫颈鳞状细胞癌中的表达水平及相关性。方法收集临床标本89例,其中20例健康对照（无感染或病变）,11例低级别CIN,36例高级别CIN（CINⅡ-Ⅲ）;22例子宫颈鳞状细胞癌。ELISA检测血清及子宫颈分泌物中IL-23A和IL-17A的表达及其相关性。第二代杂交捕获试验检测子宫颈分泌物中人乳头状瘤病毒（human papillomavirus,HPV）DNA的表达情况,分析IL-23A和IL-17A的表达与临床预后及HPV感染的关系。结果与对照组比较,IL-23A和IL-17A在CIN和子宫颈癌分泌物及血清中呈高表达,差异有统计学意义（均P〈0.05）。子宫颈癌患者血清IL-23A与IL-17A的表达呈正相关（r=0.865,P〈0.01）,子宫颈癌患者血清IL-23A、IL-17A高表达患者的生存时间明显缩短（均P〈0.01）。IL-23A和IL-17A的表达与HPV的感染有关（P〈0.01）。结论 IL-23A和IL-17A在子宫颈上皮内瘤变和子宫颈癌中高表达,有望作为早期预测子宫颈病变的生物标志物。

宫颈锥切诊治CINⅢ和宫颈癌Ⅰ_(A1)期临床观察

[目的]探讨宫颈锥切对宫颈上皮内瘤变(CIN)Ⅲ及宫颈癌ⅠA1期的诊治作用。[方法]回顾性分析2002年1月至2004年12月行宫颈锥切术的114例患者的临床资料。[结果]宫颈锥切前多点活检准确率为87.7%(100/114)。宫颈粘连狭窄率为3.2%。21例患者补充全子宫切除术,切缘阳性者标本残留率为28.6%(2/7)、阴性者则为14.3%(2/14)。中位随诊16个月,仅行锥切术的93例患者(切缘阳性者2例、切缘阴性者91例),1例切缘阴性者复发(占1.1%)。11例患者有生育要求,已妊娠9例(81.8%),其中早产率为12.5%(1/8)。[结论]宫颈锥切是一种并发症少的手术方法,可提高CINⅢ、宫颈癌ⅠA1期的诊断准确性并有治疗作用。锥切治疗后复发率低,切缘阳性者易有残留,术后应适当处理及密切随诊。

P16蛋白、HPV L-1壳蛋白在CIN和早期宫颈癌组织中的表达及其筛查价值

目的分析P16蛋白、人乳头瘤病毒(HPV)L-1壳蛋白在宫颈上皮内瘤变(CIN)和宫颈癌中的表达及筛查价值。方法选取2014年1月至2016年6月淮安市妇幼保健院妇产科CIN和早期宫颈癌共50例患者,通过第二代杂交捕获法与免疫组化法分析P16蛋白、HPV L-1壳蛋白在其组织中的表达。结果 P16蛋白在慢性宫颈炎(9.09%)、低度鳞状上皮内病变(52.94%)、高度鳞状上皮内病变(84.21%)及早期宫颈癌(100.00%)中的阳性表达率逐渐升高(χ2=45.38,P=0.00),人乳头瘤病毒L-1壳蛋白阳性表达率亦存在明显差异,分别是18.18%、35.29%、15.79%及0(χ2=12.59,P=0.00);随着病毒载量提高,P16蛋白与人乳头瘤病毒L-1壳蛋白阳性表达率均有所改变(χ2值分别为41.37、32.95,均P<0.01)。在慢性宫颈炎中,P16蛋白表达阳性率与高危型人乳头瘤病毒呈正相关关系(r=0.52,P=0.01);在低度鳞状上皮内病变中,P16蛋白、人乳头瘤病毒L-1壳蛋白阳性表达率与高危型人乳头瘤病毒均呈正相关关系(r值分别为0.58、0.33,均P<0.05);在高度鳞状上皮内病变及早期宫颈癌中,P16蛋白、人乳头瘤病毒L-1壳蛋白阳性表达率与高危型人乳头瘤病毒均未存在显著相关性(r值分别为0.12、0.26、0.62,均P>0.05)。结论 P16蛋白、人乳头瘤病毒L-1壳蛋白表达阳性可作为宫颈癌前病变出现的分子事件,在筛查CIN和早期宫颈癌中的价值较高,临床上值得应用和推广。

EZH2在宫颈上皮内瘤变(CIN)及宫颈癌组织中的表达及意义

目的探讨宫颈上皮内瘤变(CIN)及宫颈癌组织中EZH2的表达及其意义。方法应用免疫组织化学SP法,检测65例宫颈癌、90例CIN、30例正常宫颈组织中EZH2的表达水平。结果在正常宫颈组织、CIN组织、宫颈癌组织中,EZH2阳性表达率分别为13.3%(4/30)、CINⅠ组30.0%(9/30)、CINⅡ组40.0%(12/30)、CINⅢ组56.7%(17/30)和76.9%(50/65)。CIN和宫颈癌中EZH2阳性表达率均明显高于正常宫颈组织,差异均具有统计学意义(P<0.001)。结论 EZH2参与了宫颈癌的发生、发展,可作为宫颈病变早期诊断的生物学指标,可提高宫颈癌的早期诊断率。

血清鳞状上皮细胞癌抗原对子宫颈癌及CINⅢ的诊断价值

目的:探讨血清鳞状上皮细胞癌抗原(SCCAg)在宫颈癌诊断、疗效评估等方面的应用价值。方法:本研究选择了2011年9月—2012年3月天津市中心妇产科医院妇瘤科的住院患者145例,全部为可疑宫颈癌患者,经病理组织学确诊分为宫颈上皮内瘤变(CIN)Ⅲ组55例和宫颈癌组90例。采用化学发光的方法检测患者术前血清SCCAg的浓度,结合临床资料和病理组织学诊断,分析评价SCCAg与临床分期、组织分化程度的相关性及其对宫颈癌的诊断价值,通过术前与术后SCCAg检测值的比较评价其在疗效评估方面的价值。结果:血清SCCAg浓度在CIN组和宫颈癌组中的差异有统计学意义(P=0.000),治疗后SCCAg水平较治疗前显著下降(P=0.000);按国际妇产科联盟(FIGO)分期分组讨论,随疾病的进展,临床分期的加重,SCCAg的数值增高,阳性率亦增高,两者具有正相关性;SCCAg在可疑宫颈癌人群的检测敏感度为71.1%,特异度72.7%,准确度71.7%,阴性预测值60.6%,阳性预测值81.0%;CINⅢ的检测阳性率为27.3%,宫颈鳞癌Ⅰ期患者的检测阳性率为66.7%。结论:SCCAg对宫颈鳞状上皮细胞癌具有诊断价值,对疗效监测及预后判断也有重要临床意义,但在早期诊断方面仍有局限性,与宫颈癌的病理类型、临床分期有关,与组织分化程度无关。

高频电波刀电圈切除术在宫颈CINⅢ及宫颈癌Ⅰ_(A1)诊治中的应用价值

背景与目的:高频电波刀电圈切除术已经广泛应用于宫颈上皮内瘤变(cervical intraepithelial neopla-sia,CINⅢ)的诊治中。本研究主要探讨高频电波刀电圈切除术对CINⅢ及宫颈癌ⅠA1患者的诊治作用。方法:回顾性分析本院2003年1月至2006年10月396例经阴道镜下宫颈活检后病理证实为CINⅢ及宫颈癌ⅠA1且手术治疗的临床资料,将阴道镜下宫颈活检、LEEP(high frequency loop electrosurgical excision procedure)手术后的病理与进一步手术治疗后病理进行分析比较。结果:宫颈多点活检准确率为88.6%(351/396),级别不同程度升高者45例(11.4%);LEEP术前宫颈多点活检准确率88.3%(121/137),级别不同程度升高者16例(11.7%),切缘阳性者标本残留率为10.2%(6/59)、阴性者则为7.7%(6/78);LEEP手术后病理诊断准确率99.3%(136/137),级别不同程度升高者1例(0.7%)。结论:阴道镜下多点活检有一定的假阴性率,LEEP手术可提供完整的病理标本,手术前行LEEP手术有助于提高宫颈CINⅢ及宫颈癌ⅠA1诊治准确性,切缘阳性者易有残留,术后应适当处理。

维吾尔族妇女子宫颈癌和CIN中miRNA-101的表达及其与HPV的关系

目的探讨维吾尔族妇女宫颈上皮内瘤变(CIN)Ⅰ～Ⅲ级和子宫颈癌组织中miRNA-101的表达情况,并分析子宫颈癌中miRNA-101与人乳头瘤病毒(HPV)感染的关系。方法采用锁定核苷酸原位杂交技术(LNA-ISH)检测维吾尔族妇女子宫颈鳞状细胞癌、CINⅠ～Ⅲ级和慢性宫颈炎组织中miRNA-101的表达情况,并对子宫颈鳞状细胞癌中miRNA-101与HPV感染情况进行相关性分析。结果 miRNA-101在慢性宫颈炎,CINⅠ、Ⅱ、Ⅲ及子宫颈癌鳞状细胞中的表达率分别为80.00%、73.33%、46.67%、26.67%及10.00%(χ2=36.295,P=0.000)。子宫颈鳞状细胞癌中miRNA-101与HPV结果呈负相关(R=-0.767,P=0.000)。结论 miRNA-101参与子宫颈鳞状细胞癌的发生、发展,并且与HPV感染有关,miRNA-101可作为子宫颈癌筛查及早期诊断的分子指标之一。