Estimation of economic burden throughout course of cervical squamous intraepithelial lesion and cervical cancer in China:A nationwide multicenter cross-sectional study

Objective: Cervical squamous intraepithelial lesion(SIL) and cervical cancer are major threats to females' health and life in China, and we aimed to estimate the economic burden associated with their diagnosis and treatment.Methods: A nationwide multicenter, cross-sectional, hospital-based survey was conducted in 26 qualified hospitals across seven administrative regions of China. We investigated females who had been pathologically diagnosed with SIL and cervical cancer, and included five disease courses(“diagnosis”, “initial treatment”,“chemoradiotherapy”, “follow-up” and “recurrence/progression/metastasis”) to estimate the total costs. The median and interquartile range(IQR) of total costs(including direct medical, direct non-medical, and indirect costs), reimbursement rate by medical insurance, and catastrophic health expenditures in every clinical stage were calculated.Results: A total of 3,471 patients in different clinical stages were analyzed, including low-grade SIL(LSIL)(n=549), high-grade SIL(HSIL)(n=803), cervical cancer stage ⅠA(n=226), ⅠB(n=610), ⅡA(n=487), ⅡB(n=282), Ⅲ(n=452) and Ⅳ(n=62). In urban areas, the estimated total costs of LSIL and HSIL were $1,637.7(IQR:$956.4-$2,669.2) and $2,467.1(IQR:$1,579.1-$3,762.3), while in rural areas the costs were $459.0(IQR:$167.7-$1,330.3) and $1,230.5(IQR:$560.6-$2,104.5), respectively. For patients with cervical cancer stage ⅠA,ⅠB, ⅡA, ⅡB, and Ⅲ-Ⅳ, the total costs were $15,034.9(IQR:$11,083.4-$21,632.4), $19,438.6(IQR:$14,060.0-$26,505.9), $22,968.8(IQR:$16,068.8-$34,615.9), $26,936.0(IQR:$18,176.6-$41,386.0) and $27,332.6(IQR:$17,538.7-$44,897.0), respectively. Medical insurance covered 43%-55% of direct medical costs for cervical cancer patients, while the coverage for SIL patients was 19%-43%. For most cervical cancer patients, the expense was catastrophic, and the extent of catastrophic health expenditure was about twice large for rural patients than that for urban patients in each stage.Conclusions: The economic burden of SIL and cervical cancer in China is substantial, with a significant proportion of the costs being avoidable for patients with LSIL. Even for those with medical insurance, catastrophic health expenditures are also a major concern for patients with cervical cancer, particularly for those living in rural areas.

Expression and clinical significance of Klotho and Beclin1 in cervical squamous carcinoma

Objective:To detect the expression of klotho and beclin1 protein in chronic cervicitis, low grade squamous intraepithelial lesion (LSIL) group, high grade squamous intraepithelial lesion (HSIL) group and cervical squamous cell carcinoma (SCC) group.Methods:Immunohistochemical technique (Envision) was used to detect the expression of Klotho and Beclin1 proteins in each study group. The correlation between the expression of the above two proteins and the pathological features of SCC and the expression of the two proteins in SCC were analyzed.Results: The positive expression rates of Klotho protein in chronic cervicitis group, LSIL group, HSIL group and SCC group were 95%, 92.86%, 65.38%, 27.90%, respectively. The positive rates of Beclin1 protein in chronic cervicitis group, LSIL group, HSIL group were 25.0%, 28.57%, 38.46% and 74.42%, respectively. The differences were statistically significant. The expression of Klotho and Beclin1 in SCC was correlated with the degree of tumor differentiation, but not with the age, figo stage, lymph node metastasis, tumor size, depth of invasion and vessel invasion, but not with the age of the patient, tumor figo stage, lymph node metastasis, tumor size, depth of invasion and vessel invasion. There was no correlation between the expression of klotho and beclin1 in SCC tissues.Conclusion: The abnormal expression of klotho and beclin1 may be related to the development, invasion and metastasis of cervical squamous cell carcinoma.

Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization： a retrospective analysis

The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion （HSIL） patients with positive margin by conization. Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014. All patients underwent secondary conization or hysterectomy within 6 months. The rate of residual lesion was calculated, and the factors associated with residual lesion were analyzed by univariate and multivariate analyses. Among a total of 119 patients, 56 （47.06%） patients presented residual HSIL in their subsequent surgical specimens, including 4 cases of invasive cervical carcinoma （3 stage IA1 and 1 stage IA2 patients）. Univariate analysis showed that patient age 〉 35 years （P = 0.005）, menopausal period 〉 5 years （P = 0.0035）, and multiple- quadrant involvement （P=0.001） were significantly correlated with residual disease; however, multivariate analysis revealed that multiple-quadrant involvement （P=0.001; OR, 3.701; 95%CI, 1.496-9.154） was an independent risk factor for residua! disease. Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens, and those with multiple positive margins may consider re- conization or re-assessment.

Clinical Value of Human Papillomavirus E6/E7 mRNA Testing in Patients with Atypical Squamous Cells of Undetermined Significance and Low-Grade Squamous Intraepithelial Lesion

Objective: To explore the clinical significance of the quantitative detection of human papillomavirus(HPV) E6/E7 mRN A in triage of patients with atypical squamous cells of undetermined significance(ASC-US) and low-grade squamous intraepithelial lesion(LSIL).Methods: A cross-sectional screening study was conducted among women who underwent outpatient gynecological screening at the Obstetrics and Gynecology Hospital of Fudan University from September 2015 to July 2016. A total of 500 patients from our hospital with ASC-US or LSIL based on cytology testing were subjected to HPV DNA and HPV E6/E7 mRNA quantitative analysis.Results: The specificity of the HPV E6/E7 mRNA test for detecting ≥high-grade squamous intraepithelial lesion(HSIL+) was statistically higher than that of the HPV DNA test(61.3% vs. 40.0%, P< 0.05), whereas there was no significant difference in the sensitivity of HPV E6/E7 mRNA test and HPV DNA test(90.0% vs. 95.0%, P > 0.05). The positive rates of HPV in the participants tested by HPV E6/E7 mRNA and HPV DNA were, respectively, 42.8%(214/500) and 62.8%(314/500), with statistical significance(P < 0.05).Conclusions: The HPV E6/E7 mRNA test was slightly less sensitivity than that of the HPV DNA test for diagnosing HSIL+ in patients with ASC-US and LSIL, but the difference was not significant, although the specificity of the former was significantly higher. HPV E6/E7 mRNA detection can effectively reduce overdiagnosis and overtreatment of patients with ASC-US and LSIL and has important clinical value in triage of patients with ASC-US and LSIL.

Large pelvic mass arising from the cervical stump: A case report

BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.

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.

常规器械免举宫经脐单孔腹腔镜全子宫切除术

目的探讨常规器械免举宫经脐单孔腹腔镜全子宫切除术治疗宫颈病变的应用价值。方法选择2021年12月~2023年6月因宫颈高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)或宫颈癌ⅠA1期行腹腔镜全子宫切除术60例,按患者意愿行经脐单孔腹腔镜手术及多孔腹腔镜手术各30例,均使用常规器械,不使用举宫器,比较2组手术指标。结果2组均未出现中转开腹及泌尿系、肠道或大血管等损伤。单孔组出血量较少[(54.6±20.5)ml vs.(67.5±27.0)ml,P=0.041],排气较早[(27.6±8.0)h vs.(32.2±9.0)h,P=0.040],总住院时间较短[(4.4±1.5)d vs.(5.1±1.2)d,P=0.044]。2组子宫重量、手术时间以及术后并发症差异无显著性(P>0.05)。2组切口愈合良好,未出现与穿刺器相关的近期并发症(如穿刺孔感染、出血)或远期并发症(如脐疝、切口疝)。结论免举宫经脐单孔腹腔镜全子宫切除术出血少,术后恢复快,瘢痕最小化,并发症与传统腹腔镜手术相似。

宫颈癌癌组织及外周血单个核细胞中MAGE-A3的表达及其临床意义

目的探究宫颈癌癌组织及外周血单个核细胞(PBMC)中黑色素瘤相关抗原-A3(MAGE-A3)表达及临床意义。方法通过方便抽样选取2020-05至2022-05保定市妇幼保健院及河北大学附属医院收治的因宫颈病变拟行宫颈锥切术或广泛性子宫切除术患者96例,根据术后病理结果分为宫颈癌组和子宫颈鳞状上皮内病变(SIL)组,采用免疫组化法检测病变组织MAGE-A3蛋白表达情况。采用实时荧光定量PCR法检测宫颈病变组织及PBMC中MAGE-A3 mRNA表达水平,分析宫颈癌患者癌组织及PBMC中MAGE-A3mRNA表达与血清肿瘤标志物相关性以及癌组织MAGE-A3蛋白表达与临床病理特征关系。结果宫颈癌癌组织MAGE-A3蛋白表达阳性率与FIGO分期、肿瘤的直径大小、分化程度、淋巴结转移、感染高危型HPV有关(P<0.05),与年龄、病理类型无关(P>0.05)。宫颈癌组癌组织和PBMC中MAGE-A3 mRNA表达水平分别为(1.33±0.46)、(1.70±0.49),均显著高于SIL组(0.59±0.20、0.92±0.33)(P<0.05),血清SCC-Ag[(3.87±1.69)ng/ml]、CA-125[(48.62±15.10)U/ml]均显著高于SIL组[(0.70±0.32)ng/ml、(25.36±8.33)U/ml](P<0.05);宫颈癌组癌组织MAGE-A3蛋白表达阳性率(66.07%)显著高于SIL组(30.00%)(P<0.05);宫颈癌患者癌组织、PBMC中MAGE-A3 mRNA表达水平与血清SCC-Ag、CA-125均呈正相关(P<0.05)。结论宫颈癌患者癌组织及PBMC中MAGE-A3表达均上调,且与患者血清肿瘤标志物水平及病情进展有关,MAGE-A3有望成为早期宫颈癌诊断的重要标志物。

Prognostic value of human papillomavirus 16/18 genotyping in low-grade cervical lesions preceded by mildly abnormal cytology

Histological low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 （LSIL/CIN1） preceded by normal or mildly abnormal cytology is recommended for conservative follow-up, with no separated management. In this study, we assessed the triage value of human papillomavirus （HPV） 16/18 genotyping in 273 patients with LSIL/CINI. HPV16/18 genotyping was performed at baseline and follow-up was at 6-monthly intervals for up to 2 years. At each follow-up, women positive for cytology or high-risk HPV （hrHPV） were referred for colposcopy. Enrollment cytology, HPV16/18 genotyping, and questionnaire-obtained factors were linked to the 2-year cumulative progression rate. Univariate and multivariate analyses were performed taking into account time-to-event with Cox proportional hazard regression. The results showed that 190 cases （69.6%） regressed, 37 （13.6%） persisted, and 46 （16.8%） progressed. HPV16/18 positivity （hazard ratio （HR）, 2.708; 95% confidence interval （CI）, 1.432-5.121; P=-0.002） is significantly associated with higher 2-year cumulative progression rate. Sub-analysis by enrollment cytology and age restricted the positive association among patients preceded by mildly abnormal cytology and aged 30 years or older. Immediate treatment is a rational recommendation for the high-risk subgroup, when good compliance is not assured.

部分微小RNA在宫颈癌患者血清中的表达及早期筛查的意义研究

目的探讨微小RNA(miR)-126-3p、miR-199a-3p、miR-150-5p、miR-221-3p在宫颈癌患者血清中的表达及早期筛查的意义。方法选取2020年12月至2022年12月河北省邯郸市中心医院住院治疗患者及同期于该院行体检的、宫颈癌前筛查未见明显异常的健康女性作为研究对象。根据健康状况不同分为宫颈癌组(61例)、宫颈高级别鳞状上皮内病变(HSIL)组(40例)和对照组(健康女性,40例)。比较组间以上4种miR的相对表达情况差异,分析miR相对表达水平与宫颈癌患者临床及病理指标的相关性及对宫颈癌的预测价值。结果宫颈癌组患者血清中miR-126-3p、miR-199a-3p的相对表达水平低于对照组和HSIL组,miR-150-5p、miR-221-3p的相对表达水平高于对照组和HSIL组,差异均有统计学意义[(0.31±0.06)比(0.50±0.08)、(0.38±0.08),(2.56±0.36)比(3.38±0.51)、(3.25±0.60),(2.91±0.49)比(1.42±0.49)、(2.20±0.53),(3.24±0.96)比(1.83±0.63)、(2.02±0.62)](均P<0.05)。宫颈癌组患者国际妇产科联盟分期Ⅰ期+Ⅱ期和Ⅲ期者血清miR-126-3p、miR-221-3p相对表达水平差异有统计学意义(P<0.05)。miR-126-3p联合miR-199a-3p检测预测宫颈癌的敏感度为95.0%、特异度为76.3%,miR-150-5p联合miR-221-3p检测的敏感度为91.7%、特异度为85.0%。结论miR-126-3p、miR-199a-3p、miR-150-5p、miR-221-3p在宫颈癌和癌前病变患者血清中异常表达,与宫颈癌的发生发展密切相关,对于宫颈癌诊治可能提供新的靶点。miR-150-5p联合miR-221-3p检测预测宫颈癌的敏感度及特异度均较高,可以考虑作为宫颈癌早期筛查的标志物。

宫颈锥切术对患者妊娠结局的影响及不良妊娠结局危险因素分析

背景宫颈高级别鳞状上皮内病变患者锥切术后仍有部分患者有生育需求,对于这部分患者的治疗及术后管理尚未形成临床共识。目的研究宫颈锥切术对宫颈高级别鳞状上皮内病变患者妊娠结局的影响,并分析不良妊娠结局(早产、剖宫产、低体质量出生儿)的危险因素。方法2017年9月1日—2021年12月31日在解放军总医院第一医学中心进行子宫颈锥形切除术并在术后获得活产的患者65例作为观察组,并收集同时期在解放军总医院产科住院生产的正常患者65例作为对照组,比较两组患者的一般资料(年龄、身高、体质量)和妊娠结局(是否早产、分娩方式),观察组再以锥切高度(病理结果)是否>1.5 cm进行分组,分析锥切高度与早产、剖宫产率等妊娠结局的关系,寻找锥切术后不良妊娠结局的危险因素。结果锥切术后妊娠早产率改变(P<0.05)。锥切高度>1.5 cm与≤1.5 cm的剖宫产率、早产发生率差异无统计学意义(P>0.05)。锥切高度>1.5 cm是锥切术后不良妊娠结局的独立关联因素(OR=3.868,95%CI:1.256~11.918)。结论宫颈电刀锥切术后妊娠的早产率增加,对于有生育要求的患者,在切净病灶的前提下可尽量保证锥切高度不超过1.5 cm,在手术半年后备孕,妊娠过程进行严密的监测和必要的宫颈环扎术可避免不良妊娠事件的发生。

阴道灌洗液中炎症因子与CD4^(+)和CD8^(+)T细胞在高级别宫颈鳞状上皮内病变与早期宫颈癌发病中的作用研究

目的:探讨阴道灌洗液中CD4^(+)与CD8^(+)T细胞亚群分布及局部炎症因子水平在高级别宫颈鳞状上皮内病变(high-grade cervical squamous intraepithelial lesions,HSIL)与早期宫颈鳞癌发病中的作用。方法:收集桂林市人民医院高危型人类乳头状瘤病毒(high-risk human papilloma virus,HR-HPV)感染的HSIL患者120例和早期宫颈癌(cervical cancer,CC)患者144例的临床资料。并随机选取未感染HR-HPV的健康女性60例作为对照组。比较3组患者的临床资料、血清和宫颈灌洗液炎症因子(IL-2、INF-γ、IL-10、TNF-α)、CD4^(+)与CD8^(+)T细胞分布与比值。多因素逻辑回归分析HSIL进展至早期CC的影响因素,绘制ROC及校准图对模型评估。结果:对照组、HSIL组与早期CC组患者血IL-2、INF-γ、IL-10、TNF-α水平、CD4^(+)细胞分布、CD8^(+)T细胞分布与CD4^(+)/CD8^(+)比值比较,差异均无统计学意义(均P>0.05);3组患者阴道灌洗液中IL-2、INF-γ、IL-10、TNF-α水平、CD4^(+)细胞分布、CD8^(+)T细胞分布与CD4^(+)/CD8^(+)比值比较,差异均具有统计学意义(均P<0.05),且早期CC组高于HSIL组及对照组(均P<0.05),HSIL组高于对照组(P<0.05)。逻辑回归分析显示,模型2中产次>2次(OR=3.119,95%CI:4.353~6.737)与阴道灌洗液CD4^(+)T细胞百分比(OR=0.327,95%CI:0.188~0.478)(P<0.001,AUC=0.908),模型3中CD4^(+)/CD8^(+)(OR=0.809,95%CI:0.356~1.868)(P<0.001,AUC=0.873)对HSIL发展至早期CC有独立影响;两模型ROC曲线无明显差异(Z=1.550 4,P=0.121)。模型3中仅用CD4^(+)/CD8^(+)就能良好预测,该模型为优,该模型校准曲线与标准曲线接近。结论:HR-HPV感染后,宫颈局部免疫状态参与HSIL及HSIL进展至早期CC,且CD4^(+)/CD8^(+)T细胞比值可作为其独立保护因素。

高级别宫颈鳞状上皮内病变的相关治疗进展

宫颈鳞状上皮内病变是宫颈癌的前期病变,其诊断和治疗一直是医学研究的重要课题。目前针对高级别宫颈鳞状上皮内病变的治疗策略主要包括保守治疗和手术治疗,其中手术治疗在临床被广泛应用,但因育龄期女性担忧有创手术治疗的并发症,对保守治疗的研究仍在继续。本文综述近年来高级别宫颈鳞状上皮内病变的主要治疗方法(如药物治疗、消融治疗和手术治疗)、术后随访策略及预防性疫苗的接种。

个体化量化宫颈锥切术治疗阴道镜检查不充分的子宫颈鳞状上皮内病变的疗效分析

目的 分析对阴道镜检查不充分的子宫颈鳞状上皮内病变(SIL)行个体化量化宫颈锥切术的疗效。方法 192例围绝经期及绝经后阴道镜检查不充分的SIL患者作为研究对象,术前均经B超测量宫颈管长度,然后行个体化量化宫颈锥切术,其中108例行子宫颈冷刀锥切术(CKC)作为CKC组,84例行子宫颈环形电切术(LEEP)作为LEEP组。对宫颈锥切术后病理为高级别鳞状上皮内病变(HSIL)的52例患者追加筋膜外全子宫切除术或宫颈补切术。分析宫颈锥切术后切缘阳性的单因素及HSIL追加筋膜外全子宫切除术或宫颈补切术后残留宫颈病理情况。结果 192例SIL患者行宫颈锥切术后切缘阳性35例,其中CKC组术后切缘阳性率为18.52%(20/108), LEEP组术后切缘阳性率为17.86%(15/84),两组术后切缘阳性率比较,差异无统计学意义(P>0.05)。单因素分析显示,切缘阳性患者病变累及腺体占比65.71%(23/35)高于切缘阴性患者的43.95%(69/157)(P<0.05);而切缘阳性患者与切缘阴性患者的手术方式、高危人类乳头瘤病毒(HPV)感染情况、细胞学、阴道镜病理级别比较差异无统计学意义(P>0.05)。对宫颈锥切术后病理为HSIL的52例患者追加手术, 42例有子宫切除的要求或指征,追加了筋膜外全子宫切除术,其中CKC组18例, LEEP组24例。其余10例据术后病理提示阳性部位追加宫颈补切术,其中CKC组7例, LEEP组3例。追加手术后CKC组及LEEP组残留宫颈阳性率比较差异无统计学意义(P>0.05)。结论 个体化量化的两种宫颈锥切手术治疗围绝经期及绝经后阴道镜检查不充分的SIL疗效无显著性差异,对有保留子宫要求的患者, LEEP也是切实可行的治疗方法。

FAM83A与β-catenin在宫颈病变组织中的表达差异

目的探讨83序列相似成员A(FAM83A)与β-连环蛋白(β-catenin)在宫颈病变组织中的表达差异及潜在临床意义。方法利用UALCAN和GEPIA2.0在线数据库分析FAM83A在正常宫颈和宫颈鳞癌(CSCC)中的表达差异及FAM83A表达与CSCC患者预后的关系,使用LinkedOmics数据库分析FAM83A mRNA共表达基因,利用R语言进行KEGG富集分析。免疫组化方法检测60例正常宫颈组织、80例低级别鳞状上皮内病变(LSIL)、90例高级别鳞状上皮内病变(HSIL)、70例CSCC中FAM83A与β-catenin表达情况。分析FAM83A、β-catenin表达与临床病理特征之间的关系及FAM83A与β-catenin表达的相关性。结果UALCAN数据库分析显示FAM83A在CSCC组织中高表达,GEPIA 2.0数据库分析提示FAM83A高表达者预后不良。LinkedOmics数据库进行KEGG富集分析提示FAM83A的表达与Wnt/β-catenin信号通路的异常激活呈正相关。FAM83A在CSCC中的表达率高于LSIL和正常宫颈组织(P<0.001),而与HSIL相比差异无统计学意义(P=0.401);FAM83A的表达与年龄无相关性(P=0.231),与分化程度(P=0.001)和临床分期(P=0.038)的相关性差异有统计学意义。β-catenin在CSCC中的异常表达率高于LSIL和正常宫颈组织(P<0.001),而与HSIL相比差异无统计学意义(P=0.734);β-catenin的表达与年龄无关(P=0.088),与分化程度(P=0.001)和临床分期(P<0.001)有关,FAM83A与β-catenin表达具有正相关性(P<0.05)。结论FAM83A与β-catenin在HSIL及CSCC组织中均高表达,两者之间表达存在正相关性。FAM83A的高表达与CSCC患者预后存在一定的相关性,可作为判断CSCC预后的潜在标志物。

阴道微生态失衡联合血清HLA-G、HLA-E水平评估HSIL患者CKC术后HPV持续感染价值

目的:探究阴道微生态失衡联合血清人类白细胞抗原-G(HLA-G)、人类白细胞抗原-E(HLA-E)水平对宫颈高级别上皮内瘤变(HSIL)患者冷刀锥切(CKC)术后人乳头瘤病毒(HPV)持续感染的预测价值。方法:回顾性收集2021年1月-2022年12月本院收治HSIL患者137例临床资料,均行CKC治疗并术后随访1年,观察术后HPV持续感染情况,测定阴道微生态及血清HLA-G、HLA-E,分析阴道微生态及血清HLA-G、HLA-E水平与HPV持续感染关系以及评估价值。结果:137例术后1年内HPV持续感染31例(阳性组),HPV持续感染率为22.6%,未持续感染106例(阴性组),两组阴道pH值,阴道菌群密集度、多样性及滴虫阴道炎发生等均有差异,阳性组阴道微生态失衡率高于阴性组,血清HLA-G(19.84±3.53 ng/ml)、HLA-E(75.39±15.83 pg/ml)水平均高于阴性组(16.93±2.96 ng/ml、68.42±12.51 pg/ml),阳性组中阴道微生态失衡者血清HLA-G、HLA-E水平高于阴道微生态正常者(均P<0.05);Spearman相关分析显示,阴道微生态失衡、血清HLA-G、HLA-E水平与术后HPV持续感染呈正相关(r=0.633、0.529、0.608,均P<0.05);受试者工作特征曲线分析显示,阴道微生态失衡、血清HLA-G、HLA-E水平及联合评估术后HPV持续感染的曲线下面积分别为0.601、0.773、0.805、0.885(P<0.05)。结论:阴道微生态失衡联合血清HLA-G、HLA-E水平有对HSIL患者CKC术后HPV持续感染有一定预测价值。

HPV感染患者SIL临床分级与HPV分型关系

目的:探究人乳头瘤病毒(HPV)感染患者子宫颈鳞状上皮内病变(SIL)临床分级与感染HPV分型的关系。方法:将2021年4月-2023年4月本院诊治的HPV感染的SIL患者300例临床资料,依据病变分级分为高级别SIL(HSIL)组100例、低级别SIL(LSIL)组200例。对比两组一般资料、HPV基因型分布,多因素logistic回归分析影响HPV感染者SIL临床分级的危险因素。结果:HSIL组年龄>40岁、性伴侣数≥2个患者占比高于LSIL组,高危型HPV感染率高于LSIL组(P<0.05)。HSIL组中HPV感染率前两位为HPV35(20.0%)和HPV52(17.0%),LSIL组HPV感染感染率前两位为HPV39(19.5%)和HPV33(12.5%)。年龄>40岁、性伴侣≥2个和HPV高危型为影响HPV感染患者SIL临床分级的独立危险因素(P<0.05);结论:年龄大、性伴侣多和HPV分型为高危均为HPV感染患者HSIL风险因素,且HPV35、HPV52、HPV39、HPV33等亚型在SIL病变患者中感染率较高,临床应给予高度重视。

牛碱性成纤维细胞生长因子联合子宫颈LEEP治疗子宫颈鳞状上皮内病变的临床观察

目的:探究子宫颈鳞状上皮内病变(SIL)应用牛碱性成纤维细胞生长因子(bFGF)联合子宫颈环形电切术(LEEP)治疗的效果。方法:采用随机数字表法将2021年1月—2023年8月抚州市第一人民医院收治的80例SIL患者分为研究组(n=40)及对照组(n=40)。对照组采用子宫颈LEEP治疗,研究组予以子宫颈LEEP联合bFGF治疗。对比两组临床疗效、创面愈合情况、炎症因子水平及并发症发生情况。结果:相比于对照组(77.50%),研究组治疗总有效率(97.50%)高,差异有统计学意义(P<0.05)。相比于对照组,研究组阴道出血量少,阴道出血持续时间和阴道流液时间均短,术后C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)水平均低,差异均有统计学意义(P<0.05)。相比于对照组(17.50%),研究组并发症发生率(2.50%)低,差异有统计学意义(P<0.05)。结论:SIL患者应用bFGF联合子宫颈LEEP治疗,效果显著,有助于促进创面愈合,并可降低炎症因子水平和并发症发生率,安全性较高。

重组人干扰素α-2b凝胶对宫颈鳞状上皮内病变人乳头瘤病毒感染患者免疫功能及阴道微生态恢复情况的影响

目的探讨宫颈鳞状上皮内病变人乳头瘤病毒(HPV)感染患者应用重组人干扰素α-2b凝胶治疗的临床效果。方法选取2020年2月至2023年2月丽水市妇幼保健院收治的116例宫颈鳞状上皮内病变HPV感染患者作为研究对象。采用随机数字表法将其分为A组和B组,每组58例。A组给予聚甲酚磺醛栓,B组在A组基础上给予重组人干扰素α-2b凝胶。比较两组治疗3个月后的临床疗效、阴道微生态恢复情况,治疗前、治疗3个月后的免疫功能、C-反应蛋白(CRP)、Toll样受体2(TLR2)、白介素-17(IL-17)、转化生长因子-β(TGF-β)、干扰素-γ(IFN-γ)水平。结果治疗3个月后,B组总有效率高于A组(P<0.05)。治疗3个月后,两组的外周血CD3^(+)、CD4^(+)水平均比治疗前高,且B组大于A组(P<0.05);两组外周血CD8^(+)、辅助性T细胞17(Th17)、调节性T细胞(Treg)、Th17/Treg水平均比治疗前低,且B组低于A组(P<0.05)。治疗3个月后,B组阴道微生态正常或恢复及乳酸杆菌中量或大量的患者占比均高于A组,B组阴道pH低于A组(P<0.05)。治疗3个月后,两组血清TLR2、CRP、TGF-β、IL-17、IFN-γ水平均低于治疗前,且B组小于A组(P<0.05)。结论宫颈鳞状上皮内病变HPV感染患者应用重组人干扰素α-2b凝胶治疗可有效促进阴道微生态恢复,调节相关因子水平,减轻炎症反应,改善免疫功能,提高治疗效果。

小凹蛋白-1、小凹蛋白-2在宫颈鳞状细胞癌及鳞状上皮内病变中的表达及意义

目的探讨小凹蛋白(Cav)-1、Cav-2在宫颈鳞状细胞癌及鳞状上皮内病变组织中的表达及意义。方法收集2016年1月至2020年12月乌鲁木齐市妇幼保健院病理科的宫颈手术切除石蜡包埋组织样本,包括正常组织40例、宫颈低级别鳞状上皮内病变(LSIL)组织样本40例、宫颈高级别鳞状上皮内病变(HSIL)组织样本40例、宫颈鳞状细胞癌组织样本40例。应用免疫组织化学法检测正常组织、宫颈HSIL组织样本、宫颈LSIL组织样本及宫颈鳞状细胞癌组织样本中Cav-1、Cav-2的表达,应用实时荧光定量聚合酶链反应技术检测宫颈鳞状细胞癌和正常组织中Cav-1、Cav-2及上皮-间充质转化相关分子[表皮生长因子受体(EGFR)、上皮钙黏素(E-cadherin)、神经钙黏素(N-cadherin)及波形蛋白(Vimentin)]的信使RNA表达。结果宫颈鳞状细胞癌组Cav-1评分高于正常组、宫颈LSIL组、宫颈HSIL组[6.00(6.00,8.25)分比0.00(0.00,1.00)分、0.00(0.00,1.00)分、0.00(0.00,0.00)分](P<0.05),宫颈HSIL组与宫颈鳞状细胞癌组Cav-2评分均高于正常组和宫颈LSIL组,且宫颈鳞状细胞癌组Cav-2评分高于宫颈HSIL组[9.00(6.00,9.00)分比2.00(2.00,3.00)分](P<0.05)。宫颈鳞状细胞癌组Cav-1表达低于正常组(P<0.05);正常组与宫颈鳞状细胞癌组Cav-2、EGFR、E-cadherin、N-cadherin及Vimentin表达比较差异无统计学意义(P>0.05)。结论Cav-1、Cav-2在宫颈鳞状细胞癌中的表达明显高于宫颈鳞状上皮内病变及正常组织,证实其参与了宫颈鳞状细胞癌的发生发展;Cav-2在宫颈HSIL中的表达明显高于宫颈LSIL和正常组织,故Cav-2可能作为宫颈鳞状上皮内病变分级的鉴别诊断标志物。