Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps

BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.

Clinical efficacy and prognostic risk factors of endoscopic radiofrequency ablation for gastric low-grade intraepithelial neoplasia

BACKGROUND The use of radiofrequency ablation(RFA)has been reported in the treatment of gastric low-grade intraepithelial neoplasia(LGIN).However,its efficacy and prognostic risk factors have not been well analyzed.AIM To explore the efficacy and prognostic risk factors of RFA for gastric LGIN in a large,long-term follow-up clinical study.METHODS The clinical data of 271 consecutive cases from 198 patients who received RFA for treatment of gastric LGIN at the Chinese PLA General Hospital from October 2014 to October 2020 were reviewed in this retrospective study.Data on operative parameters,complications,and follow-up outcomes including curative rates were recorded and analyzed.RESULTS The curative rates of endoscopic RFA for gastric LGIN at 3 mo,6 mo,and 1-5 years after the operation were 93.3%,92.8%,91.5%,90.3%,88.5%,85.7%,and 83.3%,respectively.Multivariate analyses revealed that Helicobacter pylori(H.pylori)infection and disease duration>1 year had a significant effect on the curative rate(P<0.001 and P=0.013,respectively).None of patients had bleeding,perforation,infection,or other serious complications after RFA,and the main discomfort was postoperative abdominal pain.CONCLUSION RFA was safe and effective for gastric LGIN during long-term follow-up.H.pylori infection and disease course>1 year may be the main risk factors for relapse of LGIN after RFA.

Photodynamic Therapy for Low-grade Cervical Intraepithelial Neoplasia(CIN1):A Case Report

As a drug-mechanical combination technology,photodynamic(PDT)can achieve accurate and taurgeted therapy for maligmant tumors and benign diseases through the production of reactive oxygen species,oxygen free radicals or singlet oxygen by photosensitizers at specific wavelengths.Compared with traditional surgery,it has the advantages of selective killing.repeatable teatment,preserving target organ fiunction and so on.The purpose of this study was to explore the clinical value of photodynamic therapy in cervical precancerous lesions by taking the patients with low-grade cervical intaepithelial neoplasia(CIN1)with high-risk human papillomavinus(HR HPV)persistent infection diagnosed by"three-step diagnosis and teatment procedure"as an example.Using HiPorfn as a photosensitizer,photodynamic therapy was performed 48 hours after intavenous drip.Set laser wavelength 630nm,light dose density 137.58J/cm^2,ansmission efficiency 1.42,output power 2w.3cm columnar optical fber was placed around the 2cm in the cervical canal to cover all the lesions,and the inadiation time was 900s(600s in the cervical canal and 300s outside the cervical canal).The patients were given oxygen inhalation for 6 hours after operation,and the patients were observed for itching and other discomfort,and paid attention to avoid light.Photodynamic therapy was performed again in the same way on the second day.After two months of treatment,pathological biopsy showed chronic cervicitis,indicating that the disease had been effectively controlled.Theoretically,although the patient is not the absolhute indication of photodynamic therapy(hat is,meeting CIN Ⅱ or CIN Ⅲ,having fertility requirements and not undergoing surgery),this therapy can remove not only the superficial lesions inside and outside the cervix,but also the potential lesions not found under colposcopy.It can also block the persistent infection of HPV by.inhbting the expression of HPV18,E6 and E7mRNA in Hela cells.In combination with Baofukang suppository,it can block HPV infection.Increase the negative conversion rate of cervical HPV and reduce the probablity of recurence after CIN1 cure.For youmng female patients with persistent HR-HPV infection and fertility requirements,photodynamic therapy is an effective choice for clinical treatment of CIN1.

Differential gene expression profiling of gastric intraepithelial neoplasia and early-stage adenocarcinoma

AIM: To investigate the differentiated whole genome expression profiling of gastric high- and low-grade intraepithelial neoplasia and early-stage adenocarcinoma.

The Role of IL-2, IL-4, IL-10 and IFN-γ Cytokines Expression in the Microenvironment of Cervical Intraepithelial Neoplasia

Objective: To investigate the role of IL-2, IL-4, IL-10 and IFN-γ cytokines in the microenvironment of cervical intraepithelial neoplasia. Methods: 180 patients participating were enrolled in this trial, where 50 cases are in control group, 50 cases are in low-grade squamous intraepithelial lesion (LSIL) group, 50 cases are in high-grade squamous intraepithelial lesion (HSIL) group, and 30 cases have cervical carcinoma. ELISA methods are used to detect the expression of IL-2, IL-4, IL-10 and IFN-γ in the lavage fluid, and all data is analyzed using one-way analysis of variance. Results: The expression of IL-2 and IFN-γ in cervical lavage fluid gradually decreases with the aggravation of the lesion. The expression of IL-4 and IL-10 increases by the aggravation of pathological changes. There were statistically significant differences in IL-2 level among the four groups. IFN-γ levels are significantly different between the cervical cancer group and the other groups, also between HSIL and LSIL group, and between HSIL and the control group, but no statistically significant difference was observed in IFN-γ e between LSIL and the control group. The expressions of IL-4 and IL-10 between the cervical cancer group and the other groups were significantly different, and also between HSIL and the control group. But there was no statistically significant difference between LSIL and the control group, HSIL and LSIL. Conclusion: The cytokines of IL-2, IL-4, IL-10 and IFN-γ in the microenvironment of the cervix play an important role in the occurrence and development of cervical intraepithelial neoplasia. This study may provide the evidence for diagnosis and treatment of cervical intraepithelial neoplasia.

Optimal management of biopsy-proven low-grade gastric dysplasia

Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia(LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric highgrade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection(ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection(ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.

激光联合干扰素治疗对阴道上皮内瘤变患者阴道微生态、炎症因子及预后的影响

目的分析激光联合干扰素对阴道上皮内瘤变(VAIN)患者的阴道微生态、炎症因子以及预后的影响。方法60例VAIN患者,按随机数字表法分为对照组和研究组,每组30例。对照组患者通过二氧化碳(CO_(2))激光治疗,研究组患者通过CO_(2)激光联合干扰素治疗。比较两组患者临床治疗效果;并发症发生情况;治疗前后炎症因子指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、Toll样受体2(TLR2)];生存素(Survivin)、增殖细胞核抗原(Ki-67)阳性表达情况。结果研究组患者的临床治疗总有效率96.67%高于对照组的73.33%,差异有统计学意义(P<0.05)。治疗后,研究组患者的TNF-α(9.66±0.43)ng/L、IL-10(8.83±0.54)ng/L、TLR2(6.31±0.29)ng/L均低于对照组的(12.09±0.78)、(10.79±1.36)、(7.95±0.46)ng/L,差异有统计学意义(P<0.05)。治疗后,研究组患者Survivin阳性表达率(24.45±2.97)%、Ki-67阳性表达率(20.71±2.49)%低于对照组的(36.21±3.96)、(40.58±3.83)%,差异有统计学意义(P<0.05)。研究组并发症发生率为6.67%(2/30),与对照组的10.00%(3/30)比较,差异无统计学意义(P>0.05)。结论针对VAIN患者给予VAIN患者激光联合干扰素治疗的临床效果更佳,能够有效改善炎症因子指标及Survivin、Ki-67表达情况,减少患者并发症的发生,值得推广应用。

Risk factors for the development of vaginal intraepithelial neoplasia

Background Vaginal intraepithelial neoplasia （VAIN）, as a precursor of vaginal cancer, is a rare disease. Its prevalence has not been well analyzed. This research is to ascertain the risk factors for VAIN in a Chinese population. Methods A case-control study was conducted, including 63 VAIN cases and 64healthy controls. In all subjects Pap smear and HPV tests were performed. A questionnaire survey was distributed, covering information on socio-demographic characteristics, smoking, past history, reproductive and sexual histories. The clinical pathological data were collected from medical records including symptoms, Pap smear results, grade of lesions, and human papillomavirus （HPV） status. Results Postmenopausal women had a 2.09 times higher risk for VAIN than pre-menopausal women （95% CI： 1.10-3.85; P=-0.024）. The patients with previous hysterectomy had an increased risk of VAIN （OR=4.69; P=0.003）. Patients with a history of cervical cancer or CIN were predisposed to VAIN （OR=78.75; P 〈0.0001）. The rate of HPV infection in VAIN was significantly higher than in controls, and an increased risk of VAIN was observed in patients with higher viral load （OR=126.00; P=0.000）. Multivariate analysis showed that HPV infection and a history of CIN or cervical cancer were still found to be significant in patients. Conclusion HPV infection and a history of CIN or cervical cancer are the main risk factors for the development of VAIN.

人乳头瘤病毒感染情况、阴道微环境指标与宫颈病变的相关性分析

目的探讨人乳头瘤病毒(HPV)感染情况、阴道微环境指标与宫颈病变的相关性。方法选取2022年1月至2023年4月该院收治的307例宫颈病变患者作为研究对象,按照其液基细胞学检查(TCT)和病理检查结果分为低级别上皮内瘤变(LSIL)组(169例)、高级别上皮内瘤变(HSIL)组(97例)和宫颈癌组(SCC)(41例);另选取同期该院200例TCT结果正常无宫颈病变的健康体检者作为对照组。对所有研究对象进行HPV和阴道微环境检测。采用Spearman相关对宫颈病变严重程度与年龄的相关性进行分析。结果宫颈病变严重程度与年龄呈正相关关(r=0.306,P<0.05)。HPV感染率较高的型别依次为16、52、58、53型。LSIL组、HSIL组和SCC组HPV多重感染率均高于对照组,HSIL组和SCC组均高于LSIL组,差异均有统计学意义(P<0.05);SCC组HPV多重感染率与HSIL组比较,差异无统计学意义(P>0.05)。酸碱度(pH)、过氧化氢(H 2O 2)、白细胞酯酶(LE)异常比例均为SCC组>HSIL组>LSIL组>对照组,且SCC组、HSIL组和LSIL组与对照组比较,差异均有统计学意义(P<0.05)。阴道清洁度异常比例为SCC组>HSIL组>LSIL组>对照组,LSIL组阴道清洁度异常比例与对照组比较,差异无统计学意义(P>0.05),HSIL组和SCC组阴道清洁度异常比例与对照组比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,阴道pH>4.5、LE阳性、清洁度为Ⅲ°~Ⅳ°增加了宫颈病变发生的风险,H 2O 2阳性对宫颈病变的发生有抑制作用。结论HPV感染、阴道微环境指标异常改变与宫颈病变的发生和发展存在一定的相关性,可为临床预防和治疗宫颈病变提供参考依据。

基于阴道菌群构成变化的宫颈上皮内瘤变恶性转归风险预测模型的构建及其临床价值

目的:探讨宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)恶性转归的危险因素,构建风险预警模型并探讨其临床应用价值。方法:选取2017年01月至2019年10月在本院收治的112例CIN患者为研究对象,分为CIN恶性转归组(n=56)和CIN组(n=56)。通过Illumina MiSeq平台分析阴道菌群分布特征;采用多因素Logistic回归分析CIN恶性转归的危险因素,构建风险预警模型并转化为风险评分系统;采用Hosmer-Lemeshow拟合优度检验和受试者工作特征(receiver operating characteristic,ROC)曲线评估模型的拟合程度和风险预测效能;采用10-折交叉法对模型进行内部和外部验证。结果:CIN恶性转归组加德纳菌属、普雷沃菌属、嗜胨菌属、解脲脲原体及纤毛菌属的菌群丰度显著高于CIN组,其特征菌群为解脲脲原体和普雷沃菌属;两组研究对象高危HPV持续感染、病变面积/宫颈面积比值、腺体受累情况、解脲脲原体以及普雷沃菌群分布情况进行比较,差异具有统计学意义(χ^(2)=22.501、9.190、17.308、4.356、4.323,均P<0.05);高危HPV持续感染、病变面积/宫颈面积比值≥2/3、腺体受累、解脲脲原体以及普雷沃菌属感染是CIN恶性转归的风险因素(均P<0.05);模型组ROC曲线下面积为0.809[95%CI(0.724~0.877),P<0.001],验证组ROC曲线下面积为0.820[95%CI(0.736~0.886),P<0.001];Hosmer-Lemeshow拟合优度检验数据显示模型组拟合度较好(χ^(2)=4.3283,P=0.2281),验证组拟合度较好(χ^(2)=6.3307,P=0.1758)。结论:基于阴道菌群构成变化构建的CIN恶性转归风险预警模型具有较好的预测效果,可为宫颈癌的预防及干预提供针对性的指导价值。

基于“主客交”学说论阴道微生态与宫颈上皮内瘤变的关系

试从吴有性《瘟疫论》中“主客交”学说阐述阴道微生态与宫颈上皮内瘤变的关系。本文认为,“主”素有任脉不固、带脉失约以致阴道微生态失衡,“客”乃湿热、阴虚、血瘀等致病因素,主客交浑而致宫颈上皮内瘤变。正愈虚,则邪愈盛,使疾病进展,病邪久留,乘精血之衰而深入阴分和血脉之中,并与瘀滞之气血互结,是宫颈上皮内瘤变进展且最终发展为宫颈癌的重要病机。在治疗宫颈上皮内瘤变上,应初起“未病先防,既病防变”,“扶正祛邪”一以贯之;继而兼以清热利湿,行气活血;病瘥后注重调护,维持阴道微生态稳定。

阴道内镜诊治子宫切除术后阴道上皮内瘤变效果

目的:探究阴道内镜在诊治子宫切除术后阴道上皮内瘤变(VAIN)中的应用价值。方法:回顾分析本院2020年10月-2022年10月收治的120例子宫切除术后VAIN患者资料,均为术后复查发现薄层液基细胞学结果异常及(或)高危人乳头瘤病毒(HPV)阳性患者,所有患者均接受阴道镜及阴道内镜检查。以最终病理诊断为标准,探究阴道内镜在诊断子宫切除术后VAIN中的诊断价值。结果:120例子宫切除术后VAIN患者,共计167处病变,其中阴道壁125处(74.9%),阴道顶角42处(25.1%);高级别鳞状上皮内病变(HSIL)113处(67.7%),低级别鳞状上皮内病变(LSIL)54处(32.3%);VAINⅠ级54处(32.3%),Ⅱ级74处(44.3%),Ⅲ级39处(23.3%);有宫颈上皮内瘤变(CIN)病史65例(54.2%),合并高危HPV阳性89例(74.2%)。阴道镜联合阴道内镜检查VAIN检出率、不同程度VAIN检出率均高于单纯阴道镜检查,差异有统计学意义(P<0.05);阴道镜联合阴道内镜检查阴道顶角VAIN检出率高于单纯阴道镜检查,差异有统计学意义(P<0.05),而阴道壁VAIN检出率差异无统计学意义(P>0.05);120例VAIN患者随诊观察45例(37.5%),CO_(2)激光汽化治疗39例(32.5%),药物治疗27例(22.5%),阴道局部切除手术治疗9例(7.5%),89例合并高危HPV患者均接受抗HPV治疗。结论:联合阴道镜与阴道内镜检查有助于提高子宫切除术后VAIN检出率,有利于指导疾病管理措施,保证患者生命健康。

CIN Ⅲ级患者阴道菌群生态平衡与LEEP术后复发关系探讨

目的:探讨宫颈上皮内瘤变(CIN)Ⅲ级患者阴道菌群生态平衡情况及其与宫颈环形电切术(LEEP)术后复发的关系。方法:回顾性收集本院2018年1月-2023年12月接受LEEP治疗的200例CIN Ⅲ级[高危型人乳头瘤病毒(HR-HPV)均为阳性]患者临床资料为观察组,体检健康女性50例为对照组,均接受阴道微生态检测,对比观察组手术前后、对照组体检时阴道微生态相关指标。依据LEEP术后2年复发与否将观察组分组,对比复发组与未复发组术后阴道微生态相关指标及其他临床资料,logistic回归分析LEEP术后复发的危险因素。结果:观察组术前阴道菌群密集度多样性Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级及过氧化氢(H_(2)O_(2))阳性比例均低于对照组,阴道pH值、白细胞酯酶(LE)/唾液酸苷酶(SNA)LE/SNA阳性比例均高于对照组;术后阴道菌群密集度/多样性Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级及H_(2)O_(2)阳性比例均较术前增大,阴道pH值、LE/SNA阳性比例均较术前减小(均P<0.05)。观察组LEEP术后2年复发率为10.0%,复发组术后阴道菌群密集度/多样性Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级及H2O2阳性比例均低于未复发组,阴道pH值、LE/SNA阳性、绝经、术前HPV多重感染、术前HR-HPV病毒载量≥100 RLU/CO、病变累及阴道壁、手术切缘阳性、术后HR-HPV持续感染比例均大于未复发组(均P<0.05);logistic回归分析,阴道菌群密集度Ⅱ~Ⅲ级、乳杆菌分级Ⅰ~Ⅱa级是术后2年复发的保护因子(P<0.05),高pH值、HR-HPV持续感染是危险因子(P<0.05)。结论:CINⅢ级患者术前阴道菌群生态多失衡,LEEP能有效改善患者阴道菌群生态,但术后仍有复发风险,且复发与LEEP术后阴道菌群密集度、乳杆菌分级、pH值、术后HR-HPV持续感染有关。

高危型人乳头瘤病毒感染引发的宫颈上皮内瘤变患者阴道微生态情况及影响因素分析

目的探讨高危型人乳头瘤病毒(HR-HPV)感染引发的宫颈上皮内瘤变(CIN)患者阴道微生态情况及影响因素。方法选取2018年5月至2019年6月石家庄市妇幼保健院收治的296例CIN患者作为研究对象,根据HR-HPV检测结果分为感染组(n=260)与未感染组(n=36)。比较两组阴道微生态情况,采用Logistic回归分析CIN患者发生HR-HPV感染的影响因素。结果HR-HPV感染发生率为87.84%。感染组初次性生活年龄<18岁、性伴侣数量≥3名发生率,唾液酸苷酶、过氧化氢酶、脯氨酸氨基肽酶、细菌性阴道炎(BV)、支原体阳性率,以及阴道清洁度、菌群多样性异常率均高于未感染组(P<0.05)。初次性生活年龄<18岁、性伴侣数量≥3名、唾液酸苷酶、过氧化氢酶、脯氨酸氨基肽酶、BV、支原体阳性、阴道清洁度、菌群多样性异常是CIN患者发生HR-HPV感染的影响因素(OR>1,P<0.05)。结论HR-HPV感染与CIN患者阴道微生态情况密切相关,阴道微生态、菌群多样性异常可增加HR-HPV感染风险。

阴道微环境失衡对HPV感染及宫颈病变的影响

目的评估阴道微生态环境失衡对高危型人乳头瘤病毒(HR-HPV)感染、宫颈上皮内瘤变(CIN)及子宫颈癌的影响。方法对接受检查的2469名女性的宫颈脱落细胞进行HPV基因分型检测、阴道微环境常见菌群革兰染色镜检、液基薄层细胞学检测(TCT)和病理活检观察病变组织及细胞形态,根据是否感染HPV、发生CIN或癌变分组,采用χ^(2)或Fisher精确检验及多因素logistics回归分析探讨阴道微环境与HR-HPV感染、CIN的发展以及子宫颈癌之间的关系。结果单一HR-HPV型的阳性率为12.31%,两种及以上的混合感染率为3.85%,以HPV16、HPV52和HPV58亚型多见,38~47岁人群阳性率最高(P<0.05);乳酸杆菌的减少、细菌性阴道病(BV)和杂菌感染在HPV阳性组中的检出率显著高于HPV阴性组(P<0.01),乳酸杆菌的减少和BV是HPV感染的独立危险因素(P<0.05);乳酸杆菌减少、清洁度异常、BV、滴虫和pH异常检出率,CIN或癌变组高于宫颈正常组(P<0.05),乳酸杆菌的减少和清洁度异常是宫颈发生CIN或癌变的独立危险因素(P<0.05)。结论阴道微生物种群的异常,特别是乳酸杆菌数量的减少,可能会增加HR-HPV感染的风险,并促进CIN或癌变的发展。

LEEP联合抗HPV凝胶敷料治疗对HSIL伴HR-HPV感染患者阴道菌群、血清存活蛋白及Ki-67的影响

目的探讨宫颈环形电切术(LEEP)联合抗人乳头瘤病毒(HPV)凝胶敷料治疗对高级别鳞状上皮内病变(HSIL)伴高危型人乳头瘤病毒(HR-HPV)感染患者阴道菌群、血清存活蛋白及Ki-67的影响。方法选取2020年1月至2021年6月石家庄市妇幼保健院收治的275例HSIL伴HR-HPV感染患者作为研究对象,按照随机数字表法分为对照组(n=132)和联合组(n=143)。对照组采用LEEP联合干扰素α-2b凝胶治疗,联合组采用LEEP联合抗HPV凝胶敷料治疗。比较两组阴道菌群和致病菌分布情况、阴道微生态情况、血清存活蛋白及Ki-67表达水平。结果治疗前,两组乳酸杆菌分布率比较,差异无统计学意义(P>0.05);治疗后,两组乳酸杆菌分布率均升高,且联合组高于对照组(P<0.05)。治疗后,两组菌群溶血葡萄球菌、阴沟肠杆菌、大肠埃希菌、白色假丝酵母菌、阴道加德纳菌分布率均低于治疗前(P<0.05)。治疗后,两组菌群密集度Ⅱ+Ⅲ、多样性Ⅱ+Ⅲ、微生态正常比例均升高,且联合组微生态正常比例高于对照组(P<0.05)。治疗后,两组血清存活蛋白和Ki-67表达均降低,且联合组低于对照组(P<0.05)。结论LEEP联合抗HPV凝胶敷料能够改善HSIL伴HR-HPV感染患者阴道菌群异常分布,可促进阴道微生态平衡,抑制血清存活蛋白和Ki-67过表达,利于患者术后恢复。

CIN Ⅲ级患者阴道菌群改变及其与LEEP术后复发的关系分析

目的 探讨宫颈上皮内瘤变(CIN)Ⅲ级患者阴道菌群改变及其与宫颈环形电切术(LEEP)后复发的关系。方法 选取2016年3月至2020年8月于郑州市金水区总医院行LEEP治疗的432例CINⅢ级患者为疾病组,另选取同期体检的健康女性420例为对照组,均收集阴道分泌物检测阴道菌群指标[菌群密集度、菌群多样性、霉菌、滴虫、乳酸杆菌、Nugent评分、pH值、白细胞酯酶(LE)、过氧化氢(H_(2)O_(2))、唾液酸苷酶(SNA)、β-葡萄糖醛酸苷酶(GUS)、β-N-乙酰氨基葡萄糖苷酶(NAG)],比较疾病组与对照组的阴道菌群指标。术后对疾病组患者进行两年随访,根据疾病组患者复发情况分为复发组和未复发组。比较术前及术后6个月时复发组和未复发组阴道菌群改变情况,采用多因素Logistic回归分析法分析CINⅢ级患者LEEP术后复发的影响因素。结果 疾病组术前菌群密集度异常、菌群多样性异常、霉菌(+)、滴虫(+)、Nugent评分>7分、pH值>4.6、LE (+)、H_(2)O_(2)(+)、SNA (+)、GUS (+)占比均高于对照组(P<0.05),乳酸杆菌(+)占比低于对照组(P<0.05),两组NAG (+)占比比较差异无统计学意义(P>0.05);LEEP术后对432例CINⅢ级患者随访两年,复发率为9.49%;复发组与未复发组术前、术后6个月NAG (+)占比比较差异均无统计学意义(P>0.05),术后6个月菌群密集度异常、菌群多样性异常、霉菌(+)、滴虫(+)、Nugent评分>7分、pH值>4.6、LE(+)、H_(2)O_(2)(+)、SNA (+)、GUS (+)占比均低于术前(P<0.05),乳酸杆菌(+)占比高于术前(P<0.05);术后6个月复发组菌群密集度异常、菌群多样性异常、Nugent评分>7分、pH值>4.6、LE (+)、SNA (+)、GUS (+)占比均高于未复发组(P<0.05),乳酸杆菌(+)占比低于未复发组(P<0.05);经Logistic回归分析,术后6个月的菌群密集度异常、菌群多样性异常、Nugent评分>7分、pH值>4.6、LE (+)、SNA (+)、GUS (+)、绝经、术前高危型人乳头瘤病毒(HR-HPV)载量高负荷、累及腺体、手术切缘阳性均为影响CINⅢ级患者LEEP术后复发的危险因素(P<0.05),乳酸杆菌(+)为其保护因素(P<0.05)。结论 阴道微生态菌群失衡与CINⅢ级患者LEEP术后复发关系密切,此外,绝经、术前HR-HPV载量高负荷、累及腺体、手术切缘阳性均为影响CINⅢ级患者LEEP术后复发的危险因素,临床可根据上述因素进行针对性管理,以降低CIN复发的风险。

宫颈上皮内瘤变合并阴道上皮内瘤变临床特征分析

目的:探讨宫颈上皮内瘤变(CIN)合并阴道上皮内瘤变(VAIN)的临床特点及危险因素。方法:收集承德医学院附属医院妇产科634例CIN患者的临床资料,其中49例CIN合并VAIN,585例CIN。对比分析两组患者的临床特征,logistic回归多因素分析CIN合并VAIN的独立危险因素。结果:CIN合并VAIN组患者的中位年龄56岁,绝经后患者占85.7%,CIN组患者的中位年龄38岁,绝经后患者占16.6%,两组比较差异有统计学意义(P<0.05)。CIN合并VAIN组中,95.9%的患者具有HPV感染,其中多重HPV感染占57.1%,多重HPV感染率明显高于CIN组(35.4%)(P<0.05)。两组患者均以HPV16型感染最常见,CIN合并VAIN组中感染最多的依次为HPV16、52、66、58、53型,CIN组依次为HPV16、58、52、33、18型。多因素分析显示,年龄是CIN合并VAIN的独立危险因素(OR=1.245,P<0.05)。VAIN3患者的TCT较多为HSIL和ASC-H,VAIN1较多为ASCUS和LSIL。CIN分级与VAIN分级具有一致性(Kappa=0.294,P<0.05),随着宫颈病变分级升高,阴道病变的分级相应升高。结论:CIN合并VAIN与患者年龄密切相关,对于年龄较大尤其是绝经后、多重高危HPV感染、细胞学异常的患者,阴道镜检查宫颈时应重视对阴道的检查,以便于及时发现阴道病变,早期干预,避免漏诊漏治。

完带汤加减对HPV感染合并低度宫颈上皮内瘤变患者疾病转归及局部炎症的影响

目的:探究完带汤加减对人乳头瘤病毒(HPV)感染合并低度宫颈上皮内瘤变患者疾病转归及局部炎症的影响。方法:将80例HPV感染合并低度宫颈上皮内瘤变患者根据随机数字表法分为两组,每组40例。对照组进行HPV感染合并低度宫颈上皮内瘤变的常规西医治疗,观察组则在对照组治疗的基础上采用完带汤加减治疗。比较两组的治疗总有效率、HPV转阴率、治疗前后的中医证候积分、局部炎症相关指标阴道灌洗液防御素[β-防御素-2(HBD-2)及防御素-5(HD-5)]及阴道灌洗液炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)及白介素-6(IL-6)]。结果:观察组的治疗总有效率及治疗后3个月、6个月的HPV转阴率分别为77.50%,55.00%及75.00%,高于对照组的37.50%,30.00%及47.50%(P<0.05);治疗后两组的上述中医证候积分、阴道灌洗液防御素、阴道灌洗液炎症因子均低于治疗前,且观察组的积分及阴道灌洗液指标显著低于对照组(P<0.05)。结论:完带汤加减在HPV感染合并低度宫颈上皮内瘤变患者中的应用效果较好,可有效改善患者的疾病转归及控制局部炎症。

外涂红色诺卡氏菌细胞壁骨架制剂对人乳头瘤病毒感染并宫颈上皮瘤变患者宫颈环形电切术后人乳头瘤病毒转阴和阴道微生态的影响

目的探讨外涂红色诺卡氏菌细胞壁骨架制剂(Nr-CWS)对人乳头瘤病毒(HPV)感染并宫颈上皮瘤变(CIN)患者宫颈环形电切术(LEEP)术后HPV转阴率和阴道微生态的影响。方法采用随机数字表法将2019年1月至2022年1月于邯郸市妇幼保健院妇科就诊的95例HPV感染并CIN患者分为观察组(n=48)和对照组(n=47),所有患者均行LEEP治疗,对照组术后予常规治疗,观察组在此基础上予Nr-CWS治疗,连续治疗3个月。比较两组HPV转阴率、阴道微生态情况,检测外周血T细胞亚群及宫颈局部干扰素(IFN)-γ、白介素(IL)-2及IL-10水平。结果治疗2个月、3个月后,观察组HPV转阴率明显高于对照组(54.17%vs.30.42%、72.92%vs.51.06%,P<0.05)。治疗后,观察组阴道微生态异常率显著低于对照组(29.17%vs.59.57%,P<0.05)。治疗后,两组外周血CD3^(+)、CD4^(+)/CD8^(+)及阴道灌洗液IFN-γ、IL-2较治疗前升高,而阴道灌洗液IL-10降低,且观察组上述指标优于对照组(P<0.05)。结论外涂Nr-CWS可提高HPV感染并CIN患者LEEP术后HPV转阴率,纠正阴道微生态,其机制可能与提高外周血T淋巴细胞和宫颈局部免疫因子有关。