Early detection of multiple endocrine neoplasia type 1: A case report

BACKGROUND Multiple endocrine neoplasias(MENs)are a group of hereditary diseases invol-ving multiple endocrine glands,and their prevalence is low.MEN type 1(MEN1)has diverse clinical manifestations,mainly involving the parathyroid glands,gastrointestinal tract,pancreas and pituitary gland,making it easy to miss the clinical diagnosis.CASE SUMMARY We present the case of a patient in whom MEN1 was detected early.A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hos-pital.Blood tests at admission revealed hypercalcemia and hypophosphatemia,and emission computed tomography of the parathyroid glands revealed a hy-perfunctioning parathyroid lesion.Gastroscopy findings suggested a duodenal bulge and ulceration.Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb.Further blood tests revealed elevated levels of serum gastrin.Surgery was performed,and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy.The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year.CONCLUSION For patients who present with gastrointestinal symptoms accompanied by hyper-calcemia and hypophosphatemia,clinicians need to be alert to the possibility of MEN1.

C634Y mutation in RET-induced multiple endocrine neoplasia type 2A:A case report

BACKGROUND Multiple endocrine neoplasia type 2(MEN2)is a rare,autosomal dominant endocrine disease.Currently,the RET proto-oncogene is the only gene implicated in MEN2A pathogenesis.Once an RET carrier is detected,family members should be screened to enable early detection of medullary thyroid carcinoma,pheochromocytoma,and hyperparatitity.Among these,medullary thyroid carcinoma is the main factor responsible for patient mortality.Accordingly,delineating strategies to inform clinical follow-up and treatment plans based on genes is paramount for clinical practitioners.CASE SUMMARY Herein,we present RET proto-oncogene mutations,clinical characteristics,and treatment strategies in a family with MEN2A.A family study was conducted on patients diagnosed with MEN2A.DNA was extracted from the peripheral blood of family members,and first-generation exon sequencing of the RET protooncogene was conducted.The C634Y mutation was identified in three family members spanning three generations.Two patients were sequentially diagnosed with pheochromocytomas and bilateral medullary thyroid carcinomas.A 9-yearold child harboring the gene mutation was diagnosed with medullary thyroid carcinoma.Surgical resection of the tumors was performed.All family members were advised to undergo complete genetic testing related to the C634Y mutation,and the corresponding treatments administered based on test results and associated clinical guidelines.CONCLUSION Advancements in MEN2A research are important for familial management,assessment of medullary thyroid cancer invasive risk,and deciding surgical timing.

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.

Pregnancy and Obstetrical Outcomes Following Treatment for Cervical Intra-Epithelial Neoplasia (CIN) in Two Hospitals of a Low-Resource Country

Objective: In Cameroon, more than 80% of women suffering from cervical intraepithelial neoplasia (CIN) are within the reproductive age. This study intended to analyze the pregnancy outcomes following cervical treatment in Cameroon. Methods: This was a cohort study with two years retrospective data collection involving 82 women who underwent cervical treatment for CIN in two Cameroonian hospitals from January 2015 to December 2017. Data were collected from CIN treatment to end of pregnancy where applicable. Data analysis was done using Epi Info software version 3.5.4. Results: We collected data from 82 patients aged 27 to 48 years, with a mean age of 36.5 (SD: 5.3) years. During the study period, 33 out of 82 participants became pregnant 40.2 [29.56 - 51.66]%. The factor associated with pregnancy occurrence after treatment was age less than 35 years (Odds ratio = 4.37 [1.7 - 11.2]. From the 33 pregnancies recorded, 17 (51.5%) ended in a delivery, amongst which 15 (88.2%) were vaginal. Conclusion: Pregnancy frequency over two years following cervical treatment for CIN was relatively good, and younger women (age 35 years) were significantly more like to have conceived compared to their older counterparts. Post-treatment delivery outcomes seem to be similar to those in the general population.

Improving early diagnosis of multiple endocrine neoplasia type 1 by assessing the gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin

Despite advancements in the field,early diagnosis of multiple endocrine neoplasia type 1(MEN1)remains unachievable.This letter to the editor highlighted the importance of carefully assessing gastrointestinal symptoms,hypercalcemia,and elevated serum gastrin levels,as suggested by Yuan et al in their paper.They focused on a patient with recurrent abdominal pain and diarrhea whose diagnostic path led to establishing a MEN1 diagnosis within a year.This emphasized the need for clinicians to consider MEN1 in patients with similar presentations,particularly when gastrointestinal symptoms persist or recur after discontinuation of proton pump inhibitors,especially knowing that early recognition and intervention are crucial for improving patient outcomes.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

Molecular diagnostic approaches in detecting rearranged during transfection oncogene mutations in multiple endocrine neoplasia type 2

Different types of neuroendocrine cancer,including medullary thyroid cancer(MTC)and thyroid C-cell hyperplasia,are part of multiple endocrine neoplasia type 2(MEN2).A proto-oncogene mutation of the rearranged during transfection(RET)gene changes the way that receptor tyrosine kinases work.Multiple endocrine neoplasia,a pathological condition,involves these kinases.When the RET protooncogene changes,it can cause endocrine adenomas and hyperplasia to happen at the same time or one after the other.Pheochromocytoma,medullary thyroid carcinoma,and hyperparathyroidism,alone or in combination,are present in MEN2A patients.Some patients may also have skin lichen amyloidosis or Hirschsprung's disease.Patients with MEN2A often present with MTC.MTC is aggressive and has the worst prognosis,as most patients exhibit lymph node metastasis.MTC is one of the important causes of death in patients with MEN2A.RET mutation analysis aids in identifying MEN2A symptoms and monitoring levels of calcium,thyroid hormones,calcitonin,normetanephrine,fractionated metanephrines,and parathyroid hormone.The earlier diagnosis of MTC significantly improves survival and prompts better management of MEN2A.In this editorial,we will discuss the significance of molecular diagnostic approaches in detecting RET oncogene mutations in MEN2A.

Distribution of High-Risk Human Papillomavirus Genotypes among Women with Colposcopic Diagnosis of Cervical Intraepithelial Neoplasia in Bangladesh

Background: The incidence of cervical cancer is high in Bangladesh and there is a high prevalence of preinvasive lower genital tract disease among women of reproductive age. Persistent high-risk Human Papilloma Virus (HPV) infection is the main underlying cause of cervical cancer and its precursor, cervical intraepithelial neoplasia (CIN). Objective: The aim of the study was to identify the subtypes of high-risk HPV infection among women with the colposcopic diagnosis of cervical intraepithelial neoplasia in Bangladesh. Methods: This cross-sectional observational study was conducted in the colposcopy clinic of Dhaka Medical College Hospital over a six-month period. A total of 100 participants were enrolled. Married women, between 30 - 60 years of age with colposcopically diagnosed cervical intra epithelial neoplasia were enrolled. Women with chronic illness, pregnancy, and women unable to consent were excluded from this study. After counselling, colposcopically directed punch biopsies were taken from each CIN case concurrently with high-risk HPV testing by polymerase chain reaction (PCR). Results: The mean age of the patients was 38.69 (SD ±7.76) years. CIN 1 was diagnosed in 57% of participants, while 24% had CIN II and 19% had CIN III lesions. High-risk HPV was present in 52 patients. HPV 16 was the most common identified in 28 (53.84%) and HPV 18 was the second most common with 20 (38.46%) either singly or in combination with other high-risk subtypes. The other HPV strains, HPV 31, 33, 35, 52, 56 and 58, were also detected either as mono or co-infections. Out of the 52 HPV positive cases, 29 (55.8%) had mono infection and 23 (44.2%) had co-infection with several subtypes. The highest incidence (50%) of oncogenic HPV infections was present among women aged 35 - 45 years. Risk factors associated with HPV positive cases were high parity (P 0.05), early age at marriage (P = 0.754) and early age of first child. Conclusion: This study identified a high prevalence of HPV 16 and 18 genotypes. HPV vaccination with the current 9-valent HPV vaccine, which contains HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. Will be an effective public health measure to eradicate cervical cancer in Bangladesh.

SGK3 overexpression correlates with a poor prognosis in endoscopically resected superficial esophageal squamous cell neoplasia:A long-term study

BACKGROUND The expression status of serum and glucocorticoid-induced protein kinase 3(SGK3)in superficial esophageal squamous cell neoplasia(ESCN)remains unknown.AIM To evaluate the SGK3 overexpression rate in ESCN and its influence on the prognosis and outcomes of patients with endoscopic resection.METHODS A total of 92 patients who had undergone endoscopic resection for ESCN with more than 8 years of follow-up were enrolled.Immunohistochemistry was used to evaluate SGK3 expression.RESULTS SGK3 was overexpressed in 55(59.8%)patients with ESCN.SGK3 overexpression showed a significant correlation with death(P=0.031).Overall survival and disease-free survival rates were higher in the normal SGK3 expression group than in the SGK3 overexpression group(P=0.013 and P=0.004,respectively).Cox regression analysis models demonstrated that SGK3 overexpression was an independent predictor of poor prognosis in ESCN patients(hazard ratio 4.729;95% confidence interval:1.042-21.458).CONCLUSION SGK3 overexpression was detected in the majority of patients with endoscopically resected ESCN and was significantly associated with shortened survival.Thus,it might be a new prognostic factor for ESCN.

乌鲁木齐市11654例女性HPV分型及定量检测结果分析

目的分析新疆乌鲁木齐市女性人乳头瘤病毒(HPV)感染特点及HPV分型定量检测对宫颈病变的预测性能。方法收集2022年1-12月于新疆医科大学第一附属医院妇科就诊并进行HPV检测的11654例女性的HPV检测结果。根据年龄将所有就诊者分为低龄组(≤29岁)、青龄组(>29~39岁)、中龄组(>39~49岁)、中老龄组(>49~59岁)和老龄组(>59岁)。其中1483例患者同时进行阴道镜活检和宫颈组织病理学检测,根据组织病理学诊断结果,将1483例患者分为宫颈炎、宫颈上皮内瘤变(CIN)Ⅰ、CINⅡ、CINⅢ和宫颈癌,将CINⅠ及以上命名为CIN阳性,CINⅡ及以上命名为CINⅡ+,CINⅢ及以上命名为CINⅢ+。采用实时荧光定量PCR检测HPV亚型及病毒载量,比较不同民族、年龄、宫颈疾病女性HPV的检测结果,比较不同宫颈病变患者主要的HPV亚型病毒载量水平,采用受试者工作特征(ROC)曲线确定主要的HPV亚型预测CINⅡ+的病毒载量阈值。结果在11654例就诊者中,HPV感染率为30.60%,单一亚型感染占77.73%。HPV16、52、58是CIN阳性患者感染的主要型别,分别占38.89%、14.90%、11.11%。汉族、维吾尔族、回族和哈萨克族女性HPV感染率分别为31.89%、24.39%、31.76%和27.88%,4个民族HPV感染率比较,差异有统计学意义(χ^(2)=40.929,P<0.001)。在11654例就诊者中,老龄组HPV感染率最高(34.04%),中龄组HPV感染率最低(26.41%),不同年龄组间HPV感染率比较,差异有统计学意义(χ^(2)=37.754,P<0.001)。在396例CIN阳性患者中,高危型HPV和单一亚型感染率随CIN级别升高而升高(χ^(2)趋势=9.994、7.233,P<0.01)。CINⅡ+患者HPV16、52、58病毒载量与宫颈炎患者相比,差异均有统计学意义(P<0.05);且HPV16、52、58病毒载量预测CINⅡ+的最佳截断值分别为4.382、3.694、4.114 copy/104个细胞(经lg转化)。结论新疆乌鲁木齐市女性HPV感染以单一亚型感染为主,HPV16、52、58是主要的感染型别,并且HPV标准化定量具有作为宫颈高级病变预测标志物的潜力。

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。

光动力疗法与子宫颈环形电切术治疗宫颈上皮内瘤变2级的疗效对比

目的评价光动力疗法与宫颈环形电切术(LEEP)治疗宫颈上皮内瘤变2级(CIN2)的疗效及不良事件的发生情况。方法40例CIN2级患者依治疗方案不同分为光动力组20例和LEEP组20例,于治疗后3、6及12个月进行随访,比较2组患者高危型HPV病毒(HR-HPV)、阴道微生态、阴道镜检查和宫颈活检情况,记录不良事件发生情况。结果2组间患者治疗后3个月的病变逆转、病变残留及病变进展构成差异无统计学意义。光动力组治疗后6个月时1例复发者和LEEP组治疗后12个月时1例复发者的宫颈活检病理均为CIN1级。2组患者治疗后3、6及12个月HR-HPV转阴率、正常阴道微生态比例差异无统计学意义。光动力组治疗后3、6、12个月患者的正常阴道微生态比例呈依次增高的趋势。在治疗过程中,光动力组患者疼痛能忍受,LEEP组疼痛明显并伴有出血;2组治疗后均有阴道分泌物增多、下腹坠痛,但LEEP组有宫颈局部瘢痕形成并有1例出现阴道出血。结论光动力疗法治疗CIN2效果较好,HR-HPV转阴率高,对宫颈几乎无损伤,尤其适用于有生育要求的患者。

25岁以下女性宫颈上皮内瘤变2级消退状况研究

目的观察25岁以下宫颈上皮内瘤变2级(CIN2)患者在随访24个月后的病变消退情况。方法选择2015年1月至2020年12月在我院妇科门诊筛查确认的540例CIN2患者为研究对象。纳入患者至少每6个月进行1次阴道镜检查,并配合活检,持续24个月。根据24个月内患者CIN2病变消退情况将纳入患者分为消退组(273例)和未消退组(267例),对两组患者的基线资料进行单因素分析,并采用多因素Logistic分析探讨影响CIN2病变消退的影响因素,采用受试者工作特征曲线(ROC)及配对卡方检验评估各因素/指标的预测价值。结果24个月随访结束时,50.56%(273/540)的CIN2患者发生了病变消退。单因素及多因素分析结果显示阴道镜印象≥CIN2、人乳头瘤病毒(HPV)16感染、细胞学检查提示高度鳞状上皮内病变、吸烟是25岁以下CIN2患者病变未消退的危险因素(P<0.05);诊断年份较早是患者病变未消退的保护因素(P<0.05)。HPV16联合阴道镜检查、细胞学检查结果对CIN2患者病变未消退的预测价值较高,ROC曲线下面积(AUC)为0.822,95%CI为(0.677,0.962)。结论25岁以下CIN2患者中,超过一半的患者可能在24个月内自动消退,无需进行创伤性治疗。HPV16联合阴道镜检查、细胞学检查结果对CIN2病变未消退具有较好的预测价值,值得临床医生密切关注。

宫颈病变锥型切除锥长对妊娠结局的影响

目的分析宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)行宫颈锥切术对术后妊娠结局的影响。方法回顾性分析2012年1月至2013年12月江西省妇幼保健院妇瘤科收治的138例行宫颈锥切术CIN患者临床资料,对患者进行电话及门诊随访,分析妊娠周数、妊娠结局和终止妊娠的方式与锥长的关系。结果138例患者不良妊娠结局42例(30.43%)、足月产96例(69.56%);其中剖宫产63例(45.60%)、经阴道分娩54例(39.13%)、27周前流产21例(15.21%),流产患者平均锥长(20.10±4.50)mm。138例患者平均锥长(14.30±6.60)mm,足月及不良妊娠结局患者锥长分别为(12.00±6.10)mm、(19.60±4.10)mm,差异有统计学意义(P<0.05);线性回归分析结果显示,锥长与妊娠孕龄呈负相关(F=20.38,P<0.05)。结论锥长与出生时胎龄呈负相关,当锥长>15 mm时,不良妊娠结局的风险渐增高,但不会增加低出生体重儿的发生率及剖宫产率。

新福菌素注射液治疗低危型妊娠滋养细胞肿瘤的临床效果

目的 观察新福菌素注射液治疗低危型妊娠滋养细胞肿瘤(LRGTN)的临床效果。方法 选取2020年1月—2022年6月江西省妇幼保健院收治的LRGTN患者60例,采用随机数字表法分为新福菌素组与常规组,每组30例。常规组接受“8日疗法”治疗,新福菌素组予新福菌素注射液治疗。比较2组近期疗效、达到完全缓解所用时间,治疗前后血清β-人绒毛膜促性腺激素(β-HCG)水平及不良反应。结果 新福菌素组与常规组治疗总缓解率(96.67%vs.90.00%)比较差异无统计学意义(χ^(2)=0.268,P=0.605);新福菌素组完全缓解时间为(73.10±13.87)d,短于常规组的(88.93±16.47)d(t=4.027,P<0.001);治疗1个疗程后,2组β-HCG水平较治疗前降低,且新福菌素组低于常规组(P均<0.01);新福菌素组与常规组1~2级不良反应发生率中肝损伤(6.67%vs.46.67%)、口腔溃疡(46.67%vs.73.33%)以及3~4级不良反应发生率中骨髓抑制(6.67%vs.26.67%)组间比较差异有统计学意义(P<0.05或P<0.01)。结论 新福菌素相比常规方案治疗LRGTN的临床效果相当,但新福菌素组达到完全缓解所用时间更短,且部分不良反应发生风险更低。

宫颈环形电切术对保留生育功能宫颈上皮内瘤变患者术后宫颈修复和宫颈狭窄及并发症的影响

目的探究宫颈环形电切术(LEEP)对保留生育功能宫颈上皮内瘤变(CIN)患者术后宫颈修复、宫颈狭窄及并发症的影响。方法选取2019年1月至2021年1月吉安市中心人民医院收治的72例CIN患者作为研究对象,采用随机数字表法分为A组与B组,每组36例。A组实施冷刀锥切术(CKC)治疗,B组实施LEEP治疗。比较两组手术相关指标、宫颈愈合情况、宫颈狭窄情况及并发症发生率、复发率、残留率。结果B组手术时间短于A组,术中出血量少于A组,锥切组织面积小于A组,锥高低于A组,差异有统计学意义(P<0.05)。两组浅度锥切后宫颈完全愈合率比较差异无统计学意义;B组深度锥切后宫颈完全愈合率高于A组,差异有统计学意义(P<0.05)。两组浅度锥切宫颈狭窄发生率比较差异无统计学意义;B组深度锥切宫颈狭窄发生率、宫颈狭窄总发生率均低于A组,差异有统计学意义(P<0.05)。B组并发症发生率低于A组,差异有统计学意义(P<0.05);两组复发率、残留率比较差异无统计学意义。结论LEEP治疗保留生育功能CIN患者,可提升其宫颈愈合率,降低宫颈狭窄发生率。

HPVL1蛋白、TRIM22、HER-2联合检测在HPV阳性宫颈上皮内瘤变中的早期诊断价值

目的 探讨人乳头瘤病毒LI(HPVL1)蛋白、三结构域家族蛋白22(TRIM22)、人表皮生长因子受体-2(HER-2)联合检测在人乳头瘤病毒(HPV)阳性宫颈上皮内瘤变(CIN)中的早期诊断价值。方法 回顾性选取2021年1月至2023年6月承德医学院附属医院就诊的162例薄层液基细胞学(TCT)检查异常且HPV阳性的CIN患者为研究组,另选取同期经组织病理学诊断为正常宫颈组织的138名对象为对照组。免疫组织化学法检测宫颈组织中HPVL1蛋白、TRIM22、HER-2表达。比较对照组、研究组组织中HPVL1蛋白、TRIM22、HER-2表达,并比较不同分级CIN患者HPVL1蛋白、TRIM22、HER-2表达。多因素Logistic回归模型分析CIN发生的影响因素;受试者操作特征(ROC)曲线分析HPVL1蛋白、TRIM22、HER-2表达对CIN的早期诊断价值。结果 研究组组织中HPVL1蛋白及TRIM22蛋白阳性率分别为34.57%、32.72%,均显著低于对照组(74.64%、71.01%),HER-2阳性率为60.49%,显著高于对照组(10.87%),差异均有统计学意义(P<0.05)。CINⅠ级、CINⅡ级和CINⅢ级HPVL1蛋白和TRIM22阳性率呈下降趋势,HER-2阳性率呈上升趋势(P<0.05)。多因素Logistic回归分析结果显示,宫颈组织中HPVL1蛋白、TRIM22及HER-2表达均为CIN的影响因素(OR=5.110、5.231、9.652,P<0.05)。ROC曲线结果显示,HPVL1蛋白表达诊断CIN的曲线下面积(AUC)为0.700,敏感度为65.43%;TRIM22表达诊断CIN的AUC为0.691,敏感度为67.28%;HER-2表达诊断CIN的AUC为0.748,敏感度为60.49%。三者联合诊断CIN的AUC为0.814,显著高于单独诊断的AUC(P<0.05)。结论 宫颈组织中HPVL1蛋白、TRIM22及HER-2表达影响CIN的发生、发展,三者联合对CIN具有较高的诊断价值。

内镜热损伤术治疗胃低级别上皮内瘤变的临床疗效及术后病理升级的影响因素

目的探讨内镜热损伤术治疗胃低级别上皮内瘤变(LGIN)的临床疗效以及术后病理升级的影响因素。方法选取胃黏膜LGIN患者共98例,所有患者均接受内镜热损伤术治疗,并分析术后1年内的疗效情况;根据术后病理差异分为病理升级组和病理未升级组,采用多因素Logistic回归分析内镜热损伤术后LGIN患者出现病理升级的影响因素。结果98例患者治愈率术后12个月(82.65%)低于术后3个月(95.92%)、复发率(2.04%)高于术后3个月(11.11%)(P<0.05)。单因素结果分析显示,年龄、性别、幽门螺旋杆菌感染、病灶颜色、病变部位与内镜热损伤术后病理升级无关(P>0.05);病变直径、病灶形态、表面溃疡、自发性出血与内镜热损伤术后病理升级有关(P<0.05)。多因素Logistic回归分析结果显示,病变直径≥2 cm、凹陷型、有表面溃疡以及有自发性出血是LGIN患者内镜热损伤术后病理升级的独立危险因素(P<0.05)。结论内镜热损伤术治疗胃低级别上皮内瘤变的临床疗效较好,但患者在术后出现病理升级的概率较高,病变直径≥2 cm、凹陷型、有表面溃疡以及有自发性出血是术后病理升级的独立危险因素,临床中需针对高危人群给予积极干预,以减少疾病出现进展的几率。

血清HE4、LH、FSH对宫颈癌和宫颈上皮内瘤变的鉴别诊断价值

目的探究血清人附睾蛋白4(HE4)、促黄体生成素(LH)、卵泡刺激素(FSH)对宫颈癌和宫颈上皮内瘤变(CIN)的鉴别诊断价值。方法选择89例接受宫颈癌筛查的宫颈病变患者,经病理学或细胞学明确诊断宫颈癌51例、CIN 38例,检测所有患者血清HE4、LH、FSH水平,分析宫颈癌患者与CIN患者血清检测指标水平差异,采用受试者特征工作曲线(ROC曲线)、二元logistics回归分析法评价HE4、LH、FSH在疾病鉴别中的价值。结果宫颈癌患者血清HE4、LH、FSH水平均显著高于CIN患者(P<0.05);宫颈病变患者血清HE4与LH、FSH水平呈正相关(γ=0.357、0.392,P<0.05)。ROC曲线分析显示,血清HE4、LH、FSH诊断宫颈癌的敏感性均较低,三者联合诊断效能较单一指标更高,联合诊断曲线下面积为0.859,诊断敏感度88.24%、特异度71.05%;logistics回归分析显示,HE4>62.84 pmol/ml是宫颈癌发病的影响因素(P<0.05)。结论宫颈癌患者血清HE4、LH、FSH水平异常升高,且指标间呈正相关,三者联合用于鉴别诊断宫颈癌和CIN具有一定临床价值。

联合p16、Ki-67免疫组织化学染色在宫颈上皮内瘤变分级诊断中的应用效果观察

[目的]探究与分析联合应用p16、Ki-67免疫组织化学染色对宫颈上皮内瘤变(CIN)分级诊断的影响.[方法]回顾性分析自2019年3月至2021年11月间收治的接受宫颈液基薄层细胞学检查(TCT)且检查结果异常的60例患者的临床资料.全部患者按照苏木精-伊红染色法(HE)结果分为慢性宫颈炎组(n=19)、CINⅠ组(n=15)、CINⅡ组(n=12)、CINⅢ组(n=10)、宫颈癌组(n=4),全部患者均进行了宫颈阴道镜活检、人乳头瘤病毒(HPV)分型检测,并配合采用P16、Ki-67免疫组织化学染色的半定量评分,以判断患者宫颈病变程度.[结果]随着宫颈CIN病变程度的升高,CINⅢ组分别与CINⅠ组、CINⅡ组相比,CINⅡ组与CINⅠ组相比,P16表达阳性程度及Ki-67表达阳性程度升高,差异有统计学意义(P<0.05).慢性宫颈炎组P16、Ki-67免疫组织化学结合半定量评分与HE染色CIN分级诊断结果相符,CINⅠ组、CINⅡ组、CINⅢ组诊断结果相符率为94.59%,差异具有统计学意义(P<0.05).P16呈阳性表达时与HPV感染呈正相关(P<0.05).HPV-16、HPV-18、HPV-35、HPV-39、HPV-51在P16表达阳性与阴性方面差异具有统计学意义(P<0.05).[结论]CIN分级与P16、Ki-67的表达呈正相关,且P16与患者HPV感染有密切的关系.