人类乳头状病毒(HPV)检测对宫颈癌前病变的预测价值分析

目的分析人类乳头状病毒(HPV)检测诊断宫颈癌前病变的临床价值,为宫颈癌的临床诊断提供参考。方法将佳木斯大学附属第一医院2014年4月至2015年6月收治的90例宫颈病变患者分别采用传统宫颈细胞学及人类乳头状病毒检测,以病理学诊断为金标准,对两种方式的特异性及敏感性进行比较和分析。结果采用人类乳头状病毒检测的特异度及灵敏度分别为93.4%及93.1%;采用传统宫颈细胞学诊断的特异性及敏感性分别为80.3%及72.4%;组间比较具有统计学意义(P0.05)。结论相比传统细胞学检查,人类乳头状病毒检测诊断宫颈癌前病变的特异性及敏感性较高,值得推广。     

宫颈环形电切术联合纳米银凝胶应用于慢性宫颈炎的临床探讨

目的分析宫颈环形电切术联合纳米银凝胶应用于慢性宫颈炎的临床疗效。方法选择2014年10月至2015年10月在上栗县长平卫生院接受治疗的122例慢性宫颈炎患者作为研究对象。将122例患者随机分为常规组和实验组。常规组使用宫颈环形电切术进行治疗;实验组使用宫颈环形电切术联合纳米银凝胶进行治疗。对比两组患者的治疗效果以及阴道感染率及出血率。结果两组患者经过不同的治疗之后实验组患者的治疗总有效率(100.0%)显著高于常规组治疗总有效率(80.3%),数据差异显著,具备统计学意义(P0.05);实验组患者的阴道感染率(1.64%)及出血率(3.28%)分别明显低于常规组的阴道感染率(13.11%)与出血率(18.03%),两组数据差异显著,具备统计学意义(P0.05)。结论宫颈环形电切术联合纳米银凝胶应用于慢性宫颈炎的临床疗效显著,纳米银凝胶能够极大程度地帮助患者减少阴道出血、阴道感染的情况发生,能够很好地弥补宫颈环形电切术的不足,能够极大程度提升患者治疗效果,是慢性宫颈炎的理想治疗方式,值得临床推广。     

循证护理在慢性宫颈炎合并HPV感染患者治疗指导中的应用

目的探究循证护理在慢性宫颈炎合并HPV感染患者治疗指导中的应用。方法对63例慢性宫颈炎合并HPV感染患者,经循证护理,分别于6个月和12个月追踪HPV清除率。结果 63例经循证护理的慢性宫颈炎合并HPV感染患者,6个月后和12个月后的HPV清除率分别为41.3%(26/63)和58.7%(37/63);42例对照组6个月后和12个月后的HPV清除率分别为28.6%(12/42)和58.7%(17/42)。结论对慢性宫颈炎合并HPV感染患者进行循证护理,缩短了宫颈炎治愈时间并提高HPV清除率。     

血清降钙素原(PCT)对ICU重症患者感染性情况预估评价

目的探讨血清降钙素原(PCT)对ICU重症感染患者诊断中临床价值。方法选择80例黑龙江省佳木斯大学第一附属医院ICU重症感染患者作为观察组,并以80例ICU非感染性患者作为对照组,采集两组患者的空腹静脉血样,比较两组患者血清中PCT含量及检测的阳性率等。结果观察组血清中PCT检测阳性率为93.75%,平均质量浓度为(6.27±0.8)ng/m L均明显高于对照组的11.25%和(0.25±0.04)ng/m L,差异均具有统计学意义(P0.05)。结论 PCT特异性较高,稳定性较好,监测血清中PCT含量可作为ICU重症感染患者严重感染的重要指标。     

新鲜宫颈癌组织的拉曼光谱研究

采用便携式拉曼光谱仪对新鲜宫颈癌组织、 宫颈上皮内瘤变Ⅲ级(CIN Ⅲ)组织及正常宫颈组织进行检测, 通过光谱特征峰分析比较了各组织中化学成分的差异, 归纳了3类组织的拉曼光谱特征及区别. 正常组织以脂类特征峰(817, 1127, 1176, 1450, 1769 cm^-1)为主, 而宫颈癌和宫颈上皮内瘤变Ⅲ级组织则以蛋白特征峰(755, 1003, 1372, 1542, 1577 cm^-1)为主. 病变组织的主要区别在于宫颈上皮内瘤变Ⅲ级组织在853和1542 cm^-1处出现了较明显的蛋白特征峰; 宫颈癌组织则含有明显的核酸特征峰(784, 1094, 1345 cm^-1). 通过特征峰归属及分析发现, 3类组织在磷酸二酯基团形成氢键的能力、 DNA的相对含量、 亚甲基的无序性、 酰胺Ⅰ带的CO变形振动及类胡萝卜素的有无等方面存在显著差异. 表明拉曼光谱可检测宫颈癌组织, 探索宫颈癌与宫颈上皮内瘤变Ⅲ级的联系与区别, 以早期诊断宫颈癌, 具有良好的临床应用潜力.     

冠状动脉CTA定量评估稳定型心绞痛患者斑块进展及其在心血管事件中的预测价值

本文对非创伤性血管成像技术(CTA)定量评估稳定型心绞痛患者的冠状动脉斑块进展及其在心血管事件中的预测价值进行了分析。选取2017年1月~2017年12月我院心血管科142例因新发症状或症状加重随访行两次冠状动脉CT血管造影(CCTA)的稳定型心绞痛患者作为研究对象,根据后期随访患者是否有主要不良心脏事件发生进行分组,其中82例发生主要不良心脏事件的患者作为观察组,60例未发生主要不良心脏事件的患者作为对照组,定量评估稳定型心绞痛患者斑块的进展情况。结果显示:观察组患者有糖尿病、高血脂、吸烟史的比例均高于对照组,差异有统计学意义(P<0.05)。两组随访CCTA总体斑块负荷率、冠状动脉直径狭窄率比较差异有统计学意义(P<0.05);两组斑块进展方面,脂质斑块负荷率、纤维斑块负荷率、钙化斑块负荷率、总体斑块负荷率、冠状动脉直径狭窄率比较差异有统计学意义(P<0.05)。通过多因素Logisitic回归分析,脂质斑块负荷进展与基线高血脂有关(P<0.05),总体斑块负荷进展与基线高血脂具有相关性(P<0.05),冠状动脉直径狭窄率进展与糖尿病、高血脂、吸烟史具有相关性(P<0.05)。本文证实了CCTA检查是检测稳定型心绞痛患者斑块负荷进展的一种有效方法,且心血管危险因素能加快稳定型心绞痛患者负荷进展。     

微量元素与宫颈癌的研究进展

宫颈癌是女性生殖系统常见的恶性肿瘤之一,在女性肿瘤发病率中占第二位。通过对其病因学的研究,大多学者期望更多的掌握宫颈癌的发病原因及机理。目前研究认为高危HPV感染、性生活、孕产次、种族、饮食等多种因素与宫颈癌的发生发展都有明显相关性;而人体的微量元素不仅对于宫颈癌的发生,而且对其预后都产生着重大的影响。现对现有的研究所得出的微量元素与宫颈癌发生发展的关系以及治疗做一综述。     

瘦素水平和妊娠期糖尿病的相关性研究

目的分析瘦素水平和妊娠期糖尿病的相关性。方法选取150例妊娠期糖尿病患者作为观察组,另选取同期的38名健康妊娠者作为对照组;对比观察组与对照组的瘦素、空腹血糖(FPG)、空腹胰岛素(FINS)水平、HOMA-IR指数,分析妊娠期糖尿病患者瘦素与FPG、FINS、HOMA-IR指数的相关性。结果观察组患者的瘦素、FPG、FINS水平均显著高于对照组,HOMA-IR指数大于对照组,差异具有统计学意义(P0.05);妊娠期糖尿病患者的瘦素与FPG、FINS、HOMA-IR指数均呈正相关,均具有统计学意义(P0.05)。结论妊娠期糖尿病的发生、发展可能与瘦素水平升高具有相关性,孕期检测瘦素水平,有利于预测妊娠期糖尿病的发病,评估严重程度。     

小剂量奈达铂同步放疗对中晚期宫颈癌作用

目的对小剂量奈达铂与顺铂周疗方案同步放疗治疗中晚期宫颈癌的临床疗效及毒副反应进行分析。方法收集2012年7月至2015年12月中晚期宫颈癌患者(均为鳞状细胞癌)86例随机分两组。顺铂组采用顺铂周疗方案同步放疗治疗,奈达铂组采用小剂量奈达铂周疗方案同步放疗治疗。比较两组患者中晚期宫颈癌治疗总有效率,毒副作用发生率,治疗前和治疗后患者生存质量评分以及KPS评分的差异。结果奈达铂组患者中晚期宫颈癌治疗总有效率和顺铂组无显著差异,P0.05;奈达铂组肾脏毒性、恶心呕吐等毒副作用发生率低于顺铂组,而血液毒性反应明显高于顺铂组,P0.05。治疗前两组生存质量评分以及KPS评分比较无显著差异,P0.05;治疗后奈达铂组生存质量评分以及KPS评分改善幅度更大,P0.05。结论小剂量奈达铂周疗方案同步放疗治疗中晚期宫颈癌的临床疗效确切,优于顺铂周疗方案同步放疗治疗,可有效改善病情,减少肾脏毒性、恶心呕吐等毒副作用的发生,但也增加了血液毒性,需引起注意。     

四川地区宫颈癌组织HPV18和HPV45 E6基因突变分析

采用聚合酶链反应技术对四川地区2003~2004年收集的60例宫颈癌患者的癌组织DNA进行人乳头瘤病毒(HPV) E6基因扩增, 获得HPV18和45型E6基因. 序列分析发现, 18型三例E6基因有同样的两处同义突变; 45型两例E6基因发生突变, 一例有两处碱基突变, 另一例发生六处碱基突变, 其中两处涉及氨基酸变化, 均位于E6抗原决定簇区. HPV45型E6基因中134位c→t, 157位c→t, 259位g→t和341位t→c的碱基点突变未见报道. 另外， 该地区HPV18和45型突变株之间存在碱基互变,  它们之间的最小差异比野生型HPV18和HPV45之间的差异小4.05%, 该数值比在非洲发现的突变株的要小很多, 该结果支持HPV18和HPV45可能起源于非洲的观点.     

Effectiveness of Photodynamic Therapy in Elimination of HPV‐16 and HPV‐18 Associated with CIN I in Mexican Women

This study aimed to determine the effectiveness of photodynamic therapy (PDT), using δ‐aminolevulinic acid (5‐ALA), in the elimination of premalignant cervical lesions in Mexican patients with human papillomavirus (HPV) infection and/or cervical intraepithelial neoplasia (CIN). Thirty women diagnosed with CIN I and/or positive for HPV participated in the study. Topical 6% 5‐ALA in gel form was applied to the uterine cervix; after 4 h, the lesion area was irradiated with a light dose of 200 J cm^?2 at 635 nm. This procedure was performed three times at 48‐h intervals. Clinical follow‐up was performed at 3, 6, and 12 months after the initial PDT administration, by colposcopy, cervical cytology, histopathological analysis, polymerase chain reaction, and hybrid capture. Of HPV‐infected patients without evidence of CIN I, 80% cleared the infection, while HPV associated with CIN I was eliminated in 83% of patients (P < 0.05). At 12 months, CIN I had regressed in 57% of patients, although this response was not statistically significant. PDT using 6% 5‐ALA is concluded to be effective in eliminating HPV infection associated or not with CIN I.     

宫颈癌的低硒表征

宫颈癌是危害妇女健康的主要恶性肿瘤之一。研究表明,微量元素不仅参与机体正常代谢,而且和肿瘤的发生与发展及其预后密切相关,其中低硒与宫颈癌的关系广为人们所关注。近年来低硒与宫颈癌的关系及其相关因素的研究,为揭示宫颈癌的地理流行病学特征、生理生化改变及其致癌机理和防治研究提供了信息。     

超声造影参数对宫颈癌新辅助化疗疗效的评估价值

本文对超声造影参数对宫颈癌新辅助化疗疗效的评估价值进行了分析。选取2016年3月~2018年3月本院宫颈癌新辅助化疗患者200例,所有患者均给予紫杉醇+顺铂(TP)方案化疗治疗并行超声造影检查,分析超声造影参数:开始增强时间(AT)、达峰时间(TTP)、峰值强度(PI)、基础强度(BI),以及增强强度(EI)对新辅助化疗疗效的评估价值。结果显示,完全缓解(CR)12例、部分缓解(PR)136例、病情稳定(SD)36例、恶化(PD)16例,化疗无效者148例,有效率74.00%。化疗无效者和有效者BI、EI化疗前后比较,无效者化疗前后AT、TTP、PI比较,差异无统计学意义(P>0.05),有效者化疗后:AT、TTP明显低于化疗前,PI明显高于化疗前;无效者化疗后:AT、TTP明显高于有效者,PI明显低于有效者,有效者AT、TTP下降值及PI升高值明显高于无效,差异有统计学意义(P<0.05)。ROC曲线分析显示评估宫颈癌新辅助化疗有效性的敏感度、特异度、准确度:AT下降值以>1.0 s为临界值时,为87.84%、80.77%、86.00%,TTP下降值以>1.5 s为临界值时,为89.19%、84.62%、88.00%,PI升高值以>2.0 dB为临界值时,为85.14%、76.92%、83.00%,三者联合时为97.30%、96.15%、97.00%,三者联合时明显高于三者单独时,差异有统计学意义(P<0.05)。本文证实了超声造影参数中AT、TTP、PI与宫颈癌新辅助化疗疗效有关,并可作为评估患者化疗有效性的指标,且三者联合时评估效能更佳。     

Treatment of HPV infection-associated cervical condylomata acuminata with 5-aminolevulinic acid-mediated photodynamic therapy

The aim of this study was to investigate the efficacy of 5-aminolaevulinic acid (ALA)-mediated photodynamic therapy (PDT) in treatment of human papillomavirus (HPV)-associated cervical condylomata. A total of 56 patients with cervical and external condylomata lesions were recruited for this open-label study. HPV genotyping of exfoliated cells collected from the cervix and external lesions was performed. Cervical lesions were treated with PDT by applying ALA gel (10%) to the surface of the cervix for 4 h followed by irradiating with a 635 nm laser at 100 J cm(-2). PDT was repeated at 2-week intervals if lesion and HPV infection remained. Patients were followed up for 6-24 months. Genotyping analysis revealed four HPV subtypes (HPV6, 11, 16 and 18). The overall complete remission rate of 1-4 sessions of treatments was 98.2% and the corresponding HPV clearance rate was 83.9%. Ten cases showed complete removal of cervical lesions and HPV infection after a single treatment. Recurrence rate was 3.6%. Adverse effects were minimal and no structural complications were reported. In conclusion, topical ALA PDT is safe and effective for eradicating cervical HPV infection and eliminating condylomata lesion. Its definitive role in treating cervical condylomata deserves further investigation.     

Imaging and SERS Study of the Au Nanoparticles Interaction with HPV and Carcinogenic Cervical Tissues

In this work, gold NPs were prepared by the Turkevich method, and their interaction with HPV and cancerous cervical tissues were studied by scanning electron microscopy, energy-dispersive x-ray spectroscopy, confocal and multiphoton microscopy and SERS. The SEM images confirmed the presence and localization of the gold NPs inside of the two kinds of tissues. The light absorption of the gold NPs was at 520 nm. However, it was possible to obtain two-photon imaging (red emission region) of the gold NPs inside of the tissue, exciting the samples at 900 nm, observing the morphology of the tissues. The infrared absorption was probably due to the aggregation of gold NPs inside the tissues. Therefore, through the interaction of gold nanoparticles with the HPV and cancerous cervical tissues, a surface enhanced Raman spectroscopy (SERS) was obtained. As preliminary studies, having an average of 1000 Raman spectra per tissue, SERS signals showed changes between the HPV-infected and the carcinogenic tissues; these spectral signatures occurred mainly in the DNA bands, potentially offering a tool for the rapid screening of cancer.     

E-cadherin expression is biochemical marker in cervical intraepithelial neoplasia

The expression of E-cadherin has been investigated by the immunohistochemical method. The expression of E-cadherin is considered as a biomarker of junctions of intercellular adhesion in tissues samples with cervical intraepithelial neoplasias. The quantitative avidin-biotin-peroxidase method was used to estimate the expression. Precancer lesions, i.e., cervical intraepithelial neoplasias, CIN 1, 2, 3, precede invasive cancer of the cervix uteri by several years, the prognosis of which is variable in terms of regression and progression into invasive cancer. The expression of E-cadherin has been analyzed in cervical tissues of patients with various grades of CIN and microinvasive cancer (81 samples), as well as patients without CIN (ten samples). The sharp, statistically significant decrease in the expression of E-cadherin in CIN3 has been recorded compared to CIN1, CIN2, and the normal epithelium. It is reasonable to use this marker to assess the grade of the lesion and develop an individual prognosis of CIN progression. The data present a new way to construct pharmaceuticals based on compounds that influence E-cadherin expression.     

负载顺铂的泊洛沙姆温敏凝胶用于小鼠宫颈癌的局部化疗

为了探讨载有顺铂的温敏凝胶对小鼠宫颈癌的局部化疗作用,制备了载有顺铂的泊洛沙姆温敏凝胶,并通过流变学、体外溶蚀、体外释放等技术手段表征其结构和性能,采用鼠源宫颈癌U14细胞制备了原位宫颈/阴道癌模型,将载药凝胶灌注入荷瘤鼠阴道,评价载药凝胶对小鼠宫颈/阴道癌的抑制作用。结果表明,载有顺铂的泊洛沙姆温敏凝胶经阴道给药后对小鼠宫颈/阴道癌的抑瘤率可达到63.1%,可有效抑制小鼠宫颈癌的生长,而系统安全性则远远高于静脉注射顺铂。因此,载有顺铂的温敏凝胶有可能成为一种新型的宫颈癌治疗剂型。