阴道腺病

阴道腺病王熙清张月存（山东医科大学附属医院）阴道粘膜由非角化的复层鳞状上皮被覆，正常情况下不存在腺上皮。阴道腺病（ｖａｇｉｎａｌａｄｅｎｏ－ｓｉｓ）是指阴道壁的表面或粘膜下结缔组织内出现副中肾系统（Ｍüｌｅｒｉａｎｓｙｓｔｅｍ）的腺体组织或腺囊肿，故...     

康妇特栓治疗细菌性阴道病的临床研究

目的 ①观察康妇特栓对细菌性阴道病（bacterial vaginosis，BV）的疗效；②了解BV时阴道菌群情况。方法 对106‘例BV患者采用多中心、前瞻性、将康妇特与甲硝唑进行随机对照研究，观察患者症状、体征及实验室检查等方面的变化，并在初诊和第1次随访时进行阴道分泌物需氧菌培养。结果 ①大多数的BV患者有白带增多、白带异常的症状，检查时发现黄色分泌物占60．4％，胺试验阳性者大于80．0％，pH值绝大多数〉4．5，线索细胞均阳性。②实验组与对照组比较，在第1次随访时两组患者症状明显改善，症状、体征及实验室检查均无明显差异（P〉0．05），总有效率分别为92．0％与86．0％（P〉0．05），两组无统计学差异。第2次随访时实验组的分泌物形状及清洁度比对照组有明显改善（P=0．023及0．001），且总有效率明显高于对照组（100．0％VS92．5％，P=0．002），患者满意程度也优于对照组（P=0．002）。③BV患者的阴道内以大肠杆菌为主，其次为甲类溶血链球菌、粪肠球菌、不动杆菌、棒状杆菌、草绿链球菌、表皮葡萄球菌。结论 ①应提高对BV的认识，积极予以治疗；②康妇特在疗效上明显优于甲硝唑。     

生物膜与阴道炎症

生物膜是一种黏附于非生物或生物表面的微生物附着群落,由多糖、蛋白或核酸等构成的多聚基质形成。生物膜结构有助于抵抗机体防御系统及增强病原体对抗生素的耐受性,与慢性、持续性感染有密切关系。细菌性阴道病妇女阴道黏膜及性伴侣尿液沉渣均能检测到加德纳菌生物膜。采用甲硝唑或莫西沙星的标准治疗,虽然临床症状消失,但停药后部分以加德纳菌为主的细菌生物膜在生化失活后得以重新复活。在外阴阴道假丝酵母菌病患者的宫内节育环表面,以及小鼠白假丝酵母菌阴道炎模型上均检测到白假丝酵母菌生物膜。生物膜的研究将对阴道炎症的认识提供一种全新思路。     

细菌性阴道病阴道乳酸杆菌的生态学特征

细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）系阴道内菌群生理生态内环境改变所致，尤与阴道内乳酸杆菌（ｌａｃｔｉｃａｃｉｄｂａｃｉｌ－ｌｕｓ，ＬＡＢ）与加特纳杆菌（Ｇａｒｔｎｅｒ＇ｓｂａｃｉｌ－ｌａｓ，ＧＢ）或混合性厌氧菌群失调有关。阴道...     

妊娠合并细菌性阴道病

细菌性阴道病 (ＢＶ)系阴道菌群紊乱 ,既以高浓度的阴道加德纳杆菌、各种厌氧菌及人型支原体替代了正常、健康的阴道乳酸杆菌而引起的一种临床疾病。虽然符合这一疾病诊断标准的妇女中 5 0 %是没有症状的 ,但ＢＶ是引起异常阴道分泌物和阴道炎的最常见的原因。据报道[1 ] 妇女中ＢＶ的发病率为 10 %～ 41% ,妊娠期ＢＶ检出率远高于阴道滴虫及念珠菌感染者 ,并且新的证据[2 ,3 ] 表明ＢＶ与自然流产、早产、胎膜早破、羊膜绒毛膜炎、羊水感染、产后子宫内膜炎和剖宫产后切口感染等相关 ,在这些研究中风险指数 (ＲＲ)从 1 1到 7 3,具有显著性…     

国产硝呋太尔制霉素阴道软胶囊治疗阴道炎的临床研究

目的 评价国产硝呋太尔制霉素阴道软胶囊治疗滴虫性阴道炎、细菌性阴道病、外阴阴道念珠菌病的临床疗效和安全性。方法 随机盲法平行对照多中心临床试验，进口麦咪康帕阴道栓为对照药。结果 有效病例为滴虫性阴道炎62例、细菌性阴道病65例、外阴阴道念珠菌病65例，各适应证的试验组及对照组受试者的临床症状、体征及妇科实验检查在用药前后均有明显改善（P〈0．01），各适应证的总有效率为90．0％～96．8％，试验组与对照组的疗效相似（P〉0．05），无严重不良事件发生，对肝肾功能血尿常规等均无影响，仅个别患者有轻微的阴道局部的刺激症状。结论 临床试验结果提示，国产硝呋太尔制霉素阴道软胶囊是一种可供选择的、能用于治疗细菌性阴道病、滴虫性阴道炎及外阴阴道念珠菌病的阴道局部药物。     

基于门诊患者阴道微生态与HPV感染的相关性研究

目的: 分析以外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常为主诉就诊患者的阴道微生态及宫颈人乳头瘤病毒（human papilloma virus,HPV）分布特点,探讨阴道微生态失调与HPV感染的关系。方法: 选取2019年2月1日—2019年12月31日,因外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常就诊于天津中医药大学第二附属医院妇科门诊的483例患者为研究对象,同时进行阴道微生态检测和宫颈HPV检测,对检测结果进行分析。结果: 483例患者中,阴道微生态正常者仅有4例,占0.8%,微生态失调者479例,占99.2%,其中有明确致病菌的微生态失调（即阴道感染）者350例（73.1%）,无明确致病菌的微生态失调者129例（26.9%）;在350例阴道感染患者中,单一感染287例（82.0%）,混合感染63例（18.0%）。外阴阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）单一感染（38.7%,111/287）及含VVC的混合感染（79.4%,50/63）发生率最高。阴道感染者中乳杆菌减少者、H₂O₂含量减少者占比高于无明确致病菌的阴道微生态失调者,差异有统计学意义（P<0.05）。在483例患者中,HPV感染162例,感染率为33.5%,而阴道感染患者的HPV感染率（37.1%,130/350）明显高于无明确致病菌的阴道微生态失调患者（24.0%,31/129）,其中滴虫性阴道炎（trichomonal vaginitis,TV）、细菌性阴道病（bacterial vaginosis,BV）、需氧菌性阴道炎（aerobic vaginitis,AV）、VVC、BV中间型患者HPV感染率分别为73.3%（11/15）、52.9%（72/136）、34.5%（10/29）、29.2%（47/161）和 27.4%（20/73）。多因素回归分析结果显示,TV、BV与HPV感染正相关（OR分别为5.325和3.298,均P<0.05）。结论: 外阴阴道瘙痒、干涩、疼痛和（或）分泌物异常的患者常存在阴道微生态失调,而且容易合并HPV感染,当发生阴道感染时（特别是TV及BV）,HPV感染的风险显著增加。     

复杂性外阴、阴道念珠菌病混合感染的分析

外阴、阴道念珠菌病(vulvovaginal candidiasis,VVC)是妇科常见的感染性疾病之一,临床常见治疗外阴、阴道念珠菌病以后又出现细菌性阴道病(bacterial vaginosis,BV)的症状,患者需长时间治疗,既增加了患者的就诊次数和经济负担,也严重影响着患者的生活质量.     

细菌性阴道病患者阴道分泌物革兰染色的涂片特征

细菌性阴道病患者阴道分泌物革兰染色的涂片特征刘小平樊尚荣李世荣李耀霞细菌性阴道病（ｂａｃｔｅｒｉａｌｖａｇｉｎｏｓｉｓ，ＢＶ）系由多种微生物（主要为厌氧菌）所致的无阴道粘膜炎症表现的临床综合征。本病首先由Ｇａｒｄｎｅｒ等［１］描述，主要临床特征为白带...     

High-risk human papillomavirus DNA testing and high-grade cervical intraepithelial lesions

OBJECTIVE: To explore the role of high-risk human papillomavirus (HPV) DNA testing in the improvement of the recognition of cervical cancer and precancerous lesions in women with abnormal cervical cytology. METHODS: A total of 2152 women with abnormal cervical cytology were submitted to both HPV DNA testing and biopsy guided by colposcopy and the results were correlated. RESULTS: Positive rate of high-risk HPV DNA in groups of atypical squamous cells of undetermined significance (ASC-US), atypical squamous cells, cannot exclude high-grade (ASC-H), low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions was 53.7, 53.2, 84.6 and 93.0%, respectively. In each group, the detection rate of grade 2,3 cervical intraepithelial neoplasia (CIN 2,3) or cervical cancer in patients with positive HPV DNA was significantly higher than that with negative HPV DNA (P<0.05). In ASC-US group, the negative predictive value of high-risk HPV DNA testing for detection of CIN 2,3 and cervical cancer was 99.8% and the sensitivity 98%. CONCLUSION: HPV DNA testing is a useful indicator in the management of patients with ASC-US and plays an important role in the evaluation of risk for CIN 2,3 and cervical cancer.     

Role of Cervical Cancer Biomarkers p16 and Ki67 in Abnormal Cervical Cytological Smear

IntroductionCervical cancer is the most common cancer in India. Screening for cervical cancer helps in marked reduction of invasive cervical cancers. The low sensitivity of Papanicolaou cytology (Pap smear) and high-risk human papillomavirus (HR-HPV) in excluding high-grade intraepithelial lesion (ASC-H) leads to unnecessary referrals to colposcopy-guided biopsy. The combined cervical cytology screening and HR-HPV have its own limitations and still need further standardization. Using additional biomarkers like staining with p16 and Ki-67 might help in triaging abnormal pap smear.Materials and MethodsA prospective, cross-sectional study was performed over a period of 16 months in the Department of Obstetrics and Gynaecology, in collaboration with Department of Pathology. Study was conducted to know the efficacy of immunostaining with p16/Ki-67 in predicting the presence of significant lesion in cases of mild cytological atypia. PAP smears (conventional and LBC) along with P16, Ki-67 and available biopsies were correlated.ResultsLiquid-based cytology (LBC) was done in 2134 cases, out of which 46 cases showed abnormal cytological findings such as [22 atypical squamous cells of undetermined significance (ASCUS), 3 low-grade squamous intraepithelial lesion (LSIL), 8 atypical squamous cells cannot exclude high-grade lesion (ASC-H), 6 high-grade squamous intraepithelial lesion (HSIL), 5 squamous cell carcinoma (SCC), 2 adenocarcinoma, 1 atypical glandular cells of undetermined significance (AGUS)]. Immunostaining with p16 and Ki-67 was performed on 38 cases of abnormal cytological smears. Out of 38 abnormal cytology cases, 28 cases had shown co-staining for both p16 and Ki-67, suggestive of true HPV infection of the cells. Of the 38 cases, 07/14 ASCUS, 06/06 HSIL, 07/08 ASC-H, 05/05 squamous cell carcinoma and 02/02 adenocarcinoma also showed dual positivity for p16 and Ki-67. One case of AGUS was diagnosed, but the smear was unsatisfactory for immunocytochemical evaluation and excluded from the study. Three cases of LSIL were also diagnosed on cytological evaluation, and 1 of them however showed positivity for p16 and Ki-67 on immunocytochemistry (ICC). In the ASC-US group, the sensitivity and specificity of the immunostaining in diagnosing CIN2 + lesions were 87.51%, and in LSIL group, the sensitivity and specificity of the immunostaining in diagnosing CIN2 + lesions were 100%. p16/Ki-67 positivity also increased with cytological severity which in turn corresponded with histological findings: it reached from 50% in ASC-US to 100% in both HSIL and SCC categories.ConclusionThis immunostaining with p16 and Ki67 can be a useful method in the triaging of the ASC-US and the LSIL group as considering the high sensitivity and specificity values.     

2007-2008年北京地区25～54岁已婚妇女子宫颈上皮内瘤变的高危因素分析

目的 探讨北京地区25～54岁已婚妇女宫颈上皮内瘤变(CIN)的高危因素.方法 采用横断面调查方法,于2007年3月至2008年9月,对北京地区12个区县共137个社区内随机抽取的25～54岁已婚妇女6339例进行问卷调查、妇科检查、宫颈细胞涂片液基薄层细胞学检查(TCT)、宫颈分泌物高危型人乳头状瘤病毒(HR-HPV)检测,并对TCT结果异常者行阴道镜下宫颈活组织检查.采用logistic回归分析方法,分析CIN的高危因素及危险度比值比(OR)和95%可信区间(95%CI).结果 6339例妇女中,CIN患病率为5.90%[(374/6339,包括4例鳞状上皮细胞癌(SCC)因例数少,未单独统计].多元回归分析结果显示,HR-HPV感染(95%CI=9.953～15.811)、滴虫性阴道炎病史(95%CI=1.046～2.104)、口服避孕药避孕(95%CI=1.087～1.806)以及年龄＜45岁(95%CI=1.069～1.828)等因素与CIN患病相关.结论 HR-HPV感染是CIN患病的独立危险因素,而滴虫性阴道炎病史、口服避孕药避孕及年龄＜45岁是CIN患病相关危险因素.     

Liquid-based cytology and human papillomavirus testing: A pooled analysis using the data from 13 population-based cervical cancer screening studies from China

Objective

The objective of this study was to evaluate the impact of introducing HR-HPV testing in cytology regarding cervical cancer screening practice.

Methods

A pooled analysis of liquid-based cytology (LBC) and HR-HPV testing using data from 13 population-based cervical cancer screening studies conducted in China was performed. Participants (n = 25,404) received LBC and HR-HPV testing. Women found to be positive on screening were referred for colposcopy and biopsy. The effectiveness of screening strategies that use: LBC with HR-HPV triage for atypical squamous cells of undetermined significance (ASC-US), HR-HPV testing with cytology triage for HPV positive tests, or LBC and HPV cotesting was compared with that of LBC screening alone.

Results

LBC with HR-HPV triage for ASC-US had similar sensitivity compared with LBC alone, but significantly increased specificity for both cervical intraepithelial neoplasia grade 2 or worse (CIN2 +) and CIN3 or worse (CIN3 +) endpoints, and had the best balance between sensitivity and specificity among the strategies. LBC and HR-HPV cotesting had the highest sensitivity and negative predictive value (NPV) and could permit a safe extension of screening intervals. Through the use of an immediate colposcopy threshold of ASC-US or worse for HR-HPV positive women and the use of a raised threshold of low-grade squamous intraepithelial lesion (LSIL) or worse for HR-HPV negative women, LBC and HR-HPV cotesting could provide the same effectiveness as LBC testing with HR-HPV triage for ASC-US at baseline tests.

Conclusions

The results of the current study support the use of the cervical cancer screening guidelines in China.     

Prevalence of human papilloma virus infection of the uterine cervix in women with abnormal cervical cytology

PURPOSE OF INVESTIGATION: To determine the prevalence of human papillomavirus (HPV) using polymerase chain reaction (PCR) in women with abnormal cytology results. METHODS: A prospective study of 215 women with abnormal cytology results referred consecutively to the cervical pathology clinic was carried out. A second cervical cytology using the Bethesda System was performed on all the patients to confirm the initial diagnosis, as well as to test for the presence of HPV by PCR and a colposcopy and punch biopsy in cases presenting with an abnormal pattern on colposcopy. The sensivitiy, specificity, and positive and negative predictive value (PPV and NPV) were calculated using 2 x 2 tables. RESULTS: The women aged 35 years or younger presented a higher percentage of HPV infection (85.6%) than the women over 35 years of age (54%). The highest percentage of women with a positive result for HPV was found in those with a cytological high-grade squamous intraepithelial lesion (HSIL) (85.5%), as compared with 47.4% of the women with a cytological low-grade squamous intraepithelial lesion (LSIL). HPV infection has a high negative predictive value (93.2% of cases) and a high sensitivity (93.5%) for the detection of HSIL by biopsy, although the specificity and positive predictive value were low, 51.5% and 52.1%, respectively. CONCLUSION: Patients with cytological HSIL have a high prevalence of HPV infection.     

Prevalence and predictors of squamous intraepithelial lesions of the cervix in HIV-infected women in Lusaka, Zambia

OBJECTIVES: HIV-infected women living in resource-constrained nations like Zambia are now accessing antiretroviral therapy and thus may live long enough for HPV-induced cervical cancer to manifest and progress. We evaluated the prevalence and predictors of cervical squamous intraepithelial lesions (SIL) among HIV-infected women in Zambia. METHODS: We screened 150 consecutive, non-pregnant HIV-infected women accessing HIV/AIDS care services in Lusaka, Zambia. We collected cervical specimens for cytological analysis by liquid-based monolayer cytology (ThinPrep Pap Test) and HPV typing using the Roche Linear Array PCR assay. RESULTS: The median age of study participants was 36 years (range 23-49 years) and their median CD4+ count was 165/microL (range 7-942). The prevalence of SIL on cytology was 76% (114/150), of which 23.3% (35/150) women had low-grade SIL, 32.6% (49/150) had high-grade SIL, and 20% (30/150) had lesions suspicious for squamous cell carcinoma (SCC). High-risk HPV types were present in 85.3% (128/150) women. On univariate analyses, age of the participant, CD4+ cell count, and presence of any high-risk HPV type were significantly associated with the presence of severely abnormal cytological lesions (i.e., high-grade SIL and lesions suspicious for SCC). Multivariable logistic regression modeling suggested the presence of any high-risk HPV type as an independent predictor of severely abnormal cytology (adjusted OR: 12.4, 95% CI 2.62-58.1, p=0.02). CONCLUSIONS: The high prevalence of abnormal squamous cytology in our study is one of the highest reported in any population worldwide. Screening of HIV-infected women in resource-constrained settings like Zambia should be implemented to prevent development of HPV-induced SCC.     

Atypical squamous cells of undetermined significance in girls and women

OBJECTIVE: To estimate the outcome of adolescents with atypical squamous cells of undetermined significance (ASC-US) on cytology. METHODS: A review of ASC-US cytology in girls and women aged 10-19 years between 1995 and 1999 was performed. The cytologic and histologic follow-up of each patient was evaluated. The outcome was recorded as the most significant (highest grade) subsequent cervical smear or biopsy. RESULTS: Overall, 535 of 7897 (6.8%) cervical cytologic specimens were reported as ASC-US. The study group consisted of 398 patients for whom pathologic follow-up was available. The mean duration of follow-up was 19 months. Follow-up consisted of repeat cytology in 251 (63%) patients and colposcopy with cervical biopsies and/or endocervical curettage in 147 (37%) of the adolescents. Two hundred fifty-three (64%) adolescents had no pathologic abnormalities on follow-up. Persistent ASC-US was identified in 65 (16%), low-grade squamous intraepithelial lesions/cervical intraepithelial neoplasia (CIN) 1 was found in 44 (11%) and high-grade squamous intraepithelial lesions/CIN 2 or 3 occurred in 36 (9%) of the adolescents. No cases of invasive carcinoma were found. CONCLUSIONS: Among adolescents with ASC-US, the rate of squamous intraepithelial lesions/CIN is similar to that of adults. Although the optimal management of ASC-US in adolescents is unknown, these patients warrant close follow-up. LEVEL OF EVIDENCE: III     

贵州省三都水族自取样HPV检测宫颈癌筛查及分流模式#br#

Objective?To explore a cervical cancer screening strategy suitable for remote minority areas in China. Methods?A total of 1 874 cases of shui minority women aged 21~65 years in Sandu were randomly sampled self-sampling HPV test, TCT test and P16 cytological immunohistochemical test. The patients with HPV positive, TCT abnormality (ASC-US) and P16+underwent colposcopy and biopsy, and squamous intraepithelial lesion (SIL) was detected. Results?The positive rate of HR-HPV was 15.69% in 1 874 women. HPV52 was the most common type, followed by HPV16, HPV39, HPV58 and HPV56. Among 249 patients with colposcopy biopsy, 23 cases (9.24%) were detected with HSIL or above lesions.The positive rates of p16 in HSIL and above cervical lesions, LSIL and cervicitis were 73.91%, 34.57% and 10.34% (P<0.001).The sensitivity of self-sampled HPV test to HSIL+ was 100%, and the area under ROC curve for HSIL+ detected by HPV-positive test and p16 test was 0.577 (P>0.05) and 0.774 (P<0.05), respectively. Conclusion?Self-sampled HPV was highly sensitive to HSIL. Using self-sampling HPV detection as primary screening, combined with p16 staining triage, can be used as a screening strategy in remote areas of Guizhou province to improve the coverage of screening.     

Human papillomavirus cervical infection and associated risk factors in a region of Argentina with a high incidence of cervical carcinoma.

OBJECTIVE: To assess the prevalence and potential risk factors associated with human papillomavirus (HPV) cervical infection among women residing in a region of northeastern Argentina with a high incidence of cervical cancer. METHODS: A case-control study of 330 women participating in a cervical cytological screening program conducted in Posadas city, Misiones, Argentina, from February 1997 to November 1998 was carried out. Standardized questionnaires were administered, and clinical examination including colposcopy was performed. Fresh endocervical specimens for HPV DNA detection by generic polymerase chain reaction were collected and the products typed by dot-blot hybridization. RESULTS: Human papillomavirus DNA was found in 61% of samples analyzed (185/301). Samples with normal cytology had a 43% infection rate (85/199), while those classified as low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, and invasive cervical carcinoma had an infection rate of 96% (53/55), 100% (29/29), and 100% (18/18), respectively. Human papillomavirus typing showed a 64% (118/185) prevalence of type 16 among all the infected population analyzed; type 16 was detected among 49% (42/85) of infected samples with normal cytology and in an average of 74% (74/100) with abnormal cytology. Sexual behavior, residence in southern Paraguay, and history of a previous sexually transmitted diseases were the main risk factors associated with high-grade cervical lesions. CONCLUSIONS: An elevated prevalence of HPV infection was detected in this population, which also has a high incidence of cervical cancer. The broad distribution of high-risk HPV type 16 in women with normal cytology and colposcopy suggests that viral infection is an important determinant of regional cancer incidence.     

Prevalencia de la infección por el virus del papiloma humano en mujeres con citologías anormales del cérvix uterino y factores de riesgo asociados a la infección

Objectives

To determine the prevalence of human papillomavirus (HPV) infection in women with an abnormal pap smear of the uterine cervix and to determine the risk factors associated with HPV infection.

Subjects and methods

Eighty-one women with a cytological result of atypical cells of unknown origin (ASCUS), low-grade squamous intraepithelial lesions (LG-SIL) or high-grade squamous intraepithelial lesions (HG-SIL) were referred for epidemiological questionnaire, HPV detection performed using the Hybrid Capture II^® test, histological study, and analysis of other sexuallytransmitted diseases.

Results

Cytologic study identified 16 women with ASCUS, 44 with LG-SIL and 21 with HG-SIL. The global prevalence of HPV infection was 67.9% (55 patients) and high-risk HPV (HR-HPV) infection was detected in 50 patients (61.8%). The percentages of HR-HPV infection in women with ASCUS, L-SIL and H-SIL were 31.2%, 63.6% and 80.9%, respectively. The number of sexual partners over a woman’s lifetime was significantly associated with HPV infection (χ² for trend: 4.187; p = 0.0407).

Conclusions

Women with ASCUS detected by cytology are those who could most benefit from HR-HPV detection techniques, because of the lower prevalence of the infection. The main risk factor associated with HPV infection was the number of sexual partners over a woman’s lifetime.