Comparison Of Methods For The Detection Of Pregnancy -associated Cervical Intraepithelial Neoplasia And Clinical Significance

In recent years the incidence of cervical cancer increased and more cases were younger.CIN is a kind of precancerous lesions.The application of the three steps can clear the level of lesion.HPV infection is the basic factors of cervical cancer.Persistent infection appeared in CIN and cervical cancer.The experience of cervical cancer prevention,treatment and epidemiological data in developed countries shows that most women will be able to effectively combat cervical cancer if all of age(25-65 years old) accept effective cervical screening once every 12 months and the standardized treatment of cervical disease.Cervical cancer is the most common malignant tumor and can be diagnosed through screening during pregnancy.The purpose of this paper is to explore the need for cervical screening to pregnancy-associated women,the incidence of the status quo of pregnancy-associated cervical intraepithelial neoplasia,Compare different screening methods,to investigate the application of FISH to detect cervical epithelial cells hTERC and the clinical significance of gene amplification,and the status quo of mother-to-child vertical transmission of HPV at the same time.Objectives:1.To investigate pregnancy-associated cervical intraepithelial neoplasia status quo, explore the clinical significance of cervical screening.2.Study on the hTERC expression by FISH during pregnancy normal and abnormal cervical cell and its clinical significance.Analysis and Comparison of HPV infection in unusual,abnormal TCT,and pathological CIN in abnormal expression of genes hTERC clinical significance.3.Detect of HR-HPV type by MALDI-TOF MS in samples of the placenta and amniotic membrane,etc.Explore the mother-to-child inter-situation of vertical transmission.Methods:1.1912 cases of pregnancy and postnatal women,1165 carried out cervical cytology screening,HR-HPV was detected in 857 cases of them by Hybrid captureⅡat the same time,747 did none of two detection.Abnormalities have been follow-up in 3 month to 1 year postpartum in accordance with the three-step.2.67 cases of the cervical exfoliated cells were taken TCT film.Expression of hTERC gene by FISH in 20 cases of normal cervical exfoliated cells is taken as a control group to establish laboratory thresholds.Test the hTERC expression in the 67 cases and record the number of cells and fluorescent signal intensity. According to cytological,histological results and HPV infection,all cases were divided into normal and abnormal,inflammatory and CIN,positive and negative group.3.Collect placenta,amnion,etc in the persistent HPV infection cases.Detect HR-HPV type by MALDI-TOF MS.Analysis of HPV status of mother-to-child vertical transmission and explore ways of communication and delivery of related to each other.Results:1.118 of HR-HPV positive,during pregnancy 14.98%,postpartum 4.17%. abnormal TCT 36.HR-HPV positive rate of normal,ASCUS,ASC-H,LSIL and HSIL are 11.20%,53.85%,75%,87.5%,83.33%.19 of persistent HPV infection cases,28 negative cases from positive;the average age,viral load(≥10 pg/ml), sustained TCT abnormal is 30.4 and 30.0 years old,18 and 10,Hand 1.TCT progressed in 6 case,all were HPV-infected persistent cases.TCT improvement 12 cases of abnormal TCT;TCT abnormal status 7 cases,of which 6 were positive for HPV persistent,1 was negative.2.The rate of premature rupture of premature birth rate,membranes,cesarean section rate in screening of pregnant women were 0.74%,3.7%,24.4%,69.1%, and has no significant difference from not receiving ones.3.The percentage of amplification hTERC gene:the normal 7.7%and the abnormal 50%.The difference was significant between the two groups and during ASCUS,LSIL and HSIL.Inflammatory 25%and CIN 91.7%.The difference was significant between the two groups also.4.The rate of abnormal expression of genes hTERC in 44 of HR-HPV positive cases was 25%,while non-one cases of hTERC gene amplification in 10 of negative cases.IT was compared with significant difference the positive and negative(P＜0.05).5.Detected 58 samples,which were the placenta,amniotic membrane,umbilical cord,umbilical cord blood,neonatal oral secretions,milk etc of 15 pregnant women continued positive cases.We found 6 positive cases and 8 positive samples,including HPV16,18,52,58,66,ect al.Conclusion:1.HR-HPV infection rate was significantly lower in the postpartum than pregnancy,with a total positive rate similar to the findings of our epidemiological. The abnormal were followed up in accordance with the principles of three-step, 40%persistent infection and 60%negative.Comparing the average age,delivery mode of two groups,difference was not significant.Comparing the abnormal rate of TCT,the progress of cases and the HPV load(≥10 pg/ml) the difference was statistically significant.18%of infected persons continue to maintain the TCT abnormal status,18%TCT upgrade,18%TCT repeated variable,46%normal TCT.The TCT abnormal is closely related to persistent infection with HPV and reproductive tract with bacteria,trichomonas,chlamydia infections.The norms three-step is in favor of early detection of CIN.Screening during pregnancy is safe and necessary.2.The hTERC expression was significant during the normal,LSIL and HSIL,and significant between inflammatory and CIN groups.In HR-HPV infection group it was significantly higher than the negative group in the amplification.Histological results in CIN,hTERC amplified expression rate of 92.3 percent.FISH detection of cervical exfoliated cells in the amplification hTERC helps to further explore the pathogenesis of cervical cancer and to provide a theoretical basis for gene diagnosis.For pregnancy with a non-invasive method of diagnosis of CIN inspection.3.There was a certain proportion of the rate of vertical transmission of HPV.