妊娠高血压综合征胎盘血管紧张素转换酶基因多态性分析

研究表明,妊高征孕妇及胎儿血浆中肾素活性、血管紧张素Ⅱ及醛固酮水平较正常孕妇明显升高［１,２］,并推测肾素－血管紧张素－醛固酮系统（ＲＡＡＳ）在妊高征发病中起重要作用［３］。而最近的研究似为这种推测找到了分子遗传学证据,即发现妊高征与血浆中血管紧张素转换酶（ＡＣＥ,为ＲＡＡＳ的关键酶）基因缺失多态性呈明显相关性。已知妊高征是妊娠晚期特发性并发症,随着妊娠终止、胎盘娩出,患者的临床症状常迅速消失并恢复正常。动物模型研究也发现,表达血管紧张素原的转基因雌鼠与表达人肾素的转基因雄鼠交配后,受孕雌鼠在晚…     

妊高征监测与治疗的探讨

对１１６例妊高征患者同时检测血液变性，血管紧张素Ⅱ、醛固酮及血管内皮素，并与１００例正常孕晚期妇女作对照。结果提示：在妊高征患者中存在着三种不同情况：（１）血管紧张素Ⅱ增高；（２）醛固酮增高；（３）血管紧张素Ⅱ、醛固酮正常。     

血浆置换术在妊高征治疗中的临床应用（附5例病例报告）

目的：探讨血浆置换术在重度妊高征治疗中的临床应用，方法；选择重度妊高征，妊娠３３周以后，临床治疗一周效果不明显的患者５例，用美国ＣＳ－３０００血细胞分离机进行力浆置换术。置换总量１０００－１６００ｍｌ，总置换时间２－４小时，置换液为新鲜血浆，１０００～１６００ｍｌ，血小板１６Ｕ。结果：血浆置换后，血浆免疫物质（ＩｇＧ除外）肾素，血管紧张素，醛固酮，血栓素，前列环素，血，尿β２－ＭＧ均降低，肝肾，功     

妊高征与血管紧张素Ⅱ关系的研究

肾素-血管紧张素-醛固酮系统在调节血压及电解质平衡方面有重要作用。正常妊娠期,血浆肾素活性(简称PRA)及血管紧张索Ⅱ(简称ATn)水平常有升高,妊娠高血压综合征及原发性高血压合并妊娠者其PRA及AT_ 含量可较正常妊娠者降低,Massani则认为无论正常妊娠或妊高征患者其PRA     

妊高征的血管活性物质改变与发病机制的关系

在妊高征的发病机制中，血管活性物质起重要作用。本文综述了肾素－血管紧张素系统、心钠素、前列原素、内皮素及一氧化氮与妊高征发病机制的关系，发现妊高征时不仅仅缩血管物质明显增加，扩血管物质的水平亦显著降低，使血管对升压物质的敏感性增强，致血管痉挛，进而累及心、肝、肾等重要脏器、产生高血压，水肿和胎儿生长迟缓，甚至危及孕产妇和围产儿的生命。     

胎儿血管紧张素转换酶基因多态性与妊高征发病的关系

许多现象提示，妊高征（ＰＩＨ）不仅有较强的遗传倾向性［１］，而且胎盘胎儿单位的肾素血管紧张素系统（ＲＡＳ）与本病的发生、发展有密切关系［２，３］。作为ＲＡＳ系统关键酶之一的血管紧张素转换酶（ＡＣＥ）在ＰＩＨ孕妇血中明显升高，其不仅可催化血管紧张素...     

1eptin与妊娠高血压综合征

瘦素（1eptin）为肥胖基因编码的蛋白产物，参与调节机体的能量代谢，并在神经内分泌－生殖系统中起重要作用。有研究表明妊娠高血压综合征（妊高征）患者血清1eptin浓度增加，这可能与妊娠期1eptin、胰岛素抵抗及妊高征患者胎盘缺氧、细胞毒性因子增加、脂肪代谢紊乱、肾素－血管紧张素－醛固酮系统（RAAS）活性增加有关。     

血管紧张素Ⅱ受体与妊娠

血管紧张素Ⅱ受体（ATR）是肾素－血管紧张素系统（RAS）的效应器，介导血管紧张素Ⅱ的生理学效应，是RAS作用的关键环节。子宫胎盘组织血管紧张素Ⅱ受体ATR的表达改变对妊娠的正常发生发展起着重要的调节作用，ATR的表达异常将导致妊娠高血压综合征（简称妊高征）的发生，AT1R拮抗剂可能成为妊高征治疗的新手段。本文就ATR在妊娠及妊高征中的作用的研究进展作一综述。     

血管紧张素Ⅱ受体与妊娠

血管紧张素Ⅱ受体(ATR)是肾素-血管紧张素系统(RAS)的效应器，介导血管紧张素Ⅱ的生理学效应，是RAS作用的关键环节。子宫胎盘组织血管紧张素Ⅱ受体A7R的表达改变对妊娠的正常发生发展起着重要的调节作用，ATR的表达异常将导致妊娠高血压综合征(简称妊高征)的发生，AT1R拮抗剂可能成为妊高征治疗的新手段。本文就ATR在妊娠及妊高征中的作用的研究进展作一综述。     

肾素—血管紧张素—醛固酮系统与妊高征

肾素－血管紧张素－醛固酮系统与妊高征天津市中心妇产科医院（３０００５２）姚天一１８９８年Ｔｉｇｅｓｔｅｄｔ与Ｂｅｒｇｍａｎｎ首先发现将肾脏盐水提取物给兔注射时能引起高血压，并将此称肾素（ｒｅｎｉｎ）。１９４０年Ｐａｇｅ等和Ｂｒｕｎ－Ｍｅｎｅｄｅｚ等同...     

~(125)I-α-苦瓜子蛋白的大鼠药代动力学研究

本文采用同位素示踪技术对~(125)Ⅰ-α-苦瓜子蛋白进行药代动力学研究。药物经小鼠腹腔内吸收较快,给药后2h 吸收82.3%。大鼠静脉给药后的主要药代参数T_1/2α=1.61±0.41(h),T1/2β=48.98±8.02(h),V_c=30.94±4.18(dpm/kg),K_(21)=0.084±0.032(1/h),K_(10)=0.072±0.020(1/h),K_(12)=0.23±0.08(1/h)。消除相半衰期较长,说明药物排除缓慢。药物生物利用度76.6%,提示α-苦瓜子蛋白在体内易吸收。大鼠静脉注入~(125)Ⅰ-α-苦瓜子蛋白后,血中放射性-时间数据经拟合符合二室开放动力学模型。放射性分布结果证实,最高是肾,其次为胚胎、卵巢、子宫、肝、脂肪等组织。药物主要经尿排泄,给药24h 后,排出剂量的67.3%。胆汁排泄证实此药不易形成肠肝循环。用Sephadex G-75柱层析方法证实,代谢产物仍保持原有分子大小,未被降解。     

复方醋酸环丙孕酮与螺内酯干预对非肥胖型多囊卵巢综合征(PCOS)内分泌代谢的影响

目的:比较复方醋酸环丙孕酮和螺内酯治疗以高雄激素血症为主要表现的非肥胖型多囊卵巢综合征(PCOS)的临床疗效和对内分泌代谢的影响。方法:按前瞻性随机对照研究方法选择以高雄激素血症为主要表现的非肥胖型PCOS患者80例,按随机化分组方案分为复方醋酸环丙孕酮(EE-CA)组和螺内酯(Sp)组,每组40例,分别口服相应的药物6个月,比较治疗前、后的体质量指数(BMI)、腰臀比(WHR)、多毛体征、痤疮程度以及卵巢体积,并测定血清卵泡刺激素(FSH)、黄体生成素(LH)、雌二醇(E2)、泌乳素(PRL)、总睾酮(T)、性激素结合球蛋白(SHBG)、硫酸脱氢表雄酮(DHEAS)、空腹血糖(FPG)、空腹胰岛素(FINS)和血脂的水平,记录服药后不良反应。结果:治疗多毛EE-CA和Sp疗效接近(P>0.05);EE-CA组治疗6个月后痤疮评分下降较Sp组作用明显(P<0.05),在缩小卵巢体积方面显著优于Sp(P<0.05),降低血LH、LH/FSH、T、游离雄激素指数(FAI)、DHEAS和升高SHBG的作用较Sp组显著(P<0.05,P<0.01);EE-CA组FINS、甘油三酯(TG)和高密度脂蛋白(HDL)高于Sp组(P<0.05)。结论:本研究用于治疗以高雄激素血症为主要表现的非肥胖型PCOS的药物都是有效的;EE-CA降低高雄激素血症的效果优于Sp,但对高甘油三酯的患者使用要慎重;Sp亦有较好的降雄激素作用,且对糖、脂代谢没有显著影响。     

卵泡液中双酚A在多囊卵巢综合征发病中的作用及相关因素探讨

目的:探讨卵泡液中双酚A(bisphenol A,BPA)在多囊卵巢综合征(PCOS)发病中的作用。方法:于取卵日收集行体外受精/卵胞质内单精子显微注射(IVF/ICSI)的PCOS患者和非PCOS患者的卵泡液,检测患者卵泡液BPA水平和卵泡液性激素水平,并进一步与患者血清抗苗勒氏管激素(AMH)及临床结局等因素行相关性分析。结果:PCOS患者和非PCOS患者的卵泡液BPA水平(446.57±63.57 ng/L vs 336.29±59.02 ng/L,P0.001)、血清AMH水平(12.09±4.78μg/L vs5.69±2.98μg/L,P0.001)、卵泡液FSH(5.58±1.66 IU/L vs 3.95±1.54 IU/L,P=0.008)、LH(4.54±2.97 IU/L vs 0.96±1.10 IU/L,P0.001)和T(54.68±34.34 nmol/L vs 32.48±16.68 nmol/L,P=0.035)组间比较有统计学差异。相关性分析显示,卵泡液中BPA水平与血清AMH水平呈显著正相关(r=0.577,P=0.001)。结论:卵巢局部的BPA暴露可能参与了PCOS疾病的发生、发展。     

微小RNA(microRNA)与雄性生殖

作为非编码RNA家族的一类重要成员,目前越来越多的证据显示microRNA(miRNA)分子广泛参与细胞增殖、分化、凋亡、信号转导、器官形成、脂肪代谢、造血、胚胎发育、病毒复制,甚至肿瘤发生等多种细胞生命活动进程的调控。对人与鼠睾丸组织的小RNA克隆文库测序发现了大量表达的miRNA分子,研究显示这些睾丸高丰度或特异表达的miRNAs可能发挥极其重要的对生殖细胞性别决定、自我更新、精原细胞有丝分裂增殖、精母细胞减数分裂以及圆形精子细胞变态等过程的调控作用。     

Efficacy of the urinary hemagglutination test (Higonavis) and enzyme immunoassay (Ovustick) in detection of the spontaneous luteinizing hormone surge in an in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) program

Fifty-eight treatment cycles in an in vitro fertilization/gamete intrafallopian transfer (IVF/GIFT) program were studied to compare the efficacy of two urinary methods, hemagglutination test (Higonavis) and enzyme immunoassay (Ovustick), in detection of spontaneous luteinizing hormone (LH) surge. If an isolated rise in urinary LH level was taken as indicative of LH surge, the false-positive rate was 36.7% for Higonavis and 10.2% for Ovustick. The difference was statistically significant (P<0.001). If only a sustained rise in urinary LH was taken to indicate LH surge, the false-positive rate was 6.1% for Higonavis and 0% for Ovustick. In the seven cycles with a spontaneous plasma LH surge, there was a positive correlation between the plasma LH levels and the two urinary assay methods in six cycles (85.7%). Compared to plasma LH, there was a mean delay of 17.4 hr by the Higonavis test and 15.6 hr by the Ovustick test. If a sustained rise in urinary LH levels was taken as indicative of LH surge, both methods are quite accurate but the Ovustick appeared to be more specific.     

Atypical response to luteinizing hormone-releasing hormone (LH-RH) agonist (Suprefact nasal) in induction of ovulation in in vitro fertilization (IVF)

Animal and human research has indicated the presence of receptors to luteinizing hormone-releasing hormone (LH-RH) in the ovaries. However, the role of these receptors is not yet clear. Forty-five patients were treated with Suprefact (d-Serg-Des-Gly10-GnRGH), starting in the midluteal phase of a nonstimulatory menstrual cycle. The Suprefact (300 g t.i.d.) was administered as a nasal spray until the administration of human chorionic gonadotropin (hCG). On the third to fifth day of the following menstrual cycle, the patients were treated with a high dose of human menopausal gonadotropin (hMG). hCG was administered when at least two follicles reached a mean diameter of 18 mm. Five of these patients who ovulated spontaneously and had normal menstrual cycles did not respond to the stimulation with hMG. Treatment was stopped after 12 days of hMG administration. During the following cycle of the five patients, levels of gonadotropins were found to be in the normal range, and all of them responded as expected to hMG administered for 3 days only (hMG test). These findings suggest that LH-RH agonist may interfere with ovarian steroidogenesis.     

Mesh-related complications in single-incision transvaginal mesh (TVM) and laparoscopic abdominal sacrocolpopexy (LASC)

ObjectiveFew studies have investigated the long-term impact of synthetic mesh reconstructive surgery for pelvic organ prolapse (POP) on patient outcomes. This study aimed to examine the incidence and risk factors of mesh exposure and the subsequent requirement for surgical interventions due to mesh-related complications.Materials and methodsThis retrospective study was conducted from November 2010 to April 2018. We recruited women with Pelvic Organ Prolapse Quantification (POP-Q) stage 3 or 4 who underwent mesh reconstructive surgery for POP, and enrolled 487 women who received transvaginal mesh (TVM) and 110 women who received laparoscopic abdominal sacrocolpopexy (LASC). Assessments included mesh exposure rate and mesh-related complications requiring surgical interventions in both groups.ResultsIn the LASC group, the overall mesh-related complication rate was 8.18% over a mean follow-up period of 18 months. Concomitant laparoscopic-assisted vaginal hysterectomy was associated with mesh exposure (OR = 9.240; 95% CI = 1.752–48.728). No patients in the concurrent supracervical hysterectomy group were exposed to mesh. In the single-incision TVM group, the overall rate of mesh-related complications was 3.29% over a mean follow-up period of 19 months. Concomitant total vaginal hysterectomy was also a risk factor for mesh exposure (OR = 4.799; 95% CI = 1.313–17.359).ConclusionPreserving the cervix or uterus decreased the rate of mesh exposure in those undergoing TVM and LASC surgery. The overall rate of mesh-related complications was low after up to 8 years of follow-up.     

13,14双氢15-酮基前列腺素F_(2α)放射免疫测定法和初步应用

采用日本大耳白家免获得了亲和力高,特异性强的13,14-双氢15-酮基前列腺素F_(2α)(PGF_(2α)M)抗血清,建成了灵敏、精确、操作简便的PGF_(2α)M放射免疫测定法(RIA)。测定了人和动物血浆和尿样的正常值,同时观察了醋酸棉酚对大鼠血浆和尿中PGF_(2α)M含量的影响以及妇女月经周期中血浆PGF_(2α)M含量的变化。     

Associations between toxic metals in follicular fluid and in vitro fertilization (IVF) outcomes

Purpose

We previously reported associations between trace concentrations of Hg, Cd and Pb in blood and urine and reproductive outcomes for women undergoing in-vitro fertilization (IVF). Here we assess measurements in single follicular fluid (FF) specimens from 46 women as a presumably more relevant marker of dose for reproductive toxicity.

Methods

FF specimens were analyzed for Hg, Cd and Pb using sector field-inductively coupled plasma-mass spectrometry (SF-ICP-MS). Variability sources were assessed by nested ANOVA. Multivariable regression was used to evaluate associations for square root transformed metals with IVF outcomes, adjusting for confounders.

Results

An inverse association is detected for FF Pb and fertilization (relative risk (RR) = 0.68, P = 0.026), although positive for Cd (RR = 9.05, P = 0.025). While no other statistically significant associations are detected, odds ratios (OR) are increased for embryo cleavage with Hg (OR = 3.83, P = 0.264) and Cd (OR = 3.18, P = 0.644), and for embryo fragmentation with Cd (OR = 4.08, P = 0.586) and Pb (OR = 2.22, P = 0.220). Positive estimates are observed for Cd with biochemical (RR = 19.02, P = 0.286) and clinical pregnancies (RR = 38.80, P = 0.212), yet with very low precision.

Conclusions

We have identified associations between trace amounts of Pb and Cd in FF from a single follicle, and oocyte fertilization. Yet, the likelihood of biological variation in trace element concentrations within and between follicles, coupled with levels that are near the limits of detection suggest that future work should examine multiple follicles using a ‘one follicle-one oocyte/embryo’ approach. A larger study is merited to assess more definitively the role that these environmental factors could play with respect to egg quality in IVF programs.     

Bovine serum albumin (BSA) can replace patient serum as a protein source in an in vitro fertilization (IVF) program

Alternate protein sources have been suggested to replace the commonly used cord or patient serum for in vitro fertilization (IVF) procedures. During an 11-month period 127 patients treated for in vitro fertilization had elther their serum (N= 71) or bovine serum albumin (BSA;N= 56) used as the protein source in the insemination and growth media. Ham's F-10+0.5% BSA was used for sperm swim-up and insemination media and 1% BSA was used for the growth media. Patient's serum was added to Ham's F-10 culture media at concentrations of 7.5 and 15% for insemination and growth, respectively. Embryo transfer was performed with Ham's F-10 containing 90% maternal serum in both groups. Fertilization rate of 259 oocytes inseminated in medium containing patient's serum did not differ when compared with 200 oocytes inseminated in medium containing BSA. Likewise, rates of obnormal fertilization, cleavage, and pregnancy were similar in both groups. In a second experiment, 148 normally fertilized oocytes were transferred after 24 hr in culture to growth media containing two different concentrations of BSA (0.5 or 1%). Cleavage rates for the two groups were similar and the percentage of embryas developed to 4 cells did not differ signficantly. We conclude that a single concentration of BSA can safely be used to supplement culture media in human IVF with several practical and economical benefits.