类固醇生成因子1在卵巢子宫内膜异位囊肿及子宫腺肌病病灶中的表达

目的 探讨类固醇生成因子1( SF-1)在子宫内膜异位症(内异症)患者在位内膜、卵巢内异症囊肿、子宫腺肌病病灶中的表达.方法 选择2008年1月至2010年12月在北京大学第一医院妇科住院,因子宫腺肌病合并卵巢内异症囊肿行子宫全切除术及卵巢内异症囊肿剥除术或附件切除术的患者共30例,经病理确诊子宫腺肌病合并内异症囊肿共17例作为观察组;同期因宫颈上皮内瘤变(CIN)Ⅲ行子宫全切除术的患者10例作为对照组.将观察组患者的在位内膜、卵巢内异症囊肿病灶、子宫腺肌病病灶和对照组的子宫内膜组织进行石蜡切片,免疫组化Envision二步法检测SF-1蛋白的表达.结果 两组患者在位内膜的腺体和间质细胞中均无SF-1蛋白表达;观察组卵巢内异症囊肿病灶的间质细胞核SF-1蛋白的阳性表达率为14/17,SF-1蛋白在卵巢内异症病灶的腺体细胞及子宫腺肌病病灶中均无表达.结论 卵巢内异症囊肿与子宫腺肌病病灶中SF-1蛋白表达的差异可能在疾病的发生与发展中具有重要意义.     

不同类型卵巢子宫内膜异位囊肿临床特点及疗效分析

目的 探讨不同类型的卵巢子宫内膜异位囊肿(子宫内膜异位囊肿)的临床病理特点、手术治疗效果以及术后随诊等方面的差异.方法 将2003年3月至2008年3月就诊于北京协和医院进行腹腔镜手术的600例子宫内膜异位囊肿患者分为四组:单纯子宫内膜异位囊肿组(单纯组)、合并深部浸润型内异症组(DIE组)、合并子宫腺肌病组(AM组);同时合并子宫腺肌病、深部浸润型内异症组(复合组).比较各组间症状、手术效果以及术后随诊等情况.结果 (1)AM组35岁以上的患者比例为64.2%,明显高于单纯组(35.0%)及DIE纽(26.8%).(2)与单纯组(51.7%)比较,DIE组(69.0%)、AM组(79.2%)及复合组(83.3%)中度以上痛经率较高,病程较长(P=0.000).(3)DIE组、AM组及复合组手术时间均较单纯组长,出血量较多.(4)有AM者合并不孕率大于无AM者(30.2%vs 16.9%,OR=2.187,95%CI 1.181～4.051,P=0.011);前者术后妊娠率低(0vs 39.0%,OR=0.116,P=0.02,95%CI 0.014～0.947).(5)有AM使用GnRH-a者较无AM使用GnRH-a者疼痛缓解程度低[17.9%(10/56)vs 8.8%(23/261),OR=2.250,95%CI 1.004～5.040,P=0.044].(6)多因素logistic回归分析:与合并AM或DIE相关的因素包括年龄、痛经程度以及手术时间.结论 子宫内膜异位囊肿合并子宫腺肌病和(或)深部浸润型内膜异位症临床症状更重、手术难度更大,术后疼痛缓解率和妊娠率较低.     

TNFR1在子宫内膜异位症和子宫腺肌病表达的研究

目的:探讨肿瘤坏死因子受体1(TNFR1)在子宫内膜异位症(内异症)和子宫腺肌病(腺肌病)的表达及在其发病机制中的作用。方法:采用免疫组化SABC法检测33例内异位症患者(内异症组)和40例腺肌病患者(腺肌病组)在位及异位子宫内膜TNFR1的表达,并与20例非内异症(对照组)在位内膜进行比较。结果:内异症组和腺肌病组异位内膜TNFR1的表达水平显著低于其在位内膜和对照组(P<0.05);TNFR1在内异症Ⅰ-Ⅱ期和Ⅲ-Ⅳ期间无显著差异(P>0.05),与内异症r-AFS临床分期亦无直线相关关系(P>0.05);TNFR1在分泌期的表达为内异症、腺肌病异位内膜<其在位内膜<对照组内膜(P<0.05)。结论:异位内膜TNFR1的低表达可能在内异症和腺肌病的发生中起重要作用。TNFR1与内异症严重程度无关。     

卵巢、子宫肌层组织及静脉血中氧自由基代谢与子宫内膜异位症、子宫腺肌病发病的关系

目的探讨氧自由基与子宫内膜异位症(内异症)、子宫腺肌病(腺肌病)发病的关系.方法(1)测定32例卵巢内异症手术患者(内异症组)的静脉血,卵巢囊肿组织及囊液中脂质过氧化物(LPO)、微量元素硒(Se)、超氧化物歧化酶(SOD)、维生素E(VE)的水平;(2)测定23例腺肌病手术患者(腺肌病组)的静脉血、子宫肌层组织的LPO、Se、SOD、VE的水平.另外选取30例单纯子宫肌瘤患者作为对照(对照组).结果(1)内异症组静脉血、卵巢组织中LPO水平为(6.357±1.251)μmol/L、(3.735±1.546)nmol/g蛋白,高于对照组的(3.547±1.640)μmol/L、(1.105±0.653)nmol/g蛋白(P＜0.01);Se、SOD、VE水平均低于对照组(P＜0.01～0.05).(2)内异症组卵巢囊液中LPO水平高于自身静脉血及对照组静脉血(P＜0.01);(3)腺肌病组静脉血及子宫层肌组织LPO水平为(5.882±1.711)μmol/L及LPO水平(2.937±1.577)nmol/g蛋白,高于对照组的(3.547±1.640)μmol/L及(1.754±0.833)nmol/g蛋白(P＜0.01);静脉血Se、VE、SOD水平均低于对照组(P＜0.01);子宫肌层组织中Se、VE水平低于对照组(P＜0.01),而子宫肌层组织中SOD水平与对照组比较,差异无显著性(P＞0.05).结论内异症及腺肌病的发病与氧自由基的代谢失衡有关;与LPO增多有关.     

子宫内膜异位症和子宫腺肌病与妊娠结局

子宫内膜异位症（内异症）和子宫腺肌病是生育年龄女性的常见病,也是引起女性不孕的常见原因。由于内异症病灶的侵袭性,妊娠期可引发一系列妊娠并发症。内异症相关不孕患者是接受辅助生育技术的一个群体,对于如何改善内异症和子宫腺肌病患者的妊娠结局,在近十余年来的研究中取得了不少令人瞩目的结果。     

子宫肌腺症的临床病理特点及手术指征的探讨

目的:探讨子宫肌腺症的临床病理特点及手术指征。方法:2004年1月至12月手术治疗且病理证实为子宫肌腺症340例,其中全子宫切除284例,保守手术(子宫肌腺症病灶切除术)56例,回顾分析其临床病理特点并探讨手术方式及指征。结果:340例子宫肌腺症中合并子宫内膜异位囊肿95例(27.94%),合并子宫肌瘤148例(43·5%),合并贫血95例(27.9%),合并子宫内膜息肉20例(5.9%)。痛经组与无痛经组患者合并不孕症差异无统计学意义(P>0.05),两组合并内膜息肉有显著的统计学差异(P<0.01),痛经者合并内膜息肉是非痛经组的5倍,95%CI为0.079~0.509。两组合并子宫内膜异位囊肿有显著的统计学差异(P<0.01)。痛经患者合并卵巢子宫内膜异位症的风险是无痛经患者的3.369倍,95%CI为1.699~6.681。多因素Logistic回归分析表明,绝经前、月经量多和子宫大的患者易并发卵巢子宫内膜异位囊肿;年轻、分娩次数多和痛经重的患者易并发子宫内膜息肉;绝经前年轻女性和子宫体积大的患者易并发子宫肌瘤。分析不同手术途径表明:腹腔镜组年龄偏低,贫血、不孕比例明显增高。结论:对年轻合并性交痛、肛门坠痛等症状,伴有贫血或不孕患者首选腹腔镜检查/手术;子宫较大、B超提示合并肌瘤或既往有剖宫产史,估计盆腔粘连重者选择开腹手术;合并子宫脱垂、尿失禁等盆底组织缺陷性疾病选择阴式途径完成。保留子宫的手术可以根据患者主要症状、手术医师的技能和仪器来选择术式。对年龄大且无生育要求,合并贫血、子宫肌瘤,服药有严重副作用或无明显疗效的可行全子宫切除术。     

NGF及其受体trkA及p75NTR在子宫内膜异位症患者在位内膜中的表达及其与内异症疼痛的关系

目的:研究子宫内膜异位症(内异症)患者在位内膜神经生长因子(NGF)及其受体trkA、p75NTR的表达,探讨上述因子与内异症疼痛的关系。方法:选择就诊于北京协和医院并进行了腹腔镜手术的28例子宫内膜异位症患者作为研究组,非子宫内膜异位症患者10例作为对照组(B组),收集上述患者分泌期在位子宫内膜。根据患者有无痛经,分为内异症疼痛组(A1组,18例)及内异症非疼痛组(A2组,10例)。采用免疫组化比较各组病灶中NGF及其受体trkA、p75NTR的表达,并分析其与痛经的关系。结果:各组在位内膜腺上皮中NGF的表达显著高于间质(P<0.05);内异症疼痛组腺上皮NGF表达较非疼痛组明显升高(359.9±18.7 vs 201.3±34.3,P<0.05)。p75NTR主要在子宫内膜间质细胞中表达;内异症组明显高于非内异症组(58.8±21.1、22.5±16.1 vs 0,P<0.05);内异症疼痛组较非疼痛组p75NTR表达明显升高(58.8±21.1 vs 22.5±16.1,P<0.05)。trkA在非内异症组子宫内膜间质中表达明显高于腺上皮(P<0.05);在内异症组腺上皮中,trkA的表达较非内异症组明显增高(P<0.05);trkA的表达量与内异症患者疼痛无关。结论:p75NTR可能参与内异症的发病,NGF及其受体p75NTR在在位内膜中的表达与患者疼痛相关,表明其可能参与了内异症疼痛发病机制。     

子宫内膜异位症相关不孕合并内膜息肉的高危因素分析

目的 分析子宫内膜异位症(EM)相关不孕患者合并子宫内膜息肉(EP)的高危因素.方法 选取107例因不孕症接受宫腹腔镜联合手术,且经腹腔镜检查及术后病理证实为EM患者,根据宫腔镜检查及术后病理结果,将患者是否合并EP分为EP组(60例)与非EP组(47例).研究两组临床资料,探索EM不孕患者合并EP的高危因素.结果 1...     

子宫内膜异位症大鼠模型妊娠期孕激素受体及BKCa α表达

目的:探讨子宫内膜异位症(EM)大鼠妊娠模型子宫平滑肌子宫收缩相关因子的表达。方法:皮下种植法建立大鼠EM模型,雌雄合笼观察其受孕情况。留取妊娠期子宫平滑肌组织,qRT-PCR法检测BKCaα(大电导钙依赖的钾通道)、PR(孕激素受体)和PR-B(孕激素受体B亚型)表达情况。结果:造模成功率为16/20(80.00%),EM实验组和对照组的妊娠率分别为12/16(75.00%)和9/10(90.00%),两组比较差异无统计学意义(P=0.63)。内异症孕鼠模型中BKCaα、PR和PR-B mRNA表达分别为3.56±0.62、4.31±2.21和3.41±1.75,对照组分别为3.13±1.47、1.32±0.28和1.54±0.39,两组比较差异均无统计学意义。内异症孕鼠组的PR-B/PR比值显著高于对照组[(32.07±8.13)%vs (14.46±2.87)%,P0.05]。结论:内异症大鼠妊娠期孕激素受体亚型的异常分布可能与子宫异常收缩相关。     

单核细胞趋化蛋白-1在子宫内膜异位症患者子宫内膜组织中的表达

目的检测单核细胞趋化蛋白-1（MCP-1）在子宫内膜异位症(内异症)患者子宫内膜组织中的表达情况，并探讨其与内异症发病的关系。方法内异症患者30例作为研究组，非内异症患者20例作为对照组。用半定量逆转录聚合酶链反应（RT-PCR）方法检测两组子宫内膜组织中MCP-1信使核糖核酸(mRNA)的阳性表达率及相对水平。结果研究组26例(87%)内膜组织中可检测到MCP-1mRNA的表达，其中19例为强阳性表达，但其表达强度与内异症的严重程度无明显相关性。对照组15例(75%)内膜组织中可检测到MCP-1mRNA表达，仅3例为强阳性表达。研究组内膜组织中MCP-1mRNA的表达强度高于对照组(两组相对表达强度分别为0.746±0.345及0.460±0.341，P<0.05)。结论内异症患者的子宫内膜组织中MCP-1mRNA的表达增强，MCP-1对内异症的发病有一定促进作用。     

Anonymous and non-anonymous gamete and embryo donations: pros and cons

Consequences of legal restrictions concerning gamete and embryo donation have been increasingly discussed during the last three decades, partly dependent upon the fact that assisted reproductive technologies have opened up new medico-technical possibilities. In the present communication we want to elucidate some of the problems and consequences of a Swedish law from 1985 requiring that all sperm donors should be non-anonymous. A similar law was passed in 2003 for oocyte donation. Such legal restrictions do not seem to be in the interest of the infertile couple who, to a large extent, seek treatment abroad where the laws are more liberal or non-restrictive (reproductive tourism). Whether or not the Swedish law is in the best interest for the offspring remains to be seen.     

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND: Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS: Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS: The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.     

Adiposity and Endometriosis Severity and Typology

Study ObjectivePrior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology.DesignCross-sectional study among women with no prior diagnosis of endometriosis.SettingFourteen clinical centers in Salt Lake City, UT, and San Francisco, CA.PatientsA total of 495 women (of which 473 were analyzed), aged 18–44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study.InterventionsGynecologic laparoscopy/laparotomy regardless of clinical indication.Measurements and Main ResultsParticipants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I–IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I–IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators.ConclusionOur research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.