维生素D与男性生殖关系的研究进展

维生素D为人们所熟知的,其生理功能是参与钙磷代谢与骨盐沉积.近年来研究表明,维生素D受体在男性生殖器官中广泛表达,相关研究还证实了维生素D缺乏或不足与男性生育力下降存在相关性.本文主要从维生素D生物和代谢特点及其在男性生殖各方面的作用进行综述,以便加深对维生素D在男性生殖中作用的认识,为男性不育的治疗提供理论依据.     

维生素D缺乏与围生期抑郁症的相关性

维生素D（Vitamin D,VD）作为孕产期所必需的营养素之一,其不仅与骨代谢有关,而且具有影响脑内神经免疫调节、神经营养因子和神经传递在内的多重神经活性。近年研究发现,VD对抑郁症的发生有不同程度的影响。而产前和产后抑郁症作为抑郁症的分支,其与VD的关系也备受关注。VD缺乏不仅可能导致复发性流产、妊娠期糖尿病和子痫前期等,还与妊娠期和产后的抑郁症状有关。有文献报道VD缺乏可能是围生期抑郁症的重要危险因素之一。围生期合理补充VD对抑郁症有一定的防治作用,但对于VD补充的时机和剂量还需要更多的研究证实。结合近年发表的国内外文献,探讨VD缺乏与围生期抑郁症之间的相关性,以期为疾病的早期预防、早期诊断和及时治疗提供理论依据,并为后期的研究提供新思路。     

维生素D与母体妊娠相关疾病关系的研究进展

维生素D（Vitamin D,VD）作为人体所必需的营养素之一,参与调节体内多种生物学过程,其补充剂主要应用于预防和治疗佝偻病、骨质疏松症等疾病。VD受体广泛分布于机体组织细胞中,研究发现VD在调节免疫系统功能方面发挥重要的生理作用,同时参与了神经系统、内分泌系统及循环系统疾病的发病过程。妊娠期间,VD对维持母体及胎儿发育同样至关重要。有文献报道孕产妇VD水平偏低或缺乏与妊娠相关疾病发病率增加有关,严重的VD缺乏还可导致孕妇及胎儿不良妊娠结局。结合近年发表的国内外文献,对VD的不足或缺乏与母体妊娠相关疾病的关系进行综述,探讨疾病发生的病理机制,为早期预防、早期诊断和及时治疗提供理论依据。     

维生素D在子宫内膜癌发生发展中的作用研究进展

正子宫内膜癌(endometrial carcinoma,EC)是妇科常见恶性肿瘤,发病率和病死率均呈上升趋势,严重危害妇女健康~([1-2])。文献报道,维生素D(vitamin D,VD)在多种肿瘤发生和进展中发挥重要作用,循环中VD水平升高与乳腺癌、卵巢癌等恶性肿瘤发生风险降低有关~([3-4])。VD可通过调节细胞增殖、凋亡、黏附、侵袭和血管生成、炎性反应等参与肿瘤发生~([5])。目前,VD与子宫内膜癌发生风险之间的关系仍有争议。故在VD对子宫内膜癌有局部作用的基础上,对其潜在的分子机制进行研究可能具有一定应用价值。     

维生素D及其受体与妇科肿瘤

化疗是治疗妇科肿瘤的主要手段之一.但是,目前临床所应用的化疗药物存在较严重的毒性,限制了其在临床上的应用.近年研究发现维生素D(VD)和维生素D受体(VDR)除了已熟知的维持血清钙离子平衡和骨结构的生理功能外,还与肿瘤有密切关系.体内外试验证明VD有抑制肿瘤细胞增殖和诱导分化的作用.VD和VDR与妇科肿瘤关系的研究.     

吸烟对男性生殖功能的影响

香烟烟雾中含有多种化学致癌物和致癌物前体物质,是多种疾病和肿瘤的主要危险因素之一,而且吸烟可以影响男性精液质量、男性生殖功能、男性性腺与激素、精子DNA指标等。     

维生素D及其受体与妇科肿瘤

化疗是治疗妇科肿瘤的主要手段之一。但是，目前临床所应用的化疗药物存在较严重的毒性．限制了其在临床上的应用。近年研究发现维生素D（VD）和维生素D受体（VDR）除了已熟知的维持血清钙离子平衡和骨结构的生理功能外，还与肿瘤有密切关系。体内外试验证明VD有抑制肿瘤细胞增殖和诱导分化的作用。综述VD和VDR与妇科肿瘤关系的研究。     

生殖健康与男性保健

1　男性的生物学特征和性别角色　　男性的生物学特征 :在生殖生动中 ,男性的作用是原发的 ,女性的作用是继发的。男性的生殖活动没有类似女性的周期性 ,一旦发育成熟 ,就持续不断地产生精子 ,成年男子每天约可产生 1 6× 10 8个精子。男性生殖功能的衰退是一个渐进性漫长的退行演变过程 ,个体差异很大。年龄对精子数量和精子受精能力没有明显影响。男子一生中需要生育干预的时间几乎是女性的两倍。男性的性行为是一种主动行为 ,具有攻击性 ,同时也容易受各种因素的干扰而发生障碍。　　男性的性别角色 :几乎在每一个社会单位都有性别的角色…     

重度子痫前期母体和胎盘维生素D代谢紊乱

目的:探究重度子痫前期(sPE)母体及胎盘中维生素D(VD)代谢情况。方法:选取2016年8月至2017年3月于武汉市第四医院建卡的妊娠妇女101例,按孕妇情况将其分为sPE组(n=43)及对照组(n=58)。采集各受试者母体血、脐带血及胎盘组织,记录胎儿胎龄,测量新生儿体质量及身长;采用酶联免疫吸附法检测血清及胎盘组织中VD代谢物水平;采用RT-PCR法检测胎盘组织中1α-羟化酶、24-羟化酶及维生素D受体(VDR)mRNA水平。分析胎盘VDR mRNA水平与母体、脐带血清中25(OH)VD水平的关系,以及胎盘VDR mRNA水平与新生儿体质量、身长的关系。结果:sPE组孕妇母体血清中25(OH)VD、1,25(OH)_2VD浓度明显低于对照组(P0.05);sPE组孕妇母体血清中24,25(OH)_2VD、3-epi-25(OH)VD浓度明显高于对照组(P0.05);sPE组胎盘组织中25(OH)VD浓度明显低于对照组(P0.05);sPE组胎盘组织中24,25(OH)_2VD、3-epi-25(OH)VD浓度明显高于对照组(P0.05);sPE组孕妇胎盘中1α-羟化酶与24-羟化酶mRNA水平明显低于对照组(P0.05);VDR mRNA水平明显高于对照组(P0.05);sPE组新生儿体质量与身长明显小于对照组(P0.05);胎盘VDR mRNA水平与脐带血清中25(OH)VD水平呈负相关(P0.05);胎盘VDR mRNA水平与新生儿体质量及身长呈负相关(P0.05)。结论:sPE孕妇母体及胎盘均存在VD代谢紊乱;sPE可导致胎儿发育不良;VD代谢紊乱与sPE胎盘及胎儿发育有关。     

昼夜节律、睡眠对男(雄)性生殖系统影响的研究进展

男(雄)性生殖功能具有昼夜节律。生物钟基因作为昼夜节律的分子基础,对男(雄)性生殖功能具有重要影响。睡眠行为的改变可导致昼夜节律紊乱,并有证据提示其与男性生殖损害相关。当前研究面临的问题主要是:缺乏敏感的效应指标;昼夜节律的测量存在困难;个体差异对研究结果的影响等。未来的研究方向可能是在人群中明确昼夜节律紊乱导致的损害效应,以及探索生物钟基因调控生殖功能的具体机制。     

Male diabetes mellitus and assisted reproduction treatment outcome

The long-held view that diabetes has little effect on male reproductive function has been challenged by findings that the condition influences fertility in numerous previously undetected ways. This retrospective chart review of 3000 couples determined the incidence of couples with a male diabetic seeking assisted reproduction treatment and assessed any relationship between male diabetes and IVF/intracytoplasmic sperm injection (ICSI) outcome. Eight (2.7%) couples were found with a diabetic male partner, of which 18 couples underwent assisted reproduction treatment (five IVF, 12 ICSI, one both), with fertilization rates (IVF 68%, ICSI 62%) similar to non-diabetic patients (IVF 70%, ICSI 71%) and no difference in embryo quality. Two men had retrograde ejaculation and two were azoospermic. Other than reduced sperm motility, the remaining 14 had normal World Health Organization semen parameters. Embryo transfers produced one pregnancy (5% combined IVF/ICSI pregnancy rate/cycle) giving a lower-than-expected rate (28.8%). The pregnancy rate from seven FETs (29%) was comparable to the expected (21.3%). Compared with non-diabetics, approximately three times more couples with diabetic men sought treatment, with a larger percentage having 'unexplained' infertility. Fertilization rates and embryo quality did not differ but pregnancy rates were lower in couples with a diabetic male.     

Influence of endocrine disruptors on human male fertility

It has been suggested that during the past five decades human sperm counts have declined and the incidence of testicular cancer, hypospadias and cryptorchidism has increased. Furthermore, geographical differences, with respect to these markers of male reproductive function, have been reported. According to a recent hypothesis, all these abnormalities of the male genital system do have a common cause, namely exposure to endocrine disruptors affecting the male in early fetal life. Reduced sperm production as well as congenital abnormalities of male genitalia can be evoked in laboratory animals by exposing them to chemicals with endocrine-disrupting effect, and in humans similar effects have been seen following accidental exposures to very high concentrations of these environmental toxicants. However, the evidence for association between levels of exposure found in the general population and serious adverse effects on male reproduction, including fertility, is still lacking. A recent European Union-supported study, on the effect of persistent organohalogen pollutants on human reproduction, failed to show any correlation between post-natal exposure levels and fertility. Future studies will reveal whether prenatal exposure does more strongly affect male fertility and whether genetic predisposition regulates the susceptibility of an individual to the adverse effects of endocrine disruptors.     

New insights into fatigue and health-related quality of life after delivery

BACKGROUND: A delivery has a major impact on the health-related quality of life (HRQoL) of the new mother, especially on fatigue. A common complication during delivery that might have a relationship with maternal morbidity is blood loss. The objectives were to investigate fatigue and HRQoL in women after vaginal delivery (VD), elective caesarean section (CS) and emergency CS, and its relationship with postpartum hemoglobin (Hb) levels during the first 6 weeks postpartum. METHODS: Some 141 patients (71 after VD, 36 after elective CS and 34 after emergency CS) completed the HRQoL questionnaires MFI and EQ-5D between 12 and 24 h after VD and 24-48 h after CS (t=0). At 1, 3 and 6 weeks postpartum these questionnaires were repeated, together with the SF36. RESULTS: Patients after VD had higher mean physical HRQoL scores than after CS. The average period to reach full physical recovery was 3 weeks after VD, 6 weeks after elective CS, and >6 weeks after emergency CS. Mean mental HRQoL scores of the study groups were similar or even better compared to reference values. The significant correlation between Hb level and mean physical HRQoL scores found at t=0 had disappeared at 1 week postpartum. CONCLUSIONS: Results of this study provided insights into the natural course of fatigue and HRQoL postpartum. Important differences in fatigue and HRQoL scores were observed between the 3 modes of delivery. These HRQoL measures can be used in future clinical trials to assess the effects of interventions postpartum.     

Influence of paternal age on assisted reproduction outcome

There has been an increasing tendency to delay parenthood in developed countries in recent years, and there is not enough information available regarding the effect of this on fertility. The aim of this work was to determine the role of paternal age on the outcome of assisted reproduction. A retrospective study was designed comprising a total of 2204 intrauterine insemination (IUI) cycles, 1286 IVF cycles and 1412 IVF cycles with donated oocytes during the period 2000 to 2006. Male mean age was 34.3 years (range 25-56) for IUI, 34.8 years (range 19-62) for IVF and 41.10 years (range 25-71) for ovum donation cycles. Statistics revealed no differences regarding pregnancy and miscarriage rates when the results were compared among age groups. In standard IVF and ovum donation cycles there was no clear association between embryo quality and paternal age. There was no significant relationship between male age and implantation rate. So far this is the largest study concerning the relevance of male age in assisted reproduction. As confirmed by the present data, the effect of the age of the male in the range studied is irrelevant. This finding contributes to the information that can be provided to infertile couples.     

Survey of Mode of Delivery and Maternal and Perinatal Outcomes in Canada

ObjectiveTo identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes.MethodsWe conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes.ResultsThe cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women.ConclusionsThe CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.     

Impact of oxidative stress on male infertility

Reactive oxygen and nitrogen species (RONS) are necessary for the physiological function of sperm. Its concentration has to be kept on a level without the damage of cells. If this level is overdrawn sperm has pathological effect on many biological structures in the form of oxidative stress. Antioxidants have a key role for keeping of this balance. Oxidative stress is an important factor which causes problems with male fertility. The survey article is complexly concerned with the influence of RONS and antioxidants on male fertility. It outlines some possibilities of treatment and research on this actual issue of assisted reproduction.     

The effects of liraglutide on male fertility: a case report

Liraglutide is an agonist of the glucagon-like peptide I receptor, and is commonly recommended as a treatment for obesity and type 2 diabetes mellitus. Adverse effects related to liraglutide include acute pancreatitis and polyarthritis. No studies, however, have reported an adverse effect of liraglutide on male reproduction. This case report shows a deleterious effect of liraglutide on male reproductive function.