肌壁间子宫肌瘤对体外受精-胚胎移植临床结局的影响

目的:探讨宫腔形态无改变的肌壁间子宫肌瘤对体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)临床结局的影响。方法:选择行IVF/ICSI-ET治疗伴单发或多发肌壁间子宫肌瘤且宫腔形态正常的93例不孕症患者作为研究对象,共行胚胎移植104个周期(研究组);按对照组与研究组1:3比例随机抽取同期行IVF/ICSI-ET且无子宫肌瘤的308例患者作为对照组,共行IVF/ICSI-ET周期312个,分析控制性超促排卵(COH)、体外受精参数和妊娠结局。结果:研究组患者的年龄、不孕年限显著高于对照组(P0.05),促性腺激素(Gn)使用天数、获卵数显著低于对照组(P0.05);体质量指数(BMI)、Gn用量、双原核(2PN)率、卵裂率、优质胚胎率、临床妊娠率、着床率、异位妊娠率、早期流产率、晚期流产率、活产率、单胎活产率、双胎活产率、早产率、低体质量儿率、出生缺陷率组间均无统计学差异(P0.05)。结论:宫腔形态无改变的肌壁间子宫肌瘤对IVF-ET的临床结局无明显不良影响。     

长方案超促排卵过程中LH变化趋势对IVF/ICSI-ET结局的影响

目的:探讨控制性超促排卵(COH)周期中LH变化趋势对体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)结局的影响。方法:回顾性分析228个IVF/ICSI长方案周期,1按h CG注射日与降调节后Gn启动前血清LH水平的变化趋势,分为降低趋势组和升高趋势组;2将升高趋势组及降低趋势组根据COH中期与降调节后LH水平变化趋势分为A组和B组(升高趋势中的降低组和升高组),C组和D组(降低趋势中的降低组和升高组);3按照LH降低幅度将A组和C组分为A1组(下降幅度50%)和A2组(下降幅度≥50%)、C1组(下降幅度50%)和C2组(下降幅度≥50%),比较各组IVF/ICS-ET结局的差异。结果:1降低趋势组与升高趋势组获卵数、胚胎数、总的受精率、卵裂率、可利用胚胎率、优质胚胎率比较,差异均无统计学意义(P0.05),而胚胎种植率(26.09%vs 35.22%,P0.05)、临床妊娠率(45.11%vs 58.67%,P0.05)显著较升高趋势组低,早期流产率较升高组略高(26.08%vs 15.91%),但差异无统计学意义(P0.05)。2A组与B组、C组与D组相比较IVF/ICSI结局均无统计学差异。3 A1组、A2组的受精率、临床妊娠率、胚胎种植率、可利用胚胎率组间比较,差异均无统计学意义,但优质胚胎率A1组较高(65.48%vs40.68%,P0.05);C1组、C2组IVF/ICSI结局相比无统计学差异。结论:IVF/ICSI-ET长方案,h CG注射日较Gn启动前血清LH升高,有助于提高胚胎种植率、临床妊娠率,且在COH中期LH下降幅度50%,能显著提高优质胚胎率。故在COH的过程中适时添加LH,选择合适的血清LH水平启动COH,有助于改善助孕结局。     

体外受精-胚胎移植后双次血清β-HCG对妊娠结局的预测价值

目的:探讨体外受精-胚胎移植(IVF/ICSI-ET)后14天及18天双次血清β-人绒毛膜促性腺激素(β-HCG)预测妊娠结局的意义。方法:回顾分析2006年1月至2007年5月在我中心行新鲜周期IVF/ICSI-ET助孕后有14天及18天血清β-HCG水平的1154个周期,并追踪妊娠结局。结果:血清β-HCG水平与妊娠结局相关。移植后14天、18天继续妊娠组血清β-HCG值均高于不良妊娠组(P<0.05);而两组的上升幅度无显著性差异(P>0.05)。多胎组血清β-HCG值高于单胎组(P<0.05);单胎组血清β-HCG值高于流产组(P<0.05);流产组和异位妊娠组的血清β-HCG值均高于生化妊娠组(P<0.05);而流产组血清β-HCG值与异位妊娠组无显著性差异(P>0.05)。有233例患者移植14天抽血检测β-HCG<5IU/L后18天未抽血检测β-HCG,追踪随访有7例患者妊娠,早期流产率为85.71%(6/7),继续妊娠率为14.29%(1/7)。结论:IVF-ET后双次血清β-HCG值对早期妊娠结局有较好的预测价值,有助于临床及早期鉴别诊断。     

促甲状腺激素(TSH)水平对IVF/ICSI妊娠结局的影响

目的:探讨在IVF/ICSI-ET周期中患者基础促甲状腺激素(thyroid stimulating hormone,TSH)水平与临床妊娠结局的关系。方法:回顾性分析第1次行IVF/ICSI-ET不孕患者的促排卵结局与TSH的相关性。结果:①在1 832个IVF/ICSI周期中,TSH与PRL水平呈正相关(r=0.080,P=0.002),而与获卵数、受精卵子数、受精率、可移植胚胎数、优质胚胎数、孕囊与心芽搏动数、种植率、生化妊娠率、流产率、活产率无明显相关性(P>0.05);PRL与获卵数呈正相关(r=-0.050,P=0.032),但不影响后期的受精、可移植胚胎数、优质胚胎数、着床及后期的生化妊娠率、临床妊娠率及活产率。控制PRL后对TSH本身与获卵数行相关性分析,结果两者间无相关性(r=0.004,P=0.874)。②分别比较不同TSH界值下高于界值与低于界值组的获卵数、受精卵子数、受精率、可移植胚胎数、优质胚胎数、孕囊与心芽搏动数、种植率的情况,结果界值上、下组间实验室及临床相关指标无明显差异。但当TSH界值分别为2.7 mIU/L、3.3 mIU/L、3.9 mIU/L时,低、高组间的活产率分别为83.1%和81.0%,82.3%和78.9%,83.9%和70.3%,流产率分别为16.1%和19.0%,17.7%和21.1%,16.1%和19.7%,虽未达到统计学差异,但低水平TSH组的流产率较高水平TSH组相对较低,活产率较高,并随着界值的增大,界值上、下组间的活产率与流产率差距增大。结论:在0.3~4.2 mIU/L区间,TSH水平对于IVF/ICSI-ET的妊娠结局无明显影响。当基础TSH水平>2.7 mIU/L时,流产率有上升趋势,活产率有下降趋势,需对孕妇孕期情况进行密切随访。     

新鲜和冻融胚胎移植周期异位妊娠发生率及危险因素分析

目的:分析新鲜周期和冻融周期异位妊娠(EP)的发生情况及相关危险因素。方法:回顾分析接受助孕治疗的患者12 209例,共19 144个周期的临床资料,其中新鲜周期移植13 170个、冻融周期5 974个,分析输卵管因素、盆腔手术史、EP手术史、子宫内膜异位症(EMs)及多囊卵巢综合征(PCOS)等因素对异位妊娠发生的影响。结果:新鲜移植周期临床妊娠率显著高于冻融周期(50.12%vs 40.16%),新鲜周期组中IVF-ET周期EP发生率显著高于ICSI-ET组(3.54%vs 1.76%),差异均有统计学意义(P0.01)。冻融周期异位妊娠率高于新鲜周期组(3.37%vs 3.19%),冻融周期组中激素替代周期EP率高于自然周期(3.48%vs 3.25%),但差异均无统计学意义(P0.05)。新鲜周期组内,输卵管因素、盆腔手术史、EP手术史均可使EP率较之未合并该危险因素者显著增加(依次为3.51%vs 2.61%;4.57%vs 2.86%;4.99%vs 3.00%),差异有统计学意义(P0.05)。冻融周期组内,输卵管因素、盆腔手术史、EP手术史亦均可使EP率较之未合并该危险因素者显著增加(依次为4.25%vs 1.69%;7.64%vs 2.67%;11.03%vs 2.88%),差异有统计学意义(P0.05)。新鲜周期和冻融周期组内比较,有EMs者较之无EMs,有PCOS者较之无PCOS者,EP发生率的差异均无统计学意义(P0.05)。另将19 144个周期分别依据有无EMs或PCOS分组进行比较,有EMs者EP率高于无EMs者(1.92%vs 1.51%;P0.05),有PCOS者异位妊娠率高于无PCOS者(3.54%vs1.40%;P0.01)。结论:冻融周期胚胎移植后EP率略高于新鲜周期;输卵管因素、盆腔手术史、EP手术史是助孕治疗患者EP发生的主要危险因素,合并EMs或PCOS也是EP发生的重要因素。     

宫腔灌注绒毛膜促性腺激素对反复着床失败后冻融胚胎移植妊娠结局的作用

目的:探讨胚胎反复着床失败(RIF)后冻融胚胎移植(FET)时行宫腔内灌注基因重组人绒毛膜促性腺激素(rh CG)对妊娠结局的影响。方法:选择既往胚胎RIF再次行FET的208个周期的患者资料进行回顾性分析。将其中FET日宫腔内灌注rh CG为研究组,另按1∶1选择匹配(年龄、既往ET失败次数、不孕类型)对照组。分析比较着床率、自然流产率、生化妊娠率、临床妊娠率、多胎妊娠率。结果:研究组着床率(22.92%)、生化妊娠率(5.77%)、自然流产率(17.78%)均略高于对照组(分别为16.88%、1.92%、16.13%),多胎妊娠率略低于对照组(15.56%vs 19.35%),但差异均无统计学意义(P0.05)。研究组和对照组均未观察到异位妊娠病例,研究组临床妊娠率显著高于对照组(43.27%vs 29.82%),差异有统计学意义(P0.05)。结论:FET日行宫腔内灌注rh CG可以提高RIF患者的临床妊娠率。     

PCOS患者移植冻融胚胎后妊娠结局

目的:探讨多囊卵巢综合征(PCOS)患者在优质冻融胚胎移植(FET)后是否有更高的妊娠丢失率。方法:回顾性分析诊断为PCOS并初次接受体外受精-胚胎移植(IVF-ET)或卵胞质内单精子注射(ICSI)FET的患者,选择移植冻融胚胎中含有卵裂期优质胚胎且生化妊娠阳性的157个周期的临床资料为PCOS组,同期年龄、体质量指数(BMI)、不孕年限与PCOS组匹配的、因单纯输卵管因素接受IVF-ET助孕治疗并生化妊娠阳性的389个FET周期的临床资料为对照组,比较组间的生化妊娠丢失率、早期流产率、晚期流产率、活产率。结果:在接受优质卵裂期FET的PCOS患者妊娠后,生化妊娠丢失率、早期流产率、晚期流产率、活产率与对照组相比(8.28%vs 5.14%、7.64%vs 8.13%、6.94%vs 5.15%、79.86%vs 84.28%),差异无统计学意义(P0.05)。结论:在固定胚胎质量这个重要的影响妊娠早期丢失的影响因子的基础上,排除年龄、BMI、自然流产次数、是否多胎妊娠、移植日内膜厚度等影响因素的干扰,患PCOS并不增加IVF/ICSI的生化妊娠丢失率和临床妊娠流产率。     

复融新鲜胚胎混合周期移植应用价值探讨

目的:通过分析复融新鲜胚胎混合周期移植的妊娠结局,探寻改善高龄、反复助孕失败患者妊娠结局的方法。方法:回顾分析2014年4月至2016年4月在河南省人民医院生殖医学研究所行常规体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSIET)患者的临床资料。根据移植胚胎类型、数量,设置A组(新鲜周期移植D3新鲜胚胎1枚及D3冷冻复苏胚胎1枚,36个周期)、B组(复苏周期移植D3冷冻复苏胚胎1枚,62个周期)和C组(复苏周期移植D3冷冻复苏胚胎2枚,62个周期)、D组(新鲜周期移植D3新鲜胚胎1枚,62个周期)和E组(新鲜周期移植D3新鲜胚胎2枚,62个周期)。比较各组的胚胎种植率、生化妊娠率、临床妊娠率、多胎率和流产率等指标。结果:5组患者中,混合周期患者的既往助孕周期数显著高于其他各组(P<0.05)。5组的妊娠结局、早期流产率、流产率及新生儿出生性别比差异无统计学意义(P>0.05),生化妊娠率、临床妊娠率、胚胎种植率、异位妊娠率、畸形率比较,差异有统计学意义(P<0.05)。A组能获得相对较高的生化妊娠率、临床妊娠率和胚胎种植率。结论:对于可利用胚胎数目较少的高龄反复种植失败的患者,可依据情况建议其采用混合周期移植以改善妊娠结局。     

男性乙型肝炎病毒感染与IVF/ICSI妊娠结局的关系

目的:探讨男性在乙型肝炎病毒感染期及恢复期接受IVF/ICSI对妊娠结局是否造成影响。方法:回顾性分析首次接受IVF/ICSI治疗的496对不孕夫妇,术前进行血清HBV及乙肝5项检测,女方乙肝5项均为阴性或仅HbsAb阳性且HBV-DNA阴性。根据男方乙肝检查结果分成3组,A组(297对夫妇):男方乙肝5项均为阴性或仅HbsAb阳性且HBV-DNA阴性;B组(81对夫妇):男方乙肝大三阳且HBV-DNA阳性;C组(118对夫妇):男方乙肝小三阳且HBV-DNA阴性。统计分析3组第1次新鲜周期治疗情况及妊娠结局,并进一步比较3组中行ICSI周期的临床结局。结果:在IVF/ICSI周期中A、B、C组女方的临床妊娠率(40.1%vs47.9%vs 36.7%)、早期流产率(8.3%vs 8.6%vs 2.5%)无统计学差异;早产率、抱婴回家率(34.2%vs 42.5%vs 33.9%)和婴儿出生情况各组间亦相似。在ICSI周期中,3组的临床妊娠率、早期流产率、抱婴回家率及婴儿出生情况亦无统计学差异(P>0.05)。结论:男性在乙肝病毒感染期和恢复期无论采用IVF或ICSI方式授精,对妊娠结局及婴儿出生情况均无不良影响。     

薄型子宫内膜新鲜胚胎和冻融胚胎移植妊娠结局比较

目的探讨在薄型子宫内膜患者中新鲜胚胎移植与冻融胚胎移植(FET)妊娠结局的差异。方法回顾性分析接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗采用长方案胚胎移植h CG注射日与冻融周期胚胎移植内膜转化日的内膜厚度≤7 mm的患者共592个周期的临床资料。将移植周期按胚胎是否冻融分为新鲜胚胎移植组(n=173)和FET组(n=419)。比较组间的胚胎种植率、临床妊娠率、流产率、多胎率和异位妊娠率有无差异。结果新鲜胚胎移植组患者平均移植胚胎(2.1±0.4)枚,与FET组患者平均移植胚胎(2.1±0.5)枚比较,组间有统计学差异(P0.05);按照移植胚胎数分为3个亚组,新鲜胚胎移植组1枚胚胎者,妊娠率为7.7%,2枚者为30.2%,3枚者为23.8%;FET组1枚胚胎者15.6%,2枚者为34.9%,3枚者为41.6%,新鲜胚胎移植组与FET组间差异均无统计学意义(P0.05)。组间着床率、流产率、异位妊娠率等结果也均无统计学差异(P0.05)。移植3枚胚胎新鲜组多胎率(80.0%)高于FET组(29.7%)(P0.05)。新鲜胚胎移植组多胎率3个亚组间有统计学差异(P0.05),FET组妊娠率和流产率3个亚组间均有统计学差异(P0.05)。将移植胚胎数作为协变量,纳入Logistics回归模型对结果变量进行分析,说明周期类型与临床妊娠率间无显著相关性(OR=0.726,95%CI=0.504~1.104)。结论子宫内膜厚度≤7 mm的薄型内膜患者新鲜胚胎移植和FET妊娠结局相似,选择新鲜周期移植不影响妊娠结局并可缩短治疗周期,降低总费用。     

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.     

使用国产长效避孕皮下埋植剂妇女五年内血清雌二醇、孕酮、左旋18甲基炔诺酮水平

５例使用国产长效避孕皮埋剂（Ｓｉｎｏ－Ｉｍｐｌａｎｔ，以下简称为Ｓｉｎｏ）长达五年以上的妇女，每年末抽血一个周期（即连续４～５周，每周定时抽血一次）。用ＲＩＡ测定血清中雌二醇（Ｅ２），孕酮（Ｐ）和左旋１８甲基炔诺酮（ＬＮＧ）水平。研究结果显示：长期使用Ｓｉｎｏ未出现相似的卵巢内分泌反应。８４％（２１／２５）抽血周期血清Ｅ２水平出现峰值（Ｅ２＞１５０ｐｇ／ｍｌ），以例数计，埋植后１～４年内每年有８０％（４／５）抽血周期血清中Ｅ２显示峰值，第五年为１００％（５／５）。４０％（１０／２５）抽血周期显示黄体活性（Ｐ＞３ｎｇ／ｍｌ），以例数计，埋植第一年为０％（０／５）；第二年为４０％（２／５）；３～５年每年６０％（３／５）表现黄体活性。５例对象中有２例埋植后五年内未见血清Ｐ＞１ｎｇ／ｍｌ，而且这２例分别在埋植后１～２年及３～４年未见Ｅ２峰（Ｅ２＜１５０ｐｇ／ｍｌ）。５例对象埋植前对照周期均有正常的Ｅ２峰和黄体活性。在用Ｓｉｎｏ的５年内抽血周期血清Ｅ２和Ｐ的均值都低于对照周期。在用Ｓｉｎｏ期间，有黄体活性的周期均伴有Ｅ２峰。然而，并非所有有Ｅ２峰的周期都表现黄体活性。在埋植第一年，除第一个月外，血清ＬＮＧ水平低而相对?     

Ameliorative effect of myo-inositol on red blood cell alterations in polycystic ovary syndrome: in vitro study

Polycystic ovary syndrome (PCOS)is a gynecological endocrine disorder which is associated with systemic inflammatory status inducing red blood cells (RBC) membrane alterations related to insulin resistance and testosterone levels which could be greatly improved by myo-inositol (MYO) uptake. In this study we aim to evaluate the effect of MYO in reducing oxidative-related alterations through in vitro study on PCOS RBC. Blood samples from two groups of volunteers, control group (CG, n?=?12) and PCOS patient group (PG, n?=?12), were analyzed for band 3 tyrosine phosphorylation (Tyr-P), high molecular weight aggregate (HMWA), IgG in RBC membranes, and glutathione (GSH) in cytosol, following O/N incubation in the presence or absence of MYO. PCOS RBC underwent oxidative stress as indicated by higher band 3 Tyr-P and HMWA and increased membrane bound autologous IgG. Twenty four hours (but not shorter time) MYO incubation, significantly improved both Tyr-P level and HMWA formation and concomitant membrane IgG binding. However, no relevant modification of GSH content was detected. PCOS RBC membranes are characterized by increased oxidized level and enhanced sensitivity to oxidative injuries leading to potential premature RBC removal. MYO treatment is effective in reducing oxidative related abnormalities in PCOS patients probably restoring the inositol phospholipid pools of the membranes.     

脂质蓄积指数较腰围更好反映多囊卵巢综合征患者的胰岛素抵抗

目的:比较多囊卵巢综合征(PCOS)人群脂质蓄积指数(LAP)和腰围(WC)与胰岛素抵抗(IR)的相关性。方法:纳入121例PCOS患者和115例正常对照,测量人体参数及血液代谢指标,行75 g口服葡萄糖耐量试验,对其中20例对照及90例PCOS患者行高胰岛素-正葡萄糖钳夹术,并计算HOMA2-IR及LAP。结果:PCOS组LAP、WC等较对照组明显增高(P<0.05),胰岛素敏感性明显降低(P<0.05);匹配WC和年龄后,PCOS组LAP仍明显高于对照组(P<0.01),胰岛素敏感性明显低于对照组(P<0.05);与WC相比,LAP与M值(r=-0.66 vs r=-0.68,P<0.01)及HOMA2-IR(r=0.49 vs r=0.55,P<0.01)间关系更密切,校正WC后,LAP仍与M值(r=-0.37,P<0.01)及HOMA2-IR(r=0.26,P<0.01)相关;二项Logistic回归显示,高LAP患者发生IR的风险是正常LAP患者的6.05倍(OR=6.05,95%CI:1.67,21.90,P<0.05)。结论:在PCOS人群中,LAP与胰岛素敏感性相关,较WC更好地反映IR。     

Maternal infibulation and obstetrical outcome in Djibouti

Objective: The objective of the present study was to assess the relation between female genital mutilation and obstetric outcome in an East African urban clinic with a standardized care, taking into account medical and socioeconomic status.

Methods: This was a cohort study conducted in Djibouti between October 1, 2012 and April 30, 2014. Overall 643 mothers were interviewed and clinically assessed for the presence of female genital mutilation. The prevalence of obstetric complications by infibulation status was included in a multivariate stepwise regression model.

Results: Overall, 29 of 643 women did not have any form of mutilation (4.5%), as opposed to 238 of 643 women with infibulation (37.0%), 369 with type 2 (57.4%), and 7 with type 1 mutilation (1.1%).Women with a severe type of mutilation were more likely to have socio-economic and medical risk factors. After adjustment, the only outcome that was significantly related with infibulation was the presence of meconium-stained amniotic fluid with an odds ratio of 1.58 (1.10–2.27), p value=0.014.

Conclusions: Infibulation was not related with excess perinatal morbidity in this setting with a very high prevalence of female genital mutilation, but future research should concentrate on the relation between infibulation and meconium.     

Inducible nitric oxide synthase (iNOS) gene polymorphism in pre-eclampsia: a pilot study in North India

BACKGROUND: Pre-eclampsia is one of the most frequent complications of pregnancy, however, little is known about its aetiology. AIMS: The objective of this study was to investigate the association between inducible nitric oxide synthase (iNOS) genotypes and pre-eclampsia. We also measured the concentrations of tumour necrosis factor-alpha (TNF-alpha), nitric oxide (NO) and superoxide dismutase (SOD) in patients with pre-eclampsia to evaluate their relations to the single nucleotide polymorphisms (SNPs) observed. METHODS: This cross-sectional study included 30 pregnant women with pre-eclampsia and 30 healthy pregnant women. They were screened at 28th, 36th weeks of gestation and just after delivery (within 48 h), and their blood samples were analysed for NO, SOD, TNF-alpha and iNOS gene polymorphism. RESULTS: Patients with pre-eclampsia at 36 weeks gestation showed significantly increased serum NO levels (P=0.007), whereas SOD activity was decreased significantly (P=0.004). A doublefold increase was observed in TNF-alpha levels at 36 weeks in patients with pre-eclampsia (P=0.003) which decreased significantly (P=0.001) after delivery. A total of four SNPs were observed, of which two (G300A exon 8 and G274T exon 16) showed statistically significant association with pre-eclampsia. When compared, G274T exon 16 SNP also showed association with TNF-alpha levels and SOD activity in pre-eclamptic patients. CONCLUSION: As pre-eclampsia is a disease of multifactorial aetiopathology, NO, TNF-alpha, SOD activity and NOS2A polymorphism might play an intermingled role in its development.     

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。     

Inter-observer variability in fetal biometric measurements

Objective

To evaluate inter-observer variability and reproducibility of ultrasound measurements for fetal biometric parameters.

多囊卵巢综合征患者卵泡液LIF、IL-1β及性激素水平与IVF-ET结局关系的研究

目的:探讨多囊卵巢综合征(PCOS)患者卵泡液中白血病抑制因子(LIF)、白细胞介素-1β(IL-1β)及性激素水平与IVF-ET结局的关系。方法:用酶联免疫双抗夹心法和时间分辨免疫荧光法前瞻性研究了行IVF-ET的11例PCOS患者、14例对照组患者卵泡液中IL-1β、LIF及雌二醇(E2)和孕酮(P)的定量表达。结果:PCOS组卵泡液中LIF为21.1±11.1pg/mL,P为191.9×103nmol/L,明显低于对照组(33.5±11.8pg/mL,305.9×103nmol/L,P<0.05);而PCOS组卵泡液IL-Iβ为39.9±11.5pg/mL,E2浓度为3334.00nmol/L,明显高于对照组(28.3±10.6pg/mL,2138.1nmol/L),P<0.05。PCOS组胚胎种植率为8.8%,临床妊娠率为18.2%,明显低于对照组(16.7%,42.9%),P<0.05;PCOS组OHSS发生率为27.3%,明显高于对照组(7.1%,P<0.05)。LIF与E2在两组患者呈负相关(r=-0.442,P=0.027)、LIF与LH/FSH比值在PCOS组呈负相关(r=-0.682,P=0.021);IL-Iβ与E2在PCOS组呈正相关(r=0.612,P=0.045);LH/FSH比值与P在PCOS组呈负相关(r=-0.780,P=0.005);LIF与IL-Iβ水平两者间无明显相关性。结论:LIF可能是PCOS患者低种植率的关键因子;IL-Iβ可能是PCOS患者在控制性超排卵过程中易发生OHSS的一个致病因子;卵泡液IL-Iβ、LIF受卵巢激素调控。