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及其受体与子宫内膜癌的相关研究进展

维生素D作为脂溶性类固醇衍生物,在生理上具有维持骨质钙磷代谢平衡的功能,有研究显示在免疫系统、内分泌系统、心血管系统疾病及部分肿瘤、炎症发生发展中维生素D发挥促细胞分化、凋亡的作用。维生素D主要通过调节维生素D受体的表达介导靶基因转录过程,实现抗肿瘤的生物学效应。近年来有研究发现在子宫内膜癌组织中存在维生素D受体的表达,提示其可能与子宫内膜癌进展有关,可能是子宫内膜癌治疗的潜在靶点。随着对抗肿瘤机制的深入探索,维生素D及其类似物被用于肿瘤内分泌治疗。综述维生素D受体生物学基础、维生素D抗肿瘤作用及其在子宫内膜癌中应用的相关研究。     

儿童维生素D、钙营养与营养性维生素D缺乏性佝偻病判定与评价现状

        儿童维生素D缺乏性佝偻病（vitamin D deficiency,Rickets）是由于维生素D缺乏导致的可预防性疾病,与维生素D和钙营养密切相关。近年来,研究发现非肌肉骨骼系统的疾病,包括癌症、代谢综合征、感染和自身免疫性疾病与维生素D水平不足密切相关［1-3］。由于许多观察性研究证实维生素D不足在世界许多地区普遍存在,包括工业性国家［4-5］。因此,儿童维生素D、钙营养与营养性维生素D缺乏性佝偻病再次受到关注,国内外对儿童维生素D、钙营养与维生素D缺乏性佝偻病的判定和评价也有了新认识。     

维生素D与女性生殖疾病的关系

维生素D调节钙和磷吸收,促进骨骼的生长和重构。越来越多的研究证实,维生素D在高血压、肿瘤、自身免疫性疾病、2型糖尿病等疾病的发生和发展中起重要作用。研究发现,维生素D受体(VDR)广泛分布于卵巢、子宫、输卵管、宫颈、乳腺、睾丸、精子等生殖器官、组织与细胞中。关于维生素D的活性代谢产物的生理作用已进行了广泛研究,但其在人类生殖中的报道较少。现本文就维生素D缺乏对女性生殖系统功能的影响做一综述。     

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.     

儿童维生素D缺乏症的研究进展

近年来,随着医疗卫生水平的发展,维生素D缺乏(VDD)在儿童生长发育过程中越来越受到重视,且发病率较高。维生素D主要来源于皮肤暴露在阳光下转化的维生素D₃,VDD主要表现为佝偻病、手足搐搦症,目前VDD的诊断标准仍存在争议,治疗方案一般分为每日和每周治疗方案,VDD的预防也很重要。本文从流行病学、代谢机制与病因、临床表现、诊断、治疗、预防六个方面就儿童VDD的研究进展作一综述,为儿童VDD提供一定的临床参考。     

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。     

维生素D_3在免疫性流产中的应用

维生素D3及其衍生物是维系体内钙磷平衡最重要的调节因子,近期随着研究的深入,已逐渐发现除上述功能外,它还具有重要的免疫调节作用,主要是对免疫细胞的功能和细胞因子分泌的影响。作者深入分析了1,25二羟基维生素D3(1,α25(OH)2D3)的免疫调节作用及其在免疫性流产中所起的重要作用。国内关于维生素D3在免疫性流产中的作用尚无相关的报道,它将对我国免疫性流产的治疗开辟新的途径。     

维生素D骨骼外研究进展

维生素D（vitamin D）是大家熟知的脂溶性维生素,维生素D对人类健康特别是儿童健康具有重要意义。维生素D缺乏性佝偻病是由于缺乏维生素D引起体内钙磷代谢异常,钙盐不能正常沉着在骨骼生长部分,骨骼钙化不良而致骨骼病变,多见于婴幼儿,影响小儿生长发育,是我国儿科重点防治的四病之一。临床发现维生素D缺乏性佝偻病除导致骨骼病变外,同时也可影响神经、肌肉、造血及免疫等组织器官的功能,此引起了人们对维生素D生理作用及临床意义的极大兴趣,近年来对维生素D的研究取得了重大进展［     

VEGF促肿瘤血管生成作用及在子宫肌瘤中的意义

研究血管内皮生长因子(VEGF)对肿瘤血管生成作用的影响及在子宫肌瘤发生及治疗中的作用.通过对近年来VEGF促进肿瘤生成及与子宫肌瘤关系方面的相关文献回顾,总结VEGF促肿瘤血管生成及子宫肌瘤发病及治疗关系的研究进展,介绍其在子宫肌瘤发病及治疗中的意义.已证实VEGF在肿瘤血管生成中起关键作用,针对VEGF的抗肿瘤血管生成治疗为肌瘤治疗提供了新方向.通过抑制VEGF及其受体作用可达到治疗子宫肌瘤的目的.     

Estudio piloto sobre el efecto de la vitamina D en la patogenia de los miomas uterinos: influencia de la terapia con vitamina D en el volumen uterino y en la angiogénesis de los miomas determinados por ECO3DPW y niveles séricos de VEGF

Uterine fibroids are one of the most common gynaecological disorders, being found in 70% of Caucasian women and 80% of Afro-Caribbean women1,2.In recent years, angiogenesis and vascularisation have become a key part of study of tumour growth. Differences in vascularisation have been discovered in uterine fibroids when compared to adjacent uterine tissue.The pathogenesis of uterine fibroids is multifactorial. Several pathways are involved in their growth have been described, such as the oestrogen pathway, the gestagen pathway, and the pathway of the growth factors. Another of the pathways that influences their development is the vitamin D pathway, as inadequate levels of this vitamin may favour the growth of uterine fibroids³.In this work, an analysis is made on how vitamin D therapy influences the volume and vascularity of uterine fibroids, using serum VEGF levels and 3 DPW Ultrasound.     

Role of GnRH agonists prior to endoscopic surgical treatment of fibroids

Uterine fibroids are the most common benign tumors found in women of reproductive age and their treatment is mainly by surgery, especially if they are symptomatic. Since the boom in endoscopy, many reports conclude that treatment of fibroids can be performed safely by laparoscopy or hysteroscopy.The development of GnRH analogues is not only a breakthrough in the field of obstetrics and gynecology, but a major leap forward in the treatment of various hormone-dependent diseases in general medicine. Recently GnRH agonistic analogues have been applied to treat various gynecological conditions, such as uterine leiomyomas, endometriosis, dysfunctional uterine bleeding, hyperandrogenism (polycystic ovaries) and infertility, cancer and precocious puberty.GnRH agonist administration prior to the surgical approach to uterine fibroids has a positive role in the management of these tumors, because—despite the expense—they reduce fibroid and uterine volume and intraoperative blood loss and they increase hemoglobin levels prior to surgical intervention. GnRH agonists can be used preoperatively in the field of endoscopic surgery in selected cases, especially in hysteroscopic surgery. However, their exact role in the laparoscopic management of fibroids needs further evaluation.     

Advantages of studying the frontal plane of the uterine cavity in 3D ultrasound

Recently, computer-assisted treatment of echographic images has permitted '3D' reconstruction in gynecology. This is achieved by scanning a given volume containing the organ of interest. Two practical options exist. Some ultrasound probes are equipped with an automatic scanning device while others use manual scanning, electronically normalized or not. Both approaches make possible of an electronic matrix, i.e., a pile of '2D' echographic images. Secondary cuts are possible through the electronic matrix, including plans not normally accessible to ultrasound scanning because of anatomical limitations. One of the secondary cuts most clinically useful is the frontal plan of the uterus. This enables one to visualize the organ lying flat as it is commonly drawn on medical sketches. Studying the frontal plan of the uterus acquired electronically from a 3D matrix improves the visualization of possible interactions between structures such as uterine fibroids and the endometrium. The frontal plan of the uterus also offers marked improvements for studying uterine malformations.     

The role of uterine artery embolization in the management of uterine fibroids

PURPOSE OF REVIEW: Uterine artery embolization is increasingly being offered as an alternative to hysterectomy and myomectomy for the treatment of symptomatic uterine fibroids. This review is intended to evaluate the role of this technique in the management of uterine fibroids using information provided from recently published literature. RECENT FINDINGS: A growing body of literature supports the efficacy of uterine artery embolization in relieving fibroid-related menorrhagia, pelvic pain and pressure symptoms and in substantially reducing the fibroid size in most patients. Recent publications also show significant improvements in health-related quality of life and high long-term satisfaction rates. The procedure is associated with shorter hospitalization and recovery times and lower morbidity rates compared with conventional surgical treatments. However, serious complications, such as uterine infarction or infection leading to emergency hysterectomy, have been reported in a few cases, and considerable work is currently underway to determine how the safety of the procedure can be enhanced. Although no long-term data on subsequent fertility are yet available, early reports on ovarian function and pregnancy outcomes after uterine artery embolization are encouraging. SUMMARY: Based on current evidence, uterine artery embolization can be considered a valuable alternative to surgical therapy in the management of well-selected women with symptomatic uterine fibroids. Additional research is needed to help define the place of this technique for women who desire future pregnancy.     

不孕症合并子宫肌瘤的治疗进展

子宫肌瘤是女性生殖系统最常见的良性肿瘤。随着生育年龄的推迟以及中国二胎政策的放开,不少子宫肌瘤患者在就诊时仍有生育要求,但此类患者的最佳治疗方式至今尚无定论。尽管国内外相关共识或指南中对不孕症合并子宫肌瘤的处理给予了一定的建议,但是这些建议也常模糊不清,有时甚至相互矛盾。有指南指出有生育需求的子宫肌瘤患者不推荐孕前行子宫肌瘤剔除术,除非子宫肌瘤曾导致妊娠并发症;有指南认为子宫肌瘤合并不孕就是治疗指征;而另有指南建议对于不孕症合并子宫肌瘤的治疗要根据子宫肌瘤的类型而定,建议对黏膜下肌瘤或引起宫腔形态改变的肌壁间肌瘤行手术治疗,其他部位肌瘤不论其大小均不建议治疗。现结合文献报道及相关指南建议,探讨不孕症合并子宫肌瘤的基本处理原则,为其规范化治疗提供参考。     

The impact of uterine artery embolization on fertility and pregnancy outcome

PURPOSE OF REVIEW: Uterine artery embolization for management of symptomatic fibroids is an effective and increasingly popular treatment option. There are several studies evaluating the effects of uterine artery embolization on later pregnancies; however, the effects on fertility are still largely uncertain. This paper reviews the current literature on the effects of this technique on fertility and pregnancy outcome. RECENT FINDINGS: Two recent studies have reported pregnancy rates following uterine artery embolization in women seeking pregnancy. A small, third study reported preliminary results in a randomized controlled trial comparing uterine artery embolization with myomectomy in women wishing to preserve fertility. SUMMARY: The body of medical literature supports use of uterine artery embolization as an effective treatment for symptoms of vaginal bleeding and pelvic pressure from uterine fibroids. Patient selection is critical in determining the appropriateness of this treatment option. Myomectomy remains the standard of care for women with symptomatic fibroids seeking fertility preservation.     

Alternative treatment for symptomatic fibroids

The present review discusses treatment options for symptomatic fibroids. Although the standard treatment of fibroids has been surgical hysterectomy, an increasing number of reports indicate that uterine artery embolization with preservation of the uterus is a promising alternative. Other surgical and medical approaches reported during the past year are also addressed. The review summarizes patient selection, contraindications, results, complications and future considerations. Complications following uterine artery embolization treatment for symptomatic fibroids have been minor in comparison with those following hysterectomy. Although patient satisfaction is good, none of the studies included control individuals and further studies are needed to optimize patient selection and to evaluate long-term results of treatment.     

多发子宫肌瘤高强度聚焦超声治疗与生育

子宫肌瘤是最常见的女性生殖系统良性肿瘤,子宫肌瘤导致的不孕占所有不孕症患者的5％～10％。子宫肌瘤对于妊娠不同时期及分娩期、产褥期均可造成不良影响。多发子宫肌瘤患者占子宫肌瘤患者的50%,多发子宫肌瘤患者常比单发子宫肌瘤患者更易出现临床症状,且症状更严重,对生育的影响也更大。手术挖出肌瘤是治疗有生育要求的多发子宫肌瘤的首选方法。但因肌瘤多,手术对子宫损伤大,且术后恢复时间长。高强度聚焦超声（HIFU）治疗多发子宫肌瘤,可减少对有生育要求的多发子宫肌瘤患者子宫的损伤,缩短术后备孕时间。     

腹腔镜下旋切器误用于子宫肉瘤6例分析并文献复习

目的:探讨旋切器误用于子宫肉瘤的概率,以及应用旋切器对子宫肉瘤患者预后的影响。方法:查阅2010年1月—2015年12月新疆医科大学附属肿瘤医院妇科以诊断子宫肌瘤入院并行腹腔镜下子宫肌瘤剔除术(均应用旋切器进行辅助肌瘤剔除)的患者资料,统计其术后病理为子宫肉瘤的患者,并随访其预后。结果:以子宫肌瘤为诊断入院并行子宫肌瘤粉碎术的患者共1 886例,其中术后病理诊断为子宫肉瘤者6例;其中1例患者再次手术时发现盆腔及大网膜转移病灶;1例患者化疗后进展死亡;1例患者半年后复发,2年后死亡;其余3例患者随访至今未复发。结论:子宫肌瘤旋切器误用于子宫肉瘤的概率非常小,约为0.31%(6/1 886)。子宫肌瘤旋切器仍是可行的手术器械,但应注意应用旋切器所带来的不良后果,并采取合适措施来规避。     

Other medical management of uterine fibroids

Several medicines are emerging with the potential to treat symptomatic uterine fibroids. Anti-progesterone compounds seem particularly promising. These drugs have been widely used for nearly 20 years and are known to be safe; medical politics have prevented their proper investigation for uterine fibroids. In particular, the value of mifepristone, 50 mg per day for 3 months, seems particularly promising. Further investigation is clearly warranted for this medicine. Several anti-oestrogen compounds have recently become available and may also be useful for the medical treatment of symptomatic uterine fibroids. This includes the possibility of the use of selective oestrogen receptor modulators as well as the prospect of the use of pure anti-oestrogens. On a longer time frame, inhibitors of angiogenesis may be useful. These medicines would act upon the blood supply to uterine fibroids. Physicians also have an obligation to investigate scientifically any promising naturopathic treatment that appears to have possible activity for symptomatic fibroids.