国产重组人促卵泡激素在辅助生殖技术控制性超促排卵的临床应用

目的评价国产重组人促卵泡激素(recombinant human follicle-stimulating hormone,rhFSH)用于辅助生殖技术(assisted reproductive technology,ART)控制性超促排卵(controlled ovarian hyperstimulation,COH)的有效性及安全性。方法本试验采用多中心、随机、双盲、阳性平行对照、非劣效研究方法,于2017年7月至2019年6月间选取6家生殖医学中心纳入卵巢储备正常的不孕女性进行ART的COH治疗。受试者随机分为试验组(国产rhFSH,n=134)和对照组(进口rhFSH,n=133),研究过程中因各种因素排除受试者共8例,试验组7例,对照组1例,最终依照研究方案完成试验的受试者试验组127例,对照组132例。比较两组受试者COH周期中获得的卵母细胞总数、rhFSH用药情况、卵母细胞受精率、优质胚胎数、临床妊娠率、活产率、新生儿情况及不良反应发生率等指标。结果试验组和对照组在COH周期中获得的卵母细胞总数分别为(13.0±5.8)枚和(12.9±5.7)枚,差异无统计学意义(P>0.05);在82例卵胞质内单精子显微注射(intracytoplasmic sperm injection,ICSI)受试者中,试验组(39例)获得MII卵母细胞数[(9.9±3.9)枚]显著高于对照组(43例)[(7.5±3.0)枚,P=0.003];卵母细胞受精率试验组[63.82%(1048/1642)]显著高于对照组[56.19%(958/1705),P<0.001]。rhFSH用药时间和总量、优质胚胎数、临床妊娠率、早产率、活产率、新生儿异常发生率、新生儿体质量、Apgar评分等两组间差异无统计学意义(P均>0.05);治疗期间卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)和其他不良反应发生率差异无统计学意义(P均>0.05),且均为进口rhFSH已知的不良反应。结论在卵巢储备正常的不孕女性中使用相同卵巢刺激治疗方案,国产rhFSH有效性及安全性与进口rhFSH相当。     

Influence of growth hormone-insulin-like growth factor Ⅰ axis on normal pregnancy

Objective To investigate the role of growth hormone-insulin-like growth factor Ⅰ (IGF-Ⅰ) axis in normal pregnancy. Methods Totally, 116 normal pregnant women were recruited from January 1997 to June 1998, with 20 normal nonpregnant women as controls. Maternal growth hormone (GH) and IGF-Ⅰ concentrations were assayed by RIA and enzyme-linked immunosorbent assay, respectively. Results Maternal serum levels of GH increased throughout gestation, reached a peak at 25 weeks of pregnancy and remained fairly high (χ[2]=40.458, P&lt;0.0001).There was a significant difference between samples at 5-9 week gestational age and the controls (3.45 μg/L vs 1.61 μg/L, P&lt;0.05). The maternal serum levels of IGF-Ⅰincreased rapidly throughout gestation from 29-week gestation and reached a peak of 188.86 μg/L at term delivery (χ[2]=50.224, P&lt;0.0001). Conclusions Maternal GH levels increased progressively throughout gestation, which correlated with fetal growth. Maternal GH may regulate nutrition supply among mother, placenta and the fetus and play an important role in transporting nutritional substrates by the placenta. The maternal IGF-Ⅰin the third trimester may promote fetal growth and placental functions.     

早发型重度妊高征的临床研究

目的:探讨发生在较小妊周的重度妊高征之发生率、临床特征、治疗原则、终止妊娠时机及对母婴的影响。方法:选择妊娠≤34周的重度妊高征病例45例,按治疗方式的不同分成治疗组(遵循妊高征的治疗原则,同时给予营养支持和促胎肺成熟药物)和观察组。结果:两组病例均没有孕产妇死亡和子痫发生,但合并症、并发症的发生率高达95.24％。治疗组围产儿死亡率及发病率明显低于观察组。结论:早发型重度妊高征在终止妊娠前短期的保守治疗是安全有效的,给予积极治疗能明显减少围产儿死亡率、提高生存率。     

体外受精和胚胎移植后妊娠合并急性粟粒性肺结核的临床特点

目的总结体外受精和胚胎移植（IVF-ET）后妊娠发生急性粟粒性肺结核的临床特点。方法回顾性分析2001年1月至2005年12月在浙江大学医学院附属妇产科医院生殖中心接受IVF-ET后妊娠并发粟粒性肺结核的6例临床资料。结果IVF-ET后妊娠并发粟粒性肺结核患者的临床表现多不典型，以发热为主要表现，呼吸道症状隐匿。胸部影像学表现以粟粒性结节和浸润性改变为主。平均于移植后53．2d发病，1例人工流产终止妊娠，其余5例均在发病后2～4周内发生自然流产。结论发热为急性粟粒性肺结核的主要临床表现，IVF-ET后妊娠发生粟粒性肺结核的妊娠结局差，对抗炎治疗无效的发热患者应警惕肺结核，尽早行结核病的相关检查。     

基于脂质组学的子宫内膜异位症生物标志物研究进展

子宫内膜异位症的发病机制不明,缺乏有效的生物标志物,疾病的延误诊断非常突出。脂质组学技术为子宫内膜异位症的诊断和预测提供了新的途径。外周血、子宫内膜液、腹腔液和卵泡液的鞘磷脂、磷脂酰胆碱和磷脂酰丝氨酸等对子宫内膜异位症及疾病分型具有良好的诊断价值;在位子宫内膜的磷脂酰胆碱、磷脂酰丝氨酸联合磷脂酸有望成为早期子宫内膜异位症的生物标志物;外周血的脂代谢数据对预测子宫内膜异位症相关不孕也有重要价值。脂质组学技术的发展将进一步推进子宫内膜异位症相关发病机制、疾病预测、诊断和治疗等方面的研究进展。     

High bone morphogenetic protein-15 level in follicular fluid is associated with high quality oocyte and subsequent embryonic development

BACKGROUND: Bone morphogenetic protein-15 (BMP-15) has been shown to influence oocyte maturation and quality. However, no relationship has been established between BMP-15 and oocyte quality/embryonic development in humans. The aim of this study is to investigate BMP-15 level in human follicular fluid (FF) and its possible role in determining oocyte quality and developmental potential. METHODS: A total of 79 oocytes and their corresponding FF from 79 women undergoing ICSI were examined. Individual oocytes were inseminated and subsequently assessed on the basis of their fertilization, cleavage and preimplantation development. BMP-15, FSH, estradiol (E(2)) and progesterone levels of FF were also analysed via the techniques of western blot or radioimmunoassay. RESULTS: Higher FF BMP-15 levels were observed in the fertilized and cleaved groups versus the unfertilized and uncleaved groups, respectively (P < 0.05). The best (Grade I) embryo morphology was associated with higher FF BMP-15 levels than Grade II or III embryos (P < 0.01). A significant positive correlation was found between BMP-15 and E(2) levels in the same follicle. CONCLUSION: The present study demonstrates that the BMP-15 level in FF appears to be a potential factor in predicting oocyte quality and subsequent embryo development, and is correlated with E(2) level, which may additionally be a valuable predictor of oocyte fertilization.     

Prevention of left atrium esophagus fistula: Appraisal of existing technologies and strategies

Catheter ablation has emerged as an effective treatment for atrial fibrillation (AF). Atrial esophageal fistula (AEF) is a rare, but feared complication. With increasing utilization of ablation therapy for AF, the understanding of the relationship between AEF and ablation has been improved in recent years. Efforts to reduce the risk of AEF have focused on decreasing the risk of severe esophageal injury (EI) and the presumed subsequent progression from EI to AEF, including esophageal temperature monitoring, esophageal cooling systems, esophageal deviation devices, and decreasing and/or curtailing ablation energy delivery. Periprocedural assessment may help identify higher risk patients and detect early esophageal lesions. This review systematically summarizes and evaluates the current strategies and techniques utilized to reduce the risk of AEF in the clinical workflow for AF ablation. We expect that this review will help clinicians to better understand the principles, advantages, and disadvantages of these methods, and to find suitable strategies using current available tools.     

三维超声成像技术在宫内节育器定型与定位诊断中的应用

目的：探讨三维超声成像技术在宫内节育器（IUD）定型与定位诊断中的应用价值。方法：对30例经阴道二维超声检查怀疑IUD异常的患者行三维超声成像检查,通过对子宫腔与IUD的三维超声图像重建,明确IUD的形状与位置,将三维超声成诊断结果与宫腔镜,腹腔镜或剖腹诊治结果进行对照。结果：29例患者（96．7％）获取满意的三维超声声像图,可清晰显示IUD的形状,位置及其与子宫腔的关系;1例因绝经9年,子宫内菲薄而未能获取满意声像图,仅显示IUD嵌顿而无法显示IUD片段与宫腔的关系,诊断IUD完整者17例（单金属圆环10例,γ型IUD3例,宫腔型IUD2例,T型IUD2例）,IUD断裂者13例;IUD嵌顿24例,γ型IUD转位3例,宫腔型IUD转位1例,正常位置T型IUD2型,28例IUD异常患者中26例行宫腔镜,腹腔镜或剖腹取器手术,均一次取器成功,术中所见与三维超声诊断结果一致。结论：三维超声成像技术对IUD的定型和定位诊断具有很高的价值。对临床治疗方案的选择有指导意义。