中西医结合治疗排卵功能失调性异常子宫出血的疗效分析

目的 观察中西医结合治疗排卵功能失调性异常子宫出血的临床疗效,为预防和治疗提供临床参考。 方法 选择2014年7月-2015年12月湖州市妇幼保健院妇科诊治的排卵功能失调性异常子宫出血患者92例,将患者随机1:1分为对照组和观察组,每组各46例,对照组接受西药治疗,观察组在对照组的基础上,接受中西医结合治疗,观察2组患者的治疗效果,比较患者治疗前后子宫内膜厚度。采用SPSS 19.0统计软件对数据进行分析,计量资料采用t检验,计数资料采用χ2检验,等级资料采用秩和检验,P<0.05为差异具有统计学意义。 结果 观察组总有效率为100.0%,对照组为91.3%,观察组明显高于对照组,差异具有统计学意义(Z=2.429,P<0.05)。观察组和对照组患者治疗前子宫内膜厚度为(13.8±0.4) mm、(13.7±0.6) mm,差异无统计学意义(P>0.05);治疗后观察组和对照组患者子宫内膜厚度分别为(6.3±1.1) mm和(8.5±1.4) mm,均有显著性改善,与治疗前比较,差异有统计学意义(P<0.05),但观察组明显优于对照组,差异具有统计学意义(P<0.05)。 结论 中西医结合治疗排卵功能失调性异常子宫出血的临床疗效明显优于单独应用西药,子宫内膜厚度改善显著,值得临床推广使用。      

经阴道超声及彩色多普勒能量图对子宫黏膜下肌瘤和 子宫内膜息肉的对照分析

目的：探讨经阴道超声（TVUS）及彩色多普勒能量图（CDE）对子宫黏膜下肌瘤和子宫内膜息肉的诊断与鉴别诊断价值。方法：对本院1997年12月至1999年10月病理证实的84例85个黏膜下肌瘤与29例30个内膜息肉的术前TVUS及CDE作回顾性对照分析。结果：黏膜下肌瘤与内膜息肉在肿块大小,形态、回声性质、肿块表面内膜（以下简称肿块）与周边内膜夹角、肿块周边声晕及CDE对肿块和蒂的血流显像等方面有显著差别。结论：TVUS及CDE是黏膜下肌瘤与内膜息肉的一种简便有效的诊断方法。     

智力障碍患儿ARX基因起始密码c. 1A>G变异的遗传学分析

目的对1例智力障碍患儿进行基因变异分析,明确其遗传学病因。方法对1例智力障碍患儿进行目标区域捕获测序,将测序结果与GenBank提供的标准序列进行对比,寻找基因序列的变异。对于检出的可能致病性变异,应用Sanger测序法,对患儿双亲进行验证,并分析患儿的临床遗传学特点。结果检测出患儿ARX基因c.1A>G半合子变异;双亲验证后,证实母亲为ARX基因c.1A>G杂合变异携带者,因此患儿的变异遗传自母亲。通过检索公共数据库及本地数据库该变异未收录、也未见文献报道,ARX基因c.1A>G变异为未报道过的新变异,临床意义为“可能致病性变异”。结论AKX基因c.1A>G(pMetl?)变异可能与患儿的智力障碍的发生相关。     

Comparative antiadhesive properties of crude extract and phenolic fraction isolated from aerial parts of Tribulus pterocarpus during severe hyperhomocysteinemia

The phenolic fraction and the crude extract from Tribulus pterocarpus have different biological activity, including antiplatelet–antiadhesive properties. Since it is demonstrated that hyperhomocysteinemia may act as stimulator of blood platelet activation (platelet adhesion, aggregation, and secretion), but various antiplatelet compounds are able to reduce hyperactivation of blood platelets induced by hyperhomocysteinemia. The aim of our present experiments was to investigate in vitro one of the step in platelet activation process – platelet adhesion to collagen induced by the model of severe hyperhomocyateinemia in the presence of the phenolic fraction and the crude extract from T. pterocarpus. Severe hyperhomocysteinemia was induced by reduced form of Hcy in the concentrations 0.1 mM and 1 mM, or using HTL in the concentrations 0.1, 0.5 and 1 μM. Adhesion of blood platelets to collagen was determined according to Tuszynski and Murphy. We observed that the phenolic fraction and the crude extract from T. pterocarpus have the inhibitory effect on platelet adhesion during severe hyperhomocysteinemia. The action of tested phenolic and crude extract was concentration-dependent, but the phenolic fraction was stronger antiadhesive action than the crude extract. We suggest that T. pterocarpus may be good source of antiplatelet compounds during hyperhomocysteinemia.     

Effects of abnormal zona pellucida on fertilization and pregnancy in IVF/ICSI-ET

Objective To analyze the fertilization rate, embryo development and clinical outcome of oocytes with abnormal zona pellucida after in vitro fertilization(IVF) or intracytoplasmic sperm injection(ICSI).Methods A retrospective analysis included a total of 43 cycles(27 IVF cycles and 16 ICSI cycles) in which oocytes displaying abnormal zona pellucida were retrieved between January 2006 and December 2011. The fertilization rate, embryo quality,and the cumulative clinical pregnancy rate were analyzed.Results Rescue ICSI was applied in 27 IVF cycles in which failed extrusion of the second polar body after conventional IVF was observed, and of them, complete failure to fertilize occurred in 23 IVF cycles. The fertilization rate and the normal fertilization rate for IVF(64.83% and 59.32%, respectively) were significantly lower than those for ICSI(85.19% and 79.01%, respectively), whereas the cleavage rate(94.12%) with IVF did not differ significantly from that with ICSI(95.65%, P>0.05). The percentages of good-quality embryos in IVF group(52.67%) and ICSI group(43.75%) also did not differ significantly(P>0.05). Although the rates of implantation and pregnancy appeared to be greater in IVF group(33.33% and 40.00%, respectively) compared with those in ICSI group(25.00% and 35.71%, respectively), the differences were not significant(P>0.05).Conclusions ICSI should be carried out for oocytes with abnormal zona pellucida,for which the risk of IVF failure is high. Rescue ICSI improves the likelihood of fertili-zation of oocytes with abnormal zona pellucida, but cannot improve the clinical outcome.     

母亲MTHFR 677C/T多态性和孕期状况与子代发生先天性心脏病的相关性研究

目的 探讨母亲孕期MTHFR 677C/T多态性、孕期状况在子代先天性心脏病(CHD)发生中的相互关系。方法 采用病例对照研究,调查100对CHD胎儿和无CHD胎儿生物学母亲有关人口学、孕期环境相关情况、优生认知,并检测MTHFR 677C/T基因多态性以及血清同型半胱氨酸(HCY)、叶酸、VitB12水平,进行单因素和多因素非条件logistic回归分析。结果 病例组和对照组MTHFR 677C/T基因型和等位基因频率差异无统计学意义(χ²=1.08,P=0.582;χ²=0.53,P=0.468),血清HCY水平两组差异有统计学意义(t=-8.14,P=0.000)。单因素分析,14个因素有统计学意义(P<0.05);多因素logistic逐步回归分析,母亲教育程度(OR=3.386,95%CI:1.279~8.961)、家庭年收入(OR=8.699,95%CI:2.177~34.765)、患慢性病(OR=0.343,95%CI:0.134~0.881)、优生认知得分(OR=0.906,95%CI:0.836~0.981)、血清HCY水平(OR=1.734,95%CI:1.458~1.986)、异常生育史(OR=3.710,95%CI:1.217~11.308)等因素与子代CHD相关。结论 母亲MTHFR 677C/T多态性与子代CHD发生未发现关联;母亲教育程度低、家庭年收入低、异常生育史、优生认知得分低、血清HCY水平高可能增加子代CHD的发生危险。     

护士进修动机量表编制与信效度分析

目的编制有良好信效度的护士进修动机量表,为进一步研究护士进修动机提供可靠测量工具。方法以国内外相关研究理论为基础,经专家咨询法、探索性因子分析形成护士进修动机量表,并对量表的重测信度、内部一致性、结构效度进行检验。结果编制5因子22条目护士进修动机量表,各因子和整体量表的克朗巴哈α系数均在0.8以上,具有良好的内部一致性;各因子得分和量表总分两次测试的相关系数均在0.7以上,重测信度较好;验证性因子分析显示问卷的结构效度拟合良好。结论本次编制的护士进修动机量表具有较高的信度与效度。     

卵巢卵泡膜细胞瘤磁共振影像特征的分析

目的 探讨卵巢卵泡膜细胞瘤的磁共振成像(MRI)表现,提高该病术前MRI诊断准确率。方法 回顾性分析经手术病理证实的48例卵巢卵泡膜细胞瘤患者资料,根据病灶最大径分为≥5 cm和<5 cm组,重点分析病灶的部位、大小、形态、边界、囊变坏死、T₁WI、T₂WI平扫信号、DWI特征、强化特征、盆腔积液情况。并通过MRI影像表现进行诊断分数评价(最高为6分)。结果 48例病灶均为单发。≥5 cm组39例:边界清晰37例,不清晰2例;囊变坏死35例;T₁WI呈等信号23例,等低信号16例;T₂WI呈等信号7例,等低信号23例,稍高信号9例;DWI呈高信号23例,混杂高信号16例;动态增强扫描均呈轻度强化;33例见不同程度盆腔积液。分数评价:6分33例,5分2例,4分2例,3分2例。<5 cm组9例:边界均清晰;囊变坏死3例;T₁WI呈等信号3例,等低信号6例;T₂WI呈等信号2例,等低信号4例,稍高信号3例;DWI均呈高信号;8例病灶动态增强扫描呈轻度强化,1例呈明显强化;4例见少量盆腔积液。分数评价:6分3例,5分1例,4分4例,3分1例。≥5 cm组盆腔积液(χ²=6.680,P=0.010)和囊变坏死(χ²=14.109,P<0.001)的发生率明显高于<5 cm组。病灶囊变患者中雌激素水平升高的人数明显多于未发生病灶囊变的患者(χ²=5.847,P=0.016;列联系数=0.330)。结论 卵巢卵泡膜细胞瘤较大的病灶DWI呈高或混杂高信号,多合并盆腔积液及囊变坏死,囊变坏死多见且范围较小。较小的病灶DWI呈高信号,囊变坏死少见。MRI分数评价结合患者年龄等因素有助于提高术前诊断准确率。     

276例绝经后阴道出血患者诊断性刮宫结果分析及护理对策

回顾性调查分析276例绝经后阴道出血患者诊断性刮宫的结果,探讨绝经后阴道出血患者的年龄、绝经年限和病理类型的关系,提出护理对策。诊刮术发现功能性及功能失调性子宫出血为绝经后妇女阴道出血的首位原因,功能性及功能失调性子宫出血以增生型及萎缩型内膜改变为主,分泌型较少;患者良性病变中以炎症为主;患者年龄越大,绝经年限越长,恶性肿瘤发病率越高;宫内节育器也可导致绝经后出血。故重视患者心理护理,对绝经后阴道出血患者的随访跟踪,以降低妇科恶性肿瘤的发病率,同时加强健康宣教,指导绝经后妇女及时取出宫内节育器,主动采取有利健康的行为,自觉参加妇女病普查,做到早发现,早治疗老年妇科疾病。     

湖州地区2010年2810例不育男性精液质量分析

目的:分析2010年湖州地区2810例不育男性精液质量状况,探讨精液检查在男性不育诊断中的重要性。方法:严格按照WHO《人类精液及精子-宫颈粘液相互作用实验室检验手册》第四版技术规范,采用纯手工的方法,对2810例男性患者精液进行常规分析。结果:(1)检测指标全部正常的精液样本数286例,所占比例10.2%。精液质量有一项或多项异常者2524例,占精液检测总数的89.8%。(2)精子膜表面抗体IgG总的检测数量为1459例,异常例数为105例,阳性率为7.2%。结论:男性的精液常规检查既方便又快捷,在不孕症夫妇诊疗中非常重要,如能及早查出或排除男方不育因素,必要时配合女方治疗,有利于提高不孕症夫妇在不孕症治疗过程中的成功率。