CA125、孕酮联合雌二醇预测先兆流产的价值

目的 探讨血清癌抗原125（CA125）、孕酮联合雌二醇预测先兆流产的临床价值。方法 回顾性分析2012年3月至2014年3月解放军第一零一医院收治的孕龄在6～8周的单胎孕妇,按照妊娠结局将其分为3组：先兆流产组、难免流产组以及正常妊娠组,分别测定三组的CA125、孕酮以及雌二醇水平。结果 3组的CA125、孕酮、雌二醇经方差分析比较,差异均有统计学意义（F值分别为15．731、3．608、26．253,均P＜0．05）,两两比较后发现正常妊娠组的CA125显著低于先兆流产组和难免流产组（t 值分别为12．183、16．065,均P＜0．05）,先兆流产组的CA125低于难免流产组（t＝9．187,P＜0．05）,正常妊娠组的孕酮、雌二醇显著高于先兆流产组和难免流产组（t值分别为10．073、12．685、9．936、18．187,均P＜0．05）,先兆流产组孕酮、雌二醇显著高于难免流产组（t值分别为9．637、10．098,P＜0．05）。 CA125、孕酮、雌二醇检测的灵敏度、特异度、准确性差异无统计学意义（χ^2分别为1．962、1．734、0．985,P＞0．05）,CA125、孕酮联合雌二醇对先兆流产患者预后的灵敏度、特异度、准确性均显著高于其它三组（χ^2分别为5．184、6．861、4．086,均P＜0．05）。结论 CA125、孕酮联合雌二醇对先兆流产进行预测具有准确性高的特点,临床有重要参考价值。     

雌二醇联合孕激素对卵巢癌细胞凋亡及microRNA-15a表达的影响

目的 探讨雌二醇（E2）联合孕激素（P4）对microRNA-15a （miR-15a）表达的影响。方法 采集手术中切除的卵巢癌组织标本进行细胞培养,分3个处理组：E2组,P4组和雌二醇联合孕激素（E2+P4）组。激素处理后,MTT法检测细胞存活率;流式细胞技术检测细胞凋亡与细胞周期;qRT-PCR法检测Bcl-2,Bax和miR-15a的相对表达量。结果 高浓度（浓度均为10^-4 mol·L^-1）的E2,P4,E2+P4能够降低卵巢癌细胞的存活率,并表现为时间依赖性;低浓度（≤ 10^-8 mol·L^-1） E2能够提高卵巢癌细胞的存活率。与对照组相比,高浓度E2,P4和E2+P4能够增加卵巢癌细胞的凋亡率（P<0.001）,并且E2+P4的作用最明显;低浓度E2能够抑制肿瘤细胞的凋亡（P<0.001）。E2,P4和E2+P4对细胞周期的影响没有统计学差异。高浓度的E2,P4和E2+P4能够下调Bcl-2的表达（P<0.05或P<0.001）,上调Bax的表达（P<0.001）;但是低浓度E2作用却相反。高浓度的E2+P4能够促进miR-15a的表达（P<0.001）。结论 高浓度的E2,P4和E2+P4能够降低细胞的存活率促进细胞凋亡,下调Bcl-2的表达,上调Bax的表达;低浓度E2的作用则相反;高浓度的E2+P4能够促进miR-15a的表达。     

The comparison of the effectiveness and safety of drospirone ethinyl estradiol and ethinyl estradiol cyproterone in the treatment of polycystic ovarian syndrome: A protocol for systematic review and meta-analysis

Background:Polycystic ovarian syndrome (PCOS) is an endocrine disorder syndrome with reproductive dysfunction and abnormal glucose metabolism. Persistent non-ovulation, excessive androgens and insulin resistance are important features and they are the most common causes of menstrual disorders in women during childbearing years. At present, the cause of PCOS is not clinically clear. Current studies suggest that it may be due to the interaction of certain genetic genes with environmental factors. It is an important cause of infertility or early miscarriage with the characteristics of various causes and complex clinical manifestations. At present, for the treatment of PCOS patients, clinical treatment mainly includes hypoglycemia, insulin and menstrual regulation and other symptomatic and supportive treatment. Drospirone ethinyl estradiol and ethinyl estradiol cyproterone are 2 of the most commonly used drugs in clinical treatment of PCOS, but there is lack of the evidence of evidence-based medicine. Therefore, this study systematically evaluates the therapeutic effect and safety of PCOS patients with 2 short-acting oral contraceptives, drospirone ethinyl estradiol and ethinyl estradiol cyproterone, which provides the guidance for clinically selecting the appropriate drug to treat PCOS.Methods:Searching CNKI, WanFang Data, VIP, SinoMed, PubMed, EMbase, Web of Science, and The Cochrane Library database by computer, collecting the randomized controlled studies of DEE and EEC in the treatment of PCOS. The retrieval time limit is from the establishment of each database to July 1, 2020. In addition, tracing the references incorporated into the literature to supplement to the relevant literature. Using the retrieval method by combining the free words and the subject words, and the individual search of different databases is carried out. Meta-analysis is performed using RevMan 5.3 software after 2 researchers independently screens the literature, extracts the data, and evaluates the bias risk included in the study.Results:This study will systematically evaluate the DEE and EEC in the treatment of PCOS by collecting the required evidence to understand the effects of the 2 drugs on hypersotrophicemia, insulin resistance, lipid metabolism, and the safety during drug use in patients of this class, and the results will be published in highly influential academic journals.Conclusion:The results of this study will provide theoretical basis for the drug treatment of polycystic ovarian syndrome and provide help in the decision-making of clinical treatment of the disease.Ethics and dissemination:In this study, meta-analysis was used to conduct a second study on the published literature. Therefore, this type of systematic review research does not need to be approved by ethics.OSF Registration DOI:10.17605/OSF.IO/8GW9M.     

Estrogen potentiates the behavioral and nucleus accumbens dopamine response to continuous haloperidol treatment in female rats

Estrogen has been shown to enhance the effects of antipsychotics in humans. To investigate the mechanisms of how this may occur, the current study examined estradiol's effects on dopaminergic transmission and behavior in amphetamine‐sensitized and non‐sensitized female rats. Sixty‐four ovariectomized female Sprague–Dawley rats were used for this study. Half of the rats were sensitized to four once‐daily injections of 1 mg/kg amphetamine and the other half served as controls. Rats received chronic administration of either low‐dose haloperidol (0.25 mg/kg/day) or saline vehicle via osmotic minipumps implanted subcutaneously. The groups were further subdivided with respect to estradiol treatment: low chronic estrogen (subcutaneous estradiol implant, 0.36 mg/pellet: 90‐day release, plus an additional oil vehicle injection every second day) and high pulsatile estrogen (subcutaneous estradiol implant plus an additional 10 μg/kg estradiol injection every second day). Motor activity was assessed at day 2 and day 12 during haloperidol treatment, while nucleus accumbens dopamine availability was assessed via microdialysis 10 days into antipsychotic treatment. Haloperidol treatment along with high, but not low, estradiol replacement was effective in reducing amphetamine‐induced locomotor activity in sensitized rats. High estradiol treatment also augmented the effects of chronic haloperidol in reducing dopaminergic release in sensitized rats. These data suggest that estradiol levels affect both the behavioral and the dopamine responses to chronic antipsychotic treatment.     

辅助生殖患者宫腔粘连术后应用人工周期促内膜修复的疗效及对生育结局的影响

目的评价17-β雌二醇用于辅助生殖患者宫腔粘连术后促子宫内膜修复的效果及对生育结局的影响。方法 429例拟行体外受精-胚胎移植(IVF-ET)患者,因宫腔粘连经宫腔镜下行宫腔粘连分离术和放置宫内节育器术,215例术后应用17-β雌二醇+地屈孕酮行周期治疗(雌二醇2mg bid)2周期(实验组),214例不行周期治疗(对照组)。所有病例定期随诊,治疗结束后再行宫腔镜检查探查宫腔情况并取出宫内节育器,再行胚胎移植,随访治疗疗效及妊娠结局。结果实验组的宫腔镜治疗治愈率明显较对照组高,X2=-3.16,p=0.002,实验组术后胚胎移植临床妊娠率也明显较对照组高X2=-2.75,p=0.006。结论宫腔粘连术后采用17-β雌二醇周期治疗,不但有利于宫腔形态的恢复及内膜的修复,而且可以提高内膜的容受性,明显改善妊娠结局。     

Comparison between oral and vaginal estrogen usage in inadequate endometrial patients for frozen-thawed blastocysts transfer

Endometrial preparation with exogenous estrogen is a common practice in frozen-thawed embryo transfer (FET) cycles. The objective of this study was to compare the clinical outcomes of two endometrial preparation groups, oral estradiol valerate tablets (OEV) group versus vaginal estradiol (VE) tablets group, in inadequate endometrium patients. This retrospective, single-center, cohort study of patients undergoing FET treatment between Jan. 2012 and Jun. 2013, at an academic IVF center, included 247 patients (cycles) with endometrial thickness < 8 mm on day 13 of the hormone replacement cycle: OEV group included 69 patients (cycles) who received continuous OEV from day 1 onwards up to the day of progesterone supplement, while VE group included 178 patients (cycles) who taken OEV from day 1 to day 12, and used VE tablets from day 13 till the day of progesterone supplement. Patients in VE group required more days and higher dosage of estradiol, but had thinner endometrium on the day of transfer. However, the increase of endometrial thickness was more, when compared to OEV-treated patients. The implantation rate and pregnancy rate were, though not significantly, higher in VE group. Conclusions: Longer time of administration and higher dosage of estradiol usage did not have adverse effects on the clinical pregnancy rate. VE tablets may promote endometrial development and pregnancy success in FET cycles could not verify. Further study is needed to confirm the vaginal estradiol action on frozen-thawed embryo transfer cycles.     

定志小丸对雌性抑郁模型大鼠海马结构的影响

目的围绕海马结构的形态学研究定志小丸的抗抑郁机制。方法40只雌性大鼠分为对照组、抑郁症模型组（模型组）、蒸馏水组（DW组）和定志小丸组（中药组），Open field法检测行为学得分，ELISA法检测血清皮质醇和雌二醇（E2）含量，HE染色和电镜技术观察海马CA3区神经元形态，免疫组化技术检测齿状回神经干细胞（NSC）增殖。结果与对照组比较，模型组和DW组行为学得分及血清E2含量显著下降，皮质醇水平升高和NSC增殖明显降低，海马CA3区神经元损伤明显；中药组行为学得分和血清E2含量无明显变化，皮质醇明显减少，NSC增殖显著增加，海马CA3区神经元基本正常。结论定志小丸能够保护海马结构，这可能是其抗抑郁机制之一。     

蛇床子素对动物体内雌二醇和脂酶的影响及其相互关系的研究

目的观察蛇床子素对体内血脂、雌二醇(E2)和脂酶的影响及其相互关系。方法在建立高脂血症小鼠模型的同时,分组给予蛇床子素10～40mg.kg-1,3wk后测定肝素化后血浆LPL和HL活性及血浆TC、TG和HDL-C水平。分组给予正常小鼠蛇床子素10～40mg.kg-1,1wk后用ELISA方法观测血清E2水平的变化。建立去卵巢大鼠模型,给予蛇床子素10mg.kg-1,12wk后测定血清E2、TC和TG水平。结果给予蛇床子素10～20mg.kg-1后,能升高高脂血症小鼠肝素化后血浆LPL、HL活性和正常小鼠血清E2水平(P<0.05或P<0.01),也可使高脂血症小鼠血浆TC、TG和LDL-C降低(P<0.05或P<0.01),升高HDL-C(P<0.01)。蛇床子素剂量增至40mg.kg-1时,虽能升高正常小鼠血清E2水平(P<0.01),但高脂血症小鼠的血浆LPL、HL活性反而降低,对降低血浆TC、TG、LDL-C和升高HDL-C水平的幅度也不如低剂量的蛇床子素。去卵巢大鼠给予蛇床子素10mg.kg-1后,能增加血清E2水平(P<0.05),也能降低血清TG水平(P<0.05),TC的水平也有一定的降低。结论较低剂量的蛇床子素可通过增加血中E2水平,提高LPL和HL活性而降低血脂水平,较高剂量的蛇床子素虽可进一步增加血中E2水平,但LPL和HL活性反而降低,导致调脂作用减弱。