目的:探讨40岁以上高龄女性体外受精-胚胎移植(IVF-ET)的妊娠结局,旨在为高龄女性提供生育咨询以及为改善高龄女性个体化辅助生殖治疗结局提供临床依据。方法:选择我院生殖中心2015年1月—2017年12月女方年龄≥40岁且使用自身卵子行体外受精的共2 467个治疗周期资料,对各项临床数据进行回顾性分析。结果:40岁及以上行辅助生殖治疗的患者,随着女性年龄增加获卵数明显减少(40~48岁女性平均获卵数分别为2.97、 2.69、2.17、2.01、1.77、1.61、1.68、1.29和1.00,44~48岁与40~43岁依次组间比较均P<0.05),尤其是44岁以上女性胚胎发育潜能明显降低(40~48岁囊胚形成率分别为48.90%、43.72%、33.67%、34.29%、24.39%、21.14%、26.32%、16.67%和0%,44~48岁与40~43岁组间依次比较均P<0.05)。共有518个周期行新鲜胚胎移植,结果显示,随女性年龄增加,临床妊娠率(40~48岁临床妊娠率分别为26.92%、21.15%、20.79%、10.96%、18.87%、11.11%、5.88%、0%和0%,43~48岁与40~42岁组间依次比较均P<0.05)、种植率(40~48岁种植率分别为23.65%、19.51%、17.70%、8.54%、7.49%、10.81%、5.56%、0%和0%,43~48岁与40~42岁组间依次比较均P<0.05)和活产率均显著降低(40~46岁活产率分别为18.46%、10.58%、9.90%、5.48%、5.66%、2.78%和5.88%,43~46岁与40~42岁组间依次比较均P<0.05),43岁以上者结局更差。44岁以上女性自然流产率明显增高(40~45岁流产率分别为31.43%、50.00%、52.38%、50.00%、70.00%和75.00%,44~45岁与40~43岁组间依次比较均P<0.05)。46岁女性仅1例妊娠并分娩,47岁和48岁女性均无成功妊娠。与抗苗勒管激素(AMH)>1.0 ng/mL组相比,AMH≤1.0 ng/mL组妊娠率、种植率及活产率均显著下降(27.04% vs. 14.74%,22.99% vs. 13.50%,15.88% vs. 7.37%;均P<0.05),流产率明显升高(41.27% vs. 50.00%,P<0.05)。结论:≥40岁高龄女性随年龄增长生育力逐渐降低。40~43岁年龄段女性助孕仍有一定的价值,尤其是卵巢仍有一定储备者(AMH>1.0 ng/mL),但44岁以上女性原则上不再建议ART助孕,对于46岁以上卵巢功能衰竭的女性强烈建议卵子捐赠或收养。 相似文献
Respiratory failure is defined by the inability of the respiratory system to adequately deliver oxygen or remove carbon dioxide from the pulmonary circulation resulting in hypoxemia, hypercapnia or both. A wide variety of disease processes can lead to respiratory failure in children. Multiple interventions can support the paediatric patient with respiratory failure, from simple oxygen delivery devices to high frequency oscillatory ventilation and extracorporeal membrane oxygenation. This article will review available devices to improve oxygenation and ventilation, their advantages and disadvantages, and help guide physicians in the management of children with respiratory failure. 相似文献
Introduction: The sodium-glucose co-transporter 2 (SGLT2) is ascribed to target renal tubular glucose re-absorption, and its inhibition has been proved to induce glucosuria which improves the glycemic index. Accordingly, SGLT2 inhibitors have found to be the promising class of antidiabetic agents for the management of type 2 diabetes mellitus. A large number of SGLT2 inhibitors have developed through structural modification and investigated for their ability to selectivity inhibit SGLT2 transporters with better bioavailability.
Areas covered: This review comprises a summary of patent applications (2013–2018) of SGLT2 inhibitors with focus on chemical structural advancement and therapeutic potentials in the management of diabetes and related disorders.
Expert opinion: SGLT2 inhibitors exert multiple metabolic benefits, including reduced glycated hemoglobin (HbA1c), improved glycemic control (fasting and postprandial), reduced body weight, reduced systolic and diastolic blood pressure and improved HDL cholesterol. Due to the virtue of no interference with insulin action and secretion, their efficacy remains the same even in presence of progressive β cell failure in type 2 diabetes. Additionally, few members of this class have been reported to exhibit cardioprotective, renoprotective, and anticancer activity. However, more study on the long-term outcomes in patients taking SGLT2 inhibitors is warranted. 相似文献