中西医结合治疗卵巢储备功能减退患者成功妊娠二例并文献复习

卵巢储备功能减退（diminished ovarian reserve，DOR）是卵巢因素所致不孕症的主要原因之一，西医临床治疗方法主要依赖于口服提高卵巢储备功能的药物、人工激素周期替代疗法和辅助生殖技术助孕，中医运用补肾健脾法治疗DOR具有不良反应少、疗效持久、治疗手段多样化等优势。报告2例在常规西医治疗基础上应用中医补肾健脾法综合治疗DOR患者成功妊娠的情况，强调个体化中西医结合治疗方案对于解决疑难病证的重要性，为临床应用中医药治疗DOR患者提供证据。     

血清Hcy、IGFBP-1联合预测多囊卵巢综合征患者孕早期自然流产的价值

目的探讨血清同型半胱氨酸(Hcy)、胰岛素样生长因子结合蛋白-1(IGFBP-1)联合检测对多囊卵巢综合征患者孕早期自然流产的预测价值。方法选取2018年3月—2020年5月行促排卵治疗并成功临床妊娠的多囊卵巢综合征165例,检测血清Hcy、IGFBP-1水平。根据孕早期自然流产发生情况分为孕早期自然流产组与未自然流产组,比较两组妊娠前一次促排卵后血清Hcy、IGFBP-1水平;多囊卵巢综合征患者孕早期自然流产的危险因素采用多因素Logistic回归分析,并采用受试者工作特征(ROC)曲线分析血清Hcy、IGFBP-1水平单项及联合检测对多囊卵巢综合征患者孕早期自然流产的预测价值。结果患者妊娠前一次促排卵后血清Hcy水平低于入院时,血清IGFBP-1水平高于入院时(P<0.01);自然流产组妊娠前一次促排卵后血清Hcy水平高于未自然流产组,血清IGFBP-1水平低于未自然流产组(P<0.01)。孕早期自然流产的发生率为28.48%。年龄≥35岁、多囊卵巢综合征分型、空腹胰岛素水平偏高、空腹血糖水平偏高、血清睾酮水平偏高、血清叶酸水平偏低、妊娠前一次促排卵后血清Hcy水平偏高及血清IGFBP-1水平偏低均是多囊卵巢综合征患者孕早期自然流产的危险因素(P<0.01)。妊娠前一次促排卵后血清Hcy水平联合血清IGFBP-1水平预测多囊卵巢综合征患者孕早期自然流产的敏感度、ROC曲线下面积均高于单独预测(P<0.01)。结论多囊卵巢综合征孕早期自然流产患者血清Hcy水平偏高,IGFBP-1水平偏低,二者均与多囊卵巢综合征患者孕早期自然流产密切相关,并对多囊卵巢综合征患者孕早期自然流产的发生具有较好的预测价值,联合检测时的预测效能更高。     

The potential role of assisted oocyte activation in the management of a POSEIDON group 3 patient with fertilization failure: A case report and literature review

ObjectiveAssisted oocyte activation combined with ICSI (ICSI-AOA) has been reported to improve fertilization outcomes of couples with oocyte activation deficiency (OAD). Although there's no sufficient evidence to support ICSI-AOA as routine use, it might be beneficial for POSEIDON group 3 patients with suspected oocyte-related OAD.Case reportA 29-year-old female presented with a history of primary infertility for two years. She was classified as a POSEIDON group 3 patient and had a total fertilization failure history. With the help of ICSI-AOA, six oocytes were successfully fertilized. Pregnancy was later confirmed after embryo transfer. A living infant was born after 34 weeks of pregnancy.ConclusionOAD should be taken into consideration for POSEIDON group 3 patients since low Antimüllerian hormone is associated decreased quality. Further research needs to be done to understand the mechanism underlying oocyte-related OAD and the potential role of ICSI-AOA in young patients with suboptimal ovarian response.     

CCNE1基因在卵巢高级别浆液性癌中的研究进展

细胞周期蛋白E1（Cyclin E1,CCNE1）基因扩增是卵巢高级别浆液性癌（high-grade serous ovarian carcinoma,HGSOC）最常见的拷贝数变异之一,扩增率为20%左右。CCNE1基因扩增不仅参与HGSOC的早期癌前病变,促进恶性肿瘤的发生、发展,还可引起细胞周期紊乱和染色体不稳定,从而增加HGSOC的铂类耐药性和复发率,最终导致患者的化疗效果不佳和预后较差。为改善CCNE1扩增的HGSOC患者的预后和生活质量,在暂时没有CCNE1扩增的HGSOC的靶向治疗药物的情况下,使用细胞周期蛋白依赖性激酶2（cyclin-dependent kinases 2,CDK2）小分子抑制剂或者多腺苷二磷酸核糖聚合酶[poly (ADP-ribose) polymerase,PARP]抑制剂与其他药物联合治疗,一定程度上能有效地抑制肿瘤细胞的增殖活性,促进肿瘤细胞死亡。因此,从CCNE1扩增对HGSOC的早期发病机制的影响和产生铂类耐药的角度上来说,CCNE1基因有望成为HGSOC的潜在治疗靶标和预后评价生物学指标,在改善患者的治疗和预后方面具有重要意义。     

Clinical Outcomes and Patency after Transjugular Intrahepatic Portosystemic Shunt Reduction for Overshunting Adverse Events

PurposeTo assess clinical outcomes and patency after transjugular intrahepatic portosystemic shunt (TIPS) reduction for overshunting adverse events.Materials and MethodsThis multicenter, retrospective observational study included 33 patients (male-to-female ratio, 20:13; mean age, 59 years; mean Model for End-Stage Liver Disease [MELD] score, 15) who underwent TIPS reduction between 2007 and 2020. Procedure indications included medically refractory hepatic encephalopathy (HE) (85%), post-TIPS hepatic insufficiency (HI) (12%), and heart failure (3%). The measured outcomes included improvement in HE (classified using the West Haven system) and HI, patency of reduced TIPS, and transplant-free survival (TFS).ResultsTIPS reductions were successfully performed using parallel stent (94%) or other (6%) techniques at a median of 120 days after TIPS creation (HE, median, 164 days; HI, median, 5 days). The portosystemic pressure gradient increased from a mean of 10 to 17 mm Hg (P < .001). The overall HE rate after TIPS reduction was 54%; HE was persistent, improved, and resolved in 21%, 32%, and 46% cases, respectively. In patients with HI, the MELD score increased from a mean of 22 before TIPS to 34 after TIPS (P = .061), but without improvement (0%) in HI after TIPS reduction (mean MELD score, 30; P = .266). Recurrent ascites occurred in 14% of the patients. The median shunt patency was 961 days (95% confidence interval, 476–1,447). The 30-day, 6-month, 1-year, and 3-year shunt patency rates were 92%, 81%, 74%, and 37%, respectively. The median TFS was not reached. The 30-day, 6-month, 1-year, and 3-year survival rates were 97%, 90%, 81%, and 60%, respectively.ConclusionsAlthough TIPS reduction may be an effective and durable approach to treat post-TIPS medically refractory HE, shunt reduction may not achieve meaningful benefit for HI.