妊娠期冠状病毒感染与母婴健康研究进展

目前全球范围内正流行新型冠状病毒肺炎（COVID-19）,而其强烈的传播性已引发重大公共卫生危机。新型冠状病毒与严重急性呼吸综合征（SARS）冠状病毒、中东呼吸综合征（MERS）冠状病毒存在高度病原同源性,同为β属冠状病毒。由于孕妇群体在生理和心理上存在一定脆弱性,为疫情流行期间的易感人群和高危人群,本文将对目前所报道的孕产妇罹患SARS、MERS、COVID-19对母婴健康影响进行文献综述,旨在为COVID-19流行中孕妇健康管理与防控提供依据。     

妊娠相关焦虑对学龄前儿童执行功能的影响及性别差异

  目的  探讨母体妊娠相关焦虑对子代学龄前执行功能(EFs)的影响及性别差异,以期针对性优化子代生命早期发育环境。  方法  选取中国安徽出生队列2008年10月—2010年10月在安徽省马鞍山市妇幼保健院孕早期建卡的孕妇,收集孕妇一般情况和妊娠相关焦虑情况。对队列内的3 556名3~5岁儿童进行随访,收集儿童相关特征,采用《学龄前儿童执行功能评定量表》(父母版)评价其执行功能。  结果  与对照组相比,仅孕早期存在妊娠相关焦虑与学龄前男童工作记忆、计划/组织功能和总执行功能(GEC)异常风险有关[OR 值(95%CI)分别为 1.40(1.06~1.85),1.64(1.06~2.54),1.89(1.27~2.82)];孕早、晚期同时存在妊娠相关焦虑与学龄前男童抑制、工作记忆、计划/组织功能和 GEC 异常风险有关[ OR值(95%CI)分别为 2.60(1.45~4.67),2.45(1.69~3.57),2.23(1.28~3.88),3.27(2.03~5.28)]。 仅孕早期存在妊娠相关焦虑与学龄前女童抑制和工作记忆异常有关[OR 值(95%CI)分别为 1.79(1.13~2.83),1.45(1.07~1.98)];仅孕晚期存在妊娠相关焦虑与学龄前女童抑制功能异常有关[OR 值(95%CI)= 2.26(1.17~4.38)];孕早、晚期同时存在妊娠相关焦虑与学龄前女童抑制和工作记忆功能异常风险有关[OR 值(95%CI)分别为 2.45(1.40~4.28),2.02(1.35~3.01)]。  结论  妊娠相关焦虑显著影响子代学龄前儿童执行功能,并存在剂量反应关系。妊娠相关焦虑在男童中主要影响工作记忆、计划/组织功能和总执行功能,在女童主要影响其工作记忆和抑制功能。     

Correspondence Between Clinician Ratings of Vulvovaginal Health and Patient-Reported Sexual Function After Cancer

BackgroundTools for diagnosing sexual dysfunction and for tracking outcomes of interest include clinician interviews, physical exam, and patient self-report. Limited work has described relationships among these three sources of information regarding female sexual dysfunction and vulvovaginal health.AimWe describe correlations among data collected from clinician interviews, clinical gynecological examination, and patient self-report.MethodsData are from a single-site, single-arm, prospective trial in 100 postmenopausal patients with a history of breast or endometrial cancer who sought treatment for vulvovaginal symptoms. The trial collected a standardized clinical gynecologic exam, clinician-reported outcome (ClinRO) measures of vulvovaginal dryness and pain, and patient-reported outcome (PRO) measures of sexual function, including PROMIS Sexual Function and Satisfaction (SexFS) lubrication, vaginal discomfort, labial discomfort, and clitoral discomfort and Female Sexual Function Index (FSFI) lubrication and pain. We examined polyserial correlations between measures with bootstrapped 95% confidence intervals from the baseline and 12–14-week timepoints.ResultsAll of the relationships between the ClinRO variables and the PRO variables were in the expected direction (ie, positive), but the strength of the relationships varied substantially. At 12–14 weeks, there were medium-to-large correlations between ClinRO vaginal dryness and SexFS Lubrication (0.64), ClinRO vulvar dryness and SexFS Lubrication (0.46), ClinRO vulvar discomfort and SexFS Labial Discomfort (0.70), and ClinRO vulvar discomfort and SexFS Clitoral Discomfort (0.43). With one exception, the correlations between the exam variables and the corresponding PRO scores were small (range 0.01–0.27).Strengths & LimitationsOur study included a comprehensive, standardized gynecologic exam designed specifically to evaluate sexual dysfunction as well as established PRO measures with significant evidence for validity. A limitation of our findings is that the sample size was relatively small, and our sample was restricted to women who received cancer treatments known to have dramatic effects on vulvovaginal tissue quality.ConclusionPatient- and clinician-reported vulvovaginal dryness and discomfort were moderately correlated with each other but not with clinical gynecologic exam findings. Understanding the relationships among these different types of data highlights the distinct contributions of each to understand vulvovaginal tissue quality and patient sexual function after cancer. Flynn KE, Lin L, Carter J, et al. Correspondence Between Clinician Ratings of Vulvovaginal Health and Patient-Reported Sexual Function After Cancer. J Sex Med 2021;18:1768–1774.     

孕前BMI和妊娠期糖尿病对儿童脂肪重积聚时相提前的独立和联合效应

目的 探讨孕前BMI、妊娠期糖尿病（GDM）与儿童脂肪重积聚（AR）时相提前的关联。方法 基于已经建立的马鞍山优生优育队列，本研究共纳入2 896对母子对，收集孕妇孕前身高、体重、24~28周GDM情况，在婴儿42天、3月龄、6月龄、9月龄以及1岁后每6个月进行1次随访，连续追踪随访至6岁，获得其身长/高、体重等资料。采用多因素logistic回归分析孕前BMI、GDM与儿童AR时相提前的关联强度，并通过相乘、相加模型分析孕前BMI及GDM对于儿童AR时相提前的发生是否存在交互作用。结果 母亲孕前体重不足、体重正常、超重和肥胖者分别占23.2%（672例）、66.4%（1 923例）、8.7%（251例）和1.7%（50例）；GDM患病率为12.4%。儿童AR年龄为（4.38±1.08）岁，AR时相提前的儿童占39.3%。多因素logistic回归结果显示，孕前超重（OR=1.67，95%CI：1.27~2.19）、肥胖（OR=3.05，95%CI：1.66~5.56）以及孕期患有GDM（OR=1.40，95%CI：1.11~1.76）是AR时相提前发生的危险因素，而孕前体重不足（OR=0.60，95%CI：0.49~0.73）是AR时相提前发生的保护因素。与仅孕前超重/肥胖或孕期患有GDM相比，孕前超重/肥胖与孕期患有GDM并存，AR时相提前的发生风险更高，OR值（95%CI）分别为2.03（1.20~3.44）、3.43（1.06~11.12）。相乘模型和相加模型分析显示，孕前BMI和孕期患有GDM对儿童AR时相提前无交互作用。结论 母亲孕前较高的BMI和孕期患有GDM是儿童AR时相提前发生的独立危险因素，两者并存的风险更高，但无统计学交互作用。     

脂肪重积聚提前与5岁儿童肥胖和代谢各指标关联的队列研究

目的探讨脂肪重积聚(adiposity rebound,AR)提前与5岁儿童肥胖和代谢各指标的关联。方法研究基于已经建立的"马鞍山市优生优育(MABC)",在2013年10月至2015年4月出生的单胎活产儿,连续追踪随访至5岁时的儿童,截至2019年8月份共获得有连续性儿童测量数据≥8次及代谢指标的有720例。采用体格检查以及实验室检测的方法,获得儿童出生情况、身长/身高、体重、腰围、人体成分、代谢指标等信息。使用χ2检验、F检验、t检验、非参数检验、一般线性模型和Logistic回归模型进行分析。结果已有43.47%学龄前儿童界定为AR提前(AR≤4岁)。控制性别后,AR提前组5岁儿童超重/肥胖(OR=2.71,95%CI:1.81~4.05)、腰围超标(OR=1.88,95%CI:1.25~2.82)、体脂肪百分比≥P90(OR=2.09,95%CI:1.26~3.48)的发生风险均上升,差异均有统计学意义(P<0.05);AR提前组5岁儿童胰岛素抵抗和代谢风险因子得分虽高于未提前组,但是差异无统计学意义。5岁儿童肥胖和超重的发生率分别为6.0%和12.8%,且超重肥胖儿童、腰围超标、腰高比超标和体脂百分比≥P90者,胰岛素抵抗和代谢风险因子得分均较高,差异均有统计学意义(P<0.001)。结论 AR提前能增加5岁超重/肥胖、腰围超标和体脂肪百分比超标的风险,且5岁儿童肥胖各指标超标与胰岛素抵抗和代谢风险因子密切相关。     

Melatonin promotes the development of immature oocytes from the COH cycle into healthy offspring by protecting mitochondrial function

Melatonin (MT) regulates reproductive performance as a potent antioxidant; however, its beneficial effects on oocyte development remain largely unknown, especially in human oocytes. The collected 193 immature oocytes from the controlled ovarian hyperstimulation (COH) cycle underwent in vitro maturation (IVM) in IVM medium contained 10 μmol/L MT (n = 105, M group) and no MT (n = 88, NM group), followed by insemination and embryo culture. The results showed that the high-quality blastocyst formation rate in the M group (28.4%) was significantly higher than that in the NM group (2.0%) (P = .0001), and the aneuploidy rate was low (15.8%). In the subsequent clinical trials, three healthy infants were delivered. Next, single-cell RNA-seq data revealed 1026 differentially expressed genes (DEGs) between the two groups, KEGG enrichment analysis revealed that the majority of DEGs involved in oxidative phosphorylation pathway, which associated with ATP generation, was upregulated in the M group. Finally, confocal fluorescence staining results revealed that the mitochondrial membrane potential in the oocytes significantly increased and intracellular ROS and Ca²⁺ levels greatly decreased in the M group. Melatonin can promote the development of immature human oocytes retrieved from the COH cycle into healthy offspring by protecting mitochondrial function.     

推进实施性研究在中国公共卫生领域的应用

随着医学实践的迅速发展,循证医学将最佳证据、临床经验和患者价值有机地结合,循证公共卫生在公共卫生领域的作用也日益突显。然而,仅有约50%的循证医学证据能够真正转化成常规的卫生保健服务,且转化过程耗时长。为了弥合从最佳证据到临床或公共卫生应用之间的鸿沟,实施性研究作为一门新兴学科应运而生。本文介绍了实施性研究的产生背景、发展、理论和方法,并讨论其在中国公共卫生领域的应用及面临的挑战。     

中学生急性应激反应与同伴欺凌行为的关联

  目的  探讨新冠肺炎疫情暴发期间急性应激反应与疫情常态化管理时期中学生同伴欺凌行为的关系, 为制定减少同伴欺凌行为的相关措施提供依据。  方法  2020年12月采用整群抽样方法选取安徽省皖南(宣城市)和皖北(淮北市)2所普通初级中学2 219名学生, 调查遭受欺凌和欺凌他人中言语欺凌、关系欺凌、躯体欺凌和网络欺凌行为发生情况, 并自我回顾性评价新冠肺炎疫情暴发(社交隔离)期间急性应激反应状况。采用多因素Logistic回归模型, 探讨中学生新冠肺炎疫情暴发期间不同水平急性应激反应与同伴欺凌行为的关联。  结果  新冠肺炎疫情常态化管理时期中学生同伴欺凌行为报告率为65.8%, 遭受他人欺凌和欺凌他人的报告率分别为63.8%和27.1%;遭受他人言语欺凌报告率最高(54.8%), 对他人网络欺凌报告率最低(4.6%)。疫情期间中学生急性应激反应得分为(6.50±1.67)分。除躯体欺凌他人外, 其他类型欺凌他人与遭受他人欺凌行为报告率在高水平应激反应组均最高, 差异均有统计学意义(P值均 < 0.05)。多因素Logistic回归模型显示, 调整相关混杂因素后, 高水平急性应激反应与中学生遭受言语欺凌(OR=1.38)、关系欺凌(OR=2.28)、躯体欺凌(OR=1.87)和网络欺凌(OR=2.30)风险增加相关, 高水平急性应激反应组中学生言语(OR=1.80)、关系(OR=1.99)、躯体(OR=1.76)和网络(OR=2.32)欺凌他人的风险均高于低水平急性应激反应组(P值均 < 0.05)。  结论  中学生高水平急性应激反应与不同类型同伴欺凌行为之间均存在关联, 且与网络欺凌的关联性较强。