体外受精-胚胎移植术后宫角妊娠合并宫腔粘连1例病例报告与文献回顾

目的介绍1例行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)、出现宫角妊娠合并宫腔粘连并成功活产的病例。方法对本院1例重度宫腔粘连分解术后行IVF-ET病例发生宫角妊娠合并宫腔粘连的临床资料进行分析,并对相关文献进行系统性回顾。结果该病例于孕36+3周行子宫下段剖宫产术,成功活产一男婴。结论宫角妊娠是可能危及生命的妇产科急症,但对于妊娠困难的患者,严密监测及期待治疗可获得良好的妊娠结局。     

人胎盘滋养层细胞体外感染HCMV后的生物学特性变化

目的探讨人胎盘滋养层细胞（以下简称滋养细胞）感染人巨细胞病毒（HCMV）后生物学特性改变及意义。方法采用复合酶消化法及Pereoll密度梯度离心法分离纯化、培养人滋养细胞;采用HCMV AD169病毒感染滋养细胞,检测不同时间点病毒复制情况和细胞凋亡率。结果HCMV感染滋养细胞后快速复制,24—72h复制速度减慢;感染HCMV的滋养细胞凋亡率（34．68％±3．14％）明显高于未感染HCMV者（15．32％±2．34％）,P〈0．05.结论HCMV感染滋养细胞具有早期快速复制的特点,可导致滋养层细胞在感染早期加速凋亡。     

ADAMTS-1在排卵过程中的作用与调控

ADAMTS-1是一个新发现的金属蛋白酶ADAMTS（adisintegrin and metalloprotease with thrombospondin type 1 motif）家族的一员。排卵时ADAMTS-1在卵巢颗粒细胞层的转录活性明显增强，并且其转录活性的增强依赖于黄体生成素（1uteinizing hormone，LH）峰值的出现和孕激素受体（progesterone receptor，PR）的表达，孕激素受体基因敲除小鼠（PRKO小鼠）卵巢局部ADAMTS-1表达显著下降，有明显的排卵障碍，提示：ADAMTS-1是PR的直接下游靶基因，可能是LH和P（PR）作用下诱导排卵的关键蛋白水解酶。     

Association of controlled ovarian hyperstimulation treatment with down-regulation of key regulators involved in embryonic implantation in mice

The debate exists whether or not gonadotropin-releasing hormone(GnRH) analogs used in controlled ovarian hyperstimulation(COH) impair endometrial receptivity.Homeobox A11(Hoxa11),Meis homeobox 1(Meis1),cadherin 1(Cdh1),and catenin beta 1(Ctnnb1) are well known to be involved in successful implantation.In this study,the endometrial expression of Hoxa11,Meis1,Cdh1,and Ctnnb1 during the peri-implantation period was investigated in an in vitro fertilization(IVF) mouse model by real-time RT-PCR and Western blot to evaluate the relationship between Hoxa11,Meis1,Cdh1,and Ctnnb1 expression and the impact of the COH on endometrial receptivity.The mimic COH protocols included GnRH agonist plus human menopausal gonadotropin(HMG)(GnRH agonist group),GnRH antagonist plus HMG(GnRH antagonist group),and HMG alone(HMG group).The expression levels of Hoxa11,Meis1,Cdh1,and Ctnnb1 mRNA and protein were decreased in all of the COH groups.The expression levels of Hoxa11 and Ctnnb1 were the lowest in the GnRH agonist group,and those of Meis1 and Cdh1 were lower in the GnRH analog groups than the HMG group.There were positive correlations between the expression of Hoxa11 and Ctnnb1,as well as the expression of Meis1 and Cdh1 among all the groups.In conclusion,the COH protocols,particularly with GnRH analogs,suppressed Hoxa11,Meis1,Ctnnb1 and Cdh1 expression,in mouse endometrium during the peri-implantation period.Our data reveal a novel molecular mechanism by which the COH protocols might impair endometrial receptivity.     

足月妊娠伴自发性卵巢过度刺激综合征1例

目的:报道1例自然妊娠合并自发性卵巢过度刺激综合征(sOHSS)病例。方法:回顾性分析我院1例自然妊娠合并sOHSS患者的临床资料,并复习相关文献。结果:该患者于孕39周行子宫下段剖宫产术,同时行双侧卵巢楔形切除术+双侧卵巢打孔术。术中快速病理检查及术后常规病理检查结果示双侧卵巢黄素化囊肿。术后患者双侧卵巢迅速恢复正常。最终诊断为妊娠合并sOHSS。结论:妇产科医生需对sOHSS有充分的认识,需与卵巢肿瘤性疾病进行鉴别,以免因误诊而采取不适当的治疗。     

冻融胚胎复苏后移植时间对妊娠结局的影响

目的:探讨冻融胚胎移植周期优质胚胎体外培养时间对妊娠结局的影响。方法:以复苏后优质胚胎为研究对象,对416例接受冻融胚胎移植周期(FET)的患者进行回顾性分析。其中188例复苏后2～3 h移植(D3-ET)为对照组,228例复苏后24 h移植(D4-ET)为实验组。结果:实验组的临床妊娠率(49.56%,113/228)高于对照组的临床妊娠率(39.89%,75/188),差异有统计学意义(P<0.05);实验组的着床率(30.92%,141/456)明显高于对照组的着床率(23.94%,90/376),差异有统计学意义(P<0.05);实验组的流产率(3.95%,9/228)低于对照组(5.32%,10/188),但差异无统计学意义(P>0.05)。结论:复苏后延长体外培养时间可以更好地观察胚胎的发育潜能、改善妊娠结局。     

输卵管积水及其积水处理对体外受精及胚胎移植的影响

目的探讨输卵管积水以及因输卵管积水不孕腹腔镜下处理输卵管对体外授精-胚胎移植(in votro fertilization and embryo transfer,IVF-ET)结局的影响。方法 2006年3月至2009年3月于华中科技大学同济医学院附属同济医院生殖中心,选择双侧输卵管切除或离断术后行IVF-ET77例为积水处理组,同期年龄匹配的双侧输卵管积水未处理直接行IVF-ET78例为积水组,双侧输卵管近端梗阻且无积水,直接行IVF-ET80例为近端梗阻组。结果 (1)三组患者的年龄、不孕年限等一般临床指标比较差异均无统计学意义(P>0.05)。(2)积水组的新鲜妊娠率和活产分娩率明显比积水处理组以及近端梗阻组低(P<0.05),异位妊娠率却大大增高(P<0.05)。(3)积水处理组内处理输卵管前后行IVF-ET,各相关指标比较差异均无统计学意义(P>0.05),但积水处理后妊娠率明显提高。结论输卵管积水降低了IVF-ET的新鲜妊娠率和活产分娩率,并且增加了异位妊娠的发生,而IVF-ET前处理输卵管积水并未影响卵巢功能,同时可能提高妊娠率、减少不良妊娠结局。     

超排卵中卵泡发育不均匀不同处理方法的临床观察

目的:研究长方案超排卵中卵泡发育不均匀两种不同处理方法及其临床结局。方法:回顾性分析IVF/ICSI超排卵中出现优势卵泡的251例患者,按不同处理方法分为三组:A组(穿刺优势卵泡组)103例,B组(加大GnRH-a剂量组)92例,C组(对照组)56例。比较三组获卵数、可利用胚胎数、妊娠率、活产率等指标。结果:A组获卵数和成熟卵数高于C组(P<0.05);A组和B组成熟卵比率、受精率、可用胚胎数均显著高于C组(P<0.05),妊娠率、活产率和累计妊娠率、累计活产率高于C组,但无统计学差异。而A组与B组相比,优势卵泡与次级大卵泡的直径差异大,Gn天数长,GnRH-a用量小,但临床结局相似。结论:处理卵泡发育不均匀,优势卵泡穿刺和加大GnRH-a剂量治疗均有效,当主导卵泡和次级大卵泡的直径差异相对较小时,采用加大GnRH-a剂量较合理;而差异较大时,采用优势卵泡穿刺术更佳。     

Correlation between physical status of human papilloma virus and cervical carcinogenesis

The prevalence of human papilloma virus (HPV)-16 in patients with cervical cancer,the physical status of HPV-16 in patients with cervical lesions,and the role of HPV-16 integration in cervi-cal carcinogenesis were investigated.HPV genotyping was performed by using PCR approach with the primer GP5+/GP6+ and type-specific primer on biopsy specimens taken operatively from 198 women.Multiple PCR was done to detect physical status of HPV-16 in a series of cervical liquid-based cytology samples and biopsy specimens obtained from different cervical lesions with HPV-16 infection,includ-ing 112 specimens with cervical cancer,151 specimens with CINⅠ,246 specimens with CINⅡ and 120 specimens with CINⅢ.The results showed that there were 112 cervical cancer samples (56.57% of total cervical cancer patients) with HPV-16 infection.The frequency of HPV-16 pure integration was 65.18% (73/112),56.57% (47/120),23.58% (58/246) and 7.95% (12/151) in cervical cancer,CINⅢ,CINⅡand CINⅠ patients respectively.In situ hybridization was performed on some paraffin-embedded sections of CINⅡ,CINⅢ and cervical cancer to verify the physical status of HPV-16 infection.Sig-nificant difference was observed between cervical cancer and CINⅠ,CINⅡ,CINⅢ in the frequency of HPV-16 integration (P<0.01).It is suggested that HPV-16 is the most prevalent type and is associated with cervical cancer.In the case of HPV-16 infection there are close associations between the severity of cervical lesions and the frequency of HPV-16 integration.The application of testing HPV genotyping and physical status based on detection of HC-Ⅱ HPV DNA would be in favor of predicting the progno-sis of cervical precancerosis and enhancing the screening accuracy of cervical cancer.     

多囊卵巢综合征不孕妇女助孕时机与助孕方式选择

多囊卵巢综合征(polycystic ovary syndrome, PCOS)是最常见的导致排卵障碍性不孕症的原因。对于PCOS患者,助孕方法有很多种,主要包括：改变生活方式、胰岛素增敏剂、选择性雌激素受体拮抗剂、芳香化酶抑制剂、促性腺激素、腹腔镜卵巢打孔以及辅助生殖技术等。这些方法的作用机制、适用范围各不相同,各有优缺点。该文就多囊卵巢综合征不孕妇女助孕时机与助孕方式选择做一阐述。