上海市浦东新区妇女绝经年龄及行经年限调查与影响因素分析

Objective To investigate natural spontaneous menopausal age , menstruation span and their relationship with menarche age and parity in Pudong district of Shanghai. Methods From Jan 2007 to Jul 2008, 15 083 spontaneous menopause women undergoing cervical cancer screening were enrolled in this study. The questionnaire included menarche age, parity, spontaneous menopausal age and menstruation span. Those women were divided into four groups based on age, which were group of 56 -60, 61 -65, 66 -70 and more than 70. Analysis of variance (ANOVA) was used for comparing difference between menopausal age and menstruation span. Multiple factor regressions was used to analyze the relationship between menarche age, parity and menopausal age and menstruation span. Results (1) Spontaneous menopausal age: the minimum was 29 years old, the maximum was 61 years old, and the mean age was (50.6 ±3.7)years old. The mean spontaneous menopause age were (50.9 ± 3.4), ( 50.7 ± 3.7 ), (50.0 ± 4.1 ), (49.6 ±4.0) years in groups of 56 -60, 61 -65, 66 -70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menopausal age were observed, which the difference of 1.36 year was shown between groups of 56 - 60 and more than 70 years. (2) Menstruation span: the mean of menstruation span was (34.3 ± 4.1 ) years, which the minimal age of 12 years and maximal age of 48 years were recorded. (34.6 ± 3.8), (34.3 ± 4.1 ), (33.9 ± 4.6), (33.2 ± 4. 5) were observed in groups of 56 - 60,61 -65, 66 -70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menstruation span were observed, which the difference of 1.41 year was shown between groups of 56 –60 and more than 70 years. (3)The impact of menarche age on menopausal age and menstruation span: there was no correlation between menarche age and menopausal age ( r = 0.02); however, menstruation span was found to be negatively correlated with the menarche age ( r = - 0.43 ). (4) The impact of parity on menopausal age and menstruation span: the mean menopausal age of women who had 1 -2 deliveries was significantly higher than those had no delivery or more than 3 deliveries ( P < 0.05 ). However, there was no difference in menopausal age between women with 1 and 2 deliveries or between women without delivery and more than 3 deliveries (P > 0.05). Menstruation span of women with 1 delivery was significantly longer that those with more than 1 delivery( P < 0.05 ), similarly, women with 2 deliveries had longer menstruation span than women without delivery or more than 3 deliveries(P < 0.05 ). There were no difference in menstruation span between women with more than 3 deliveries and without delivery ( P >0.05 ). (5) Multifactor regression analysis for menstruation span: menarche age was correlated with menstruation span negatively ( r = - 0.97,P <0.001 ). There was significantly different menstruation span between group of 61 -65, 66 -70 or more than 70 years and group of 56-60 (r= -0. 18, P=0.020; r= -0.78,P <0.001 and r= - 1.23,P<0.001). Menstruation span in women with 1 -2 deliveries was significantly longer than that of women without delivery or more than 3 deliveries. (6)Multifactor logistic analysis of menopausal age: there was no association between menarche age and menopausal age, however, significant differences were found in mean menopausal age between different groups, which show that menopausal age of group 56 - 60 years was significant higher than the other groups, including age-group 61 -65 years ,66 -70 years and over 70 years ( r = - 0.18, P = 0.020; r = - 0.78,P < 0.001; r = - 1.23, P < 0.001 ). Menopausal age in women with 1 - 2 deliveries was significantly higher than those of women without delivery or with more than 3 deliveries,however, no difference between women with 1 and 2 deliveries or between women without deliveries and more than 3 deliveries was observed. Conclusion (1) Menopausal age and menstruation span exhibited increasing trends in Pudong district of Shanghai. (2) Menarche age and parity were the important factors influencing menopausal age and menstruation span. (3) With younger age of menarche, the menstruation span become longer. (4) Deliveries of 1 -2 times can significantly delay the menopause and prolong menstruation span, however, the multiple deliveries ( ≥ 3 times) had no significant impact on menopausal age and menstruation span.     

剖宫产后早孕药物流产加服米非司酮的临床观察

目的:探讨剖宫产后早孕药物流产加服米非司酮是否能提高完全流产率。方法:剖宫产后再次妊娠(停经≤49 d)行药物流产的孕妇240例,随机分为研究组和对照组。对照组120例,米非司酮75 mg/d(早50 mg,晚25 mg)连用2 d,第3日口服米索前列醇600μg;研究组120例,在对照组的基础上,服用米索前列醇后加服米非司酮25 mg,bid×3 d。结果:研究组和对照组的完全流产率分别为92.50%和73.33%,差异有统计学意义(P<0.01),阴道流血时间分别为11.0±4.0 d和14.7±5.4 d,差异有统计学意义(P<0.01)。结论:剖宫产后早孕药物流产加服米非司酮25 mg,bid×3 d,可提高完全流产率,缩短阴道流血时间。     

KAI1转移抑制蛋白在宫颈鳞癌中的表达

目的　探讨宫颈鳞癌中KAI1蛋白的表达与宫颈癌病理特征和侵袭转移的关系。方法　采用免疫组织化学SABC法检测12 0例石蜡切片KAI1蛋白表达,宫颈上皮内瘤样病变(CIN)组3 0例,宫颈癌组45例,其中正常宫颈对照组45例。结果　1)在正常宫颈组织,CIN及宫颈癌中KAI1表达阳性率分别为95 .5 6% ,93 .3 3 % ,64 .44 % ,宫颈癌组与前两组差异有显著意义(P <0 .0 5 ) ;2 )KAI1蛋白表达在宫颈鳞癌高、中、低分化组阳性表达率分别为76.47%、66.67%和2 8.5 7% ,三组间差异有显著意义(P <0 .0 5 )。KAI1表达强度与分化程度呈负相关(r =-0 .3 49,P <0 .0 1) ;3 ) ,KAI1蛋白在临床分期≤ⅡA期、ⅡB期、Ⅲ/Ⅳ期表达阳性率分别为78.95 %、70 .5 9%和2 2 .2 2 % ,各期间差异有显著意义(P <0 .0 5 )。KAI1蛋白表达强度与临床分期呈负相关(r =-0 .5 75 ,P <0 .0 1) ;4)KAI1蛋白表达在未转移中的阳性率79.3 1%明显高于淋巴转移组3 7.5 0 % ,差异有显著意义(P <0 .0 5 )。结论　KAI1蛋白与宫颈癌的发展密切相关,有可能从一定程度上预测宫颈癌侵袭转移的潜能。     

p53基因突变对预测葡萄胎恶变的初步研究

随着人们对肿瘤分子生物学认识的不断深入 ,已知癌基因的激活和抑癌基因的失活对肿瘤的发生发展起重要作用。ｐ5 3基因是一种肿瘤抑制基因 ,在肝癌、肺癌、乳腺癌、胃癌、卵巢癌等肿瘤中有突变失活[1] 。而在葡萄胎组织中ｐ5 3基因突变与恶变的关系研究较少 ,尚无定论。本研究采用聚合酶链反应 单链构象多态分析 (ＰＣＲ ＳＳＣＰ)技术检测葡萄胎组织中ｐ5 3基因第 5～ 8外显子突变情况 ,并结合患者的临床随访结果进行初步研究。现报道如下。一、资料与方法1.资料来源与分组 :收集 1992～ 1996年在我院住院清宫的葡萄胎患者 2 0例 ,根据 2…     

图像分析检测滋养细胞瘤嗜银蛋白的临床意义

本文选取妊娠滋养细胞肿瘤石蜡包埋的组织块１００例，共分５组：（１）正常绒毛（对照组）２０例；（２）葡萄胎未恶变组４０例；（３）葡萄胎恶变组４０例；（４）恶性葡萄胎１０例；（５）绒毛膜癌组１０例。上述组织切片先按Ｐｌｏｔｏｎ’ｓ法行核仁组成区银染。再用图像分析法行核仁组成区嗜银蛋白颗粒计数和面积测量，两者结果均显著：组２高于组１（ｐ〈０．００１），组３高于组２（ｐ〈０．００１），组４高于组３（ｐ〈０     

妊娠中期疤痕子宫破裂2例报告

随着剖宫产率的升高,疤痕子宫破裂的发生率也越来越高。疤痕子宫妊娠破裂大多发生于分娩期和妊娠末期,发生于妊娠中期罕见。本院2004年1月至2013年12月收治2例中期妊娠疤痕子宫破裂患者,由于诊断和处理及时,抢救成功。报告如下。     

清热解毒制剂宫颈用药对HPV感染者局部免疫因子变化的影响

目的:观察清热解毒制剂宫颈用药对人乳头状瘤病毒(HPV)感染者的临床疗效及对局部免疫因子的影响。方法:将高危型人乳头状瘤病毒(HR-HPV)持续感染而无宫颈组织学病变患者100例随机分为治疗组和对照组,治疗组以中药清热解毒制剂宫颈局部上药处理,对照组仅随访观察。采用酶联免疫法(ELISA)测定入组时及随访6、12个月时两组患者宫颈局部环境中γ-干扰素(IFN-γ)及白介素-4(IL-4)的水平;随访6、12个月复查HR-HPV及宫颈液基细胞(TCT),以HPV清除率为指标评价临床疗效。结果:与入组时比较,随访期间两组患者宫颈局部环境中IFN-γ水平均明显升高,IL-4水平均明显下降,IFN-γ/IL-4均明显升高(P0.01),其中治疗组各指标与对照组同期比较均有显著性差异(P0.05或P0.01);在随访期间,治疗组6个月时的HPV转阴率明显高于对照组(P0.01),随访12个月时治疗组仍优于对照组(P0.05)。在随访6和12个月时,HPV清除者的IFN-γ水平和IFN-γ/IL-4均明显高于未清除者(P0.01),而IL-4的水平明显低于未清除者(P0.01);所有患者在治疗过程中均无严重不良反应。结论:清热解毒制剂宫颈局部上药可清除HPV感染,且安全有效;其作用可能与上调IFN-γ表达、下调IL-4表达,扭转IFN-γ/IL-4比值有关。     

上海浦东新区56 924例妇女月经初潮年龄调查

目的 调查上海浦东新区妇女的月经初潮年龄.方法 对参加2007年1月至2008年7月上海浦东新区宫颈癌筛查的、年龄在20～81岁的56 924例妇女,进行月经初潮年龄的问卷调查.被调查妇女按每5岁1个年龄段,从≤25岁开始,到＞75岁,分为12个年龄组;初潮年龄按每1岁记录从最小初潮年龄开始,1岁1组,连续记录到＞20岁,分为12组.采用方差分析方法比较各组平均初潮年龄;采用χ2检验分析并计算各组10～12岁和＞18岁初潮者的百分率.结果 (1)被调查妇女最早初潮年龄为10岁,最晚初潮年龄为28岁,平均初潮年龄为15.7岁.26～30岁年龄组平均初潮年龄为14.6岁,随着年龄的增加,初潮年龄也旱增大趋势,＞75岁组平均初潮年龄最大,为16.5岁,不同年龄组妇女平均初潮年龄比较,差异有统计学意义(P＜0.01).(2)10～12岁初潮者占总人数的1.82%(1034/56 924).31～35岁组中10～12岁初潮者比例最高,为4.45%(197/4431);随着年龄的增加,10～12岁初潮者比例呈降低趋势,71～75岁组中,10～12岁初潮者比例最低,为0.84%(10/1191);各年龄组10～12岁初潮者比例比较,差异有统计学意义(P＜0.01).＞18岁初潮者占总人数的5.20%(2959/56 924),31～35岁组＞18岁初潮者比例最低,为0.38%(17/4431);随着年龄的增加,＞18岁初潮者比例呈升高趋势,＞75岁组中,初潮年龄＞18岁者的比例最高,为14.70%(91/619);各年龄组＞18岁初潮者比例比较,差异有统计学意义(P＜0.01).结论 上海浦东新区20～81岁妇女平均初潮年龄随着年龄的年轻化呈提前趋势,并且10～12岁初潮者比例相应增多,＞18岁初潮者比例呈逐渐降低趋势.     

HPV16感染患者外周血中Treg/Th17细胞平衡偏移的表达意义

目的探讨HPV16感染患者外周血中Treg/Th17细胞平衡偏移的表达意义,为HPV的细胞免疫治疗提供参考依据。方法选取上海市浦东新区人民医院2014年8月-2017年1月门诊或住院部宫颈细胞学正常,HPV阴性或单一HPV16阳性患者为研究对象,采用宫颈TCT对所有研究对象进行细胞学检测,反向斑点杂交技术进行HPV亚型分析及实时荧光PCR(RTPCR)进行HPV16 DNA定量;采用流式细胞术检测外周血单个核细胞(PBMC)中Th17细胞及Treg细胞的表达频率。上述试验每3个月重复1次。按照HPV16感染结局的不同,将研究对象分为三组:第一组为HPV阴性组,即连续1年检测HPV均为阴性;第二组为HPV16阳性,但在1年内HPV逐渐被清除,简称HPV16感染清除组;第三组为HPV16阳性,但在1年后HPV16持续存在,简称HPV16感染持续组。结果与HPV阴性组对照相比,HPV16阳性患者Treg/Th17平衡表达向Th17明显偏移,差异有统计学意义(P0.05);在HPV16感染持续组Treg/Th17平衡表达向Th17持续偏移,而HPV16感染清除组Treg/Th17平衡表达由初始感染时的向Th17偏移逐渐转向Treg偏移,HPV感染转阴时Treg/Th17平衡以Treg细胞占优势。结论 Treg/Th17细胞平衡由向Th17偏移转为向Treg偏移可能预示着HPV16病毒的逐渐清除,同时如果持续性向Th17偏移则可能预示着HPV16的持续性感染。