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.     

卵巢癌伴腹水术前化疗的作用

盆腔肿块伴腹水是卵巢癌患者就诊的常见临床表现,是否采用术前化疗尚无定论。我院自1993年起采用先化疗后手术的方法治疗卵巢癌伴腹水患者共18例,疗效较好,现报道如下。材料与方法一　病例选择　自1993年1月—1998年5月间在本院就诊的卵巢癌伴腹水患者共18例,年龄33—70岁,平均(5633±1072)岁。妇科检查及Ｂ超证实有肿块伴中至大量腹水,腹水脱落细胞检查找到恶性细胞。术后临床分期(1985年ＦＩＧＯ标准):Ⅰ期2例,Ⅲ期7例,Ⅳ期5例,转移性癌4例。病理诊断:浆液性腺癌9例,内膜样癌3例,粘液性癌1例,浆液性及内膜样癌1例,转移性癌4例。二　治疗方…     

激素对女性生殖道组织Hox基因表达的调控

同源框基因(Homeobox gene,Hox gene)是胚胎发育过程中编码对尿殖管、外生殖管分化发育有重要意义的一系列转录因子.该轴打开的时间及模式可决定副中肾管的发育过程,而激素是Hox基因正常的表达调控者.雌、孕激素及其受体可直接与Hox基因中雌激素受体和孕激素受体结合位点结合而调控Hox基因的表达;此外,孕激素还对内膜腺上皮Hox基因通过间质细胞介导起负调控作用;雄激素可通过雄激素受体介导机制调节Hox基因的表达;维生素D则通过与受体蛋白结合DNA结合蛋白在蛋白基因水平上起作用.     

妊娠期卵巢恶性生殖细胞肿瘤的治疗

卵巢恶性生殖细胞肿瘤多发生于年轻女性，甚至幼女。一般卵巢恶性生殖细胞肿瘤生长迅速，易早期转移，预后差。年轻女性正处于生育阶段，临床上常出现卵巢恶性生殖细胞肿瘤合并妊娠的情况。目前卵巢恶性生殖细胞肿瘤常采取单侧附件切除加术后辅助化疗，但妊娠期化疗对胎儿存在潜在威胁。目前卵巢恶性生殖细胞肿瘤合并妊娠的处理尚缺乏大样本的治疗学研究，相关文献比较分散，该综述总结这些分散的文献，希望找出治疗上的规律性，供临床处理上的参考。     

妇科肿瘤化疗的新药及进展

近２０年来，虽然许多药物已被证实为治疗妇科肿瘤的有效药物，但仍未能有效地提高病人的生存率。因此，各国学者在已有基础上不断开发出更为有效，毒副作用更少的新药。有的新药已投入市场，有的已在进一步研究其应用价值。     

促卵泡激素通过活性氧途径调控卵巢癌细胞Nrf2蛋白的表达

目的 通过观察促卵泡激素(FSH)、活性氧(ROS)及其特异性抑制剂对卵巢癌细胞中红系衍生的核因子2相关因子2(nuclear factor-erythroid 2-related factor-2,Nrf2)表达的影响,探讨FSH是否通过ROS途径调控卵巢癌细胞Nrf2的表达.方法 (1)采用免疫组织化学方法检测Nrf2在卵巢癌良恶性组织中的表达.(2)用不同浓度的FSH刺激卵巢癌Hey细胞不同时间,采用蛋白质印迹法检测细胞内Nrf2蛋白的表达.(3)采用ROS检测试剂盒检测80 mIU/ml的FSH刺激后不同时间Hey细胞内ROS的生成情况.(4)Hey细胞经不同浓度的H2O2刺激48 h后,或经ROS特异性抑制剂N-乙酰半胱氨酸(NAC)预处理后加入150 mmol/L的H2O2处理48 h,观察细胞内Nrf2的表达.(5)Hey细胞经不同浓度的NAC预处理1h,加入80 mIU/ml的FSH共孵育48 h,观察细胞内Nrf2表达的变化.结果 (1)10例良性卵巢囊肿组织中仅3例有Nrf2蛋白的弱阳性表达,而64例卵巢癌组织中42例(65.6％)有Nrf2蛋白的阳性表达,两组差异有统计学意义(P=0.042).(2)FSH可上调Hey细胞内Nrf2的表达,并呈一定的剂量、时间依赖效应.(3) FSH可促进Hey细胞ROS的产生.(4) H2O2可诱导Hey细胞Nrf2蛋白的表达,且其作用可被NAC阻断.(5)NAC可阻断FSH所诱导的Nrf2蛋白的表达.结论 FSH可促进卵巢癌Hey细胞中ROS产生,上调Nrf2蛋白表达,抑制ROS途径可阻断FSH诱导的Nrf2高表达.提示FSH可能通过ROS途径调控卵巢癌Nrf2的表达,进而促进肿瘤发生.     

宫颈癌合并妊娠

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未肯定恶性潜能的子宫平滑肌肿瘤

子宫平滑肌肿瘤是最常见的良性肿瘤 ,通常情况下诊断和处理并无困难。但有的情况下 ,子宫平滑肌肿瘤又是最难诊断的肿瘤并会带来相关的处理问题。导致子宫平滑肌肿瘤诊断困难有如下三方面因素 :①通常的组织相中 ,因细胞较为丰富 (富于细胞性平滑肌瘤 )、肿瘤细胞多形性改变 (奇怪性平滑肌瘤 )、核分裂较多 (核分裂活跃的平滑肌瘤 )或以上的综合因素 ,导致和平滑肌肉瘤鉴别诊断困难 ;②平滑肌肿瘤具有良性的形态学外观 ,但存在特殊生长方式 ,包括 :弥漫性平滑肌瘤病 (diffuseleiomyomatosis)、伴血管浸润的平滑肌瘤 (leiomyomawithvasculari…