不孕不育夫妇生殖道解脲支原体、沙眼衣原体感染及抗精子抗体、抗子宫内膜抗体关系探讨

目的探讨不孕不育夫妇生殖道解脲支原体（UU）、沙眼衣原体（CT）感染及抗精子抗体（AsAb）、抗子宫内膜抗体（EMAb）间的关系。方法采用PCR荧光定量法对120对不孕不育夫妇进行生殖道分泌物UU、CT检测,与对照组比较,同时采用酶联免疫法（ELISA）对不孕不育夫妇血清中AsAb和EMAb进行检测,分析比较感染组与未感染组AsAb和EMAb阳性率。结果120对不孕不育患夫妇中,男性：UU感染率为25．8％、CT感染率为24．2％,UU与CT混合感染率为10．0％,与对照组男性比较差异有统计学意义P〈0．05,女性：UU感染率为33．3％。CT感染率为26．7％,UU与CT混合感染率为11．7％,与对照组女性比较差异均有统计学意义P〈0．05。在不孕不育夫妇感染组中,AsAb阳性率为32．3％,与未感染组比较差异有高度显著性P〈0．01,EMAb阳性率为10．8％,与未感染组比较差异有统计学意义P〈0．05。结论生殖道UU、CT感染是造成不孕不育的原因之一,AsAb、EMAb的产生与生殖道UU、CT感染有关。     

微柱凝胶法检测疾病对ABO血型抗原的影响及血清学特性分析

目的：探讨疾病对ABO血型抗原性的影响及其血清学特性分析。方法：应用微柱凝胶法、单克隆抗体血型分型试剂和RBC试剂，对100例患者和30例献血员的RBC（检测抗原）和血清（检测抗体）进行正反定型，测定血型抗原性和抗体效价。对血型抗原性极度减弱导致血型鉴定困难的患者血液，进行吸收放散、血型物质测定、不规则抗体筛选和抗球蛋白试验。结果：100例患者中血型抗原性减弱者占24％，其中自血病患者占40％（12／30），恶性肿瘤患者占36．67％（11／30），其他疾病患者占2．50％（1／40）。抗原性减弱在ABO血型中的分布：A型为40．48（17／42），B型为16．67％（5／30），O型为7．14％（2／28）；献血员血型抗原性减弱者为3．33％（1／30）。100例患者中血清血型抗体效价降低者2％，献血员血清血型抗体效价降低者为0％。结论：白血病和恶性肿瘤对血型抗原性的影响较其他疾病大，患者ABO血型抗原性减弱正定型时容易导致血型误判，但其血清中仍存在着规则的抗A或抗B抗体，唾液中含有血型物质，应用微柱凝胶法进行正反定型，同时进行吸收放散试验和血型物质的测定，能提高血型检测的准确性.     

胃肠道癌患者血清中抗胚抗原（CEA）抗体的检测及意义

目的：探讨循环中抗癌胚抗原（CEA）特异性抗体的情况，评价CEA及抗体的联合检测在胃肠道癌诊断中的作用。方法：用放免法检测血清中CEA含量，用酶联免疫吸附法（ELISA）检测抗CEAIgG抗体，用竞争抑制法检测抗体的特异性。结果；胃肠疲乏癌患者血清CEA含量高者（≥15ng/ml）为30．9％（21／68），抗CEAIgG抗体阳性者为35．3％（24／68），CEA及抗CEA抗体的联合检测可使阳性率提高到54．3％（37／68）；胃肠道良性疾病患者（多发性息肉、溃疡、胰腺炎等）血清CEA升高者为3．3％（1／30）；抗CEAIgG抗体阳性者为3．3％（1／30）；健康对照缓血清CEA升高者为0，抗CEAIgG抗体阳性者为2．5％（1／40）。结论：胃肠道癌患者血清中抗癌胚还原（CEA）抗体的检出率较高，这些抗体可作为胃肠道癌的一种肿瘤标志物。     

免疫斑点法检测抗精抗体的建立及其与ELISA法比较

目的建立检测抗精抗体的免疫斑点法，并与ELISA法进行比较。方法收集20份正常精液，混合，洗涤，混悬于0．5％NP-40 Tris—HCI缓冲液中，制备精予膜抗原，辣根过氧化物酶标记SPA，制备HRP—SPA，建立免疫斑点法检测抗精抗体，并对两种方法检测结果进行比较。结果免疫斑点法检测正常生育组30对夫妇共60例，其中阳性者1例为男性，阳性率为3．3％；检测不孕夫妇116对，共232例，阳性患者51例，阳性率为22．0％，其中男方占23例，阳性率为19．8％，女方占28例，阳性率为24．1％；检测习惯性流产夫妇53对，共106例，阳性患者16例，阳性率为15．1％，其中男方占2例，阳性率为3．8％，女方占14例，阳性率为26．4％。两种方法检测结果一致或差异不显著。结论免疫斑点法是一种比较稳定和敏感的方法，重复性、特异性好，结果易于判断，可应用于临床检验。     

胃肠道癌患者血清中抗癌胚抗原(CEA)抗体的检测及意义

目的：探讨循环中抗癌胚抗原（ＣＥＡ）特异性抗体的情况，评价ＣＥＡ及抗体的联合检测在胃肠道癌诊断中的作用。方法：用放免法检测血清中 ＣＥＡ含量，用酶联免疫吸附法（ＥＬＩＳＡ）检测抗 ＣＥＡ ＩｇＧ抗体，用竞争抑制法检测抗体的特异性。结果：胃肠道癌患者血清 ＣＥＡ含量升高者（≥１５ ｎｇ／ｍｌ）为 ３０．９％（２１／６８），抗 ＣＥＡ ＩｇＧ抗体阳性者为３５．３％（２４／６８），ＣＦＡ及抗 ＣＥＡ抗体的联合检测可使阳性率提高到５４．３％（３７／６８）；胃肠道良性疾病患者（多发性息肉、溃疡、胰腺炎等）血清ＣＥＡ升高者为３．３％（１／３０），抗 ＣＥＡ　ＩｇＧ抗体阳性者为 ３．３％（１／３０）；健康对照组血清 ＣＥＡ升高者为 ０，抗 ＣＥＡ ＩｇＧ抗体阳性者为 ２．５％（１／４０）。结论：胃肠道癌患者血清中抗癌胚抗原（ＣＥＡ）抗体的检出率较高，这些抗体可作为胃肠道癌的一种肿瘤标志物。     

类风湿关节炎患者RA33／36抗体,角质蛋白抗体及抗核 …

目的 对类风湿关节炎（ＲＡ）患者血清中的ＲＡ３３／３６抗体，角质蛋白抗体（ＡＫＡ）及抗核周因子（ＡＰＦ）进行检测，并对这些抗体间的相关性进行探讨。方法 采用免疫印迹法检测血清ＲＡ３３／３６抗体；采用ＩＩＦ法检测ＡＫＡ及ＡＰＦ抗体；采用卡方检验及Ｆｉｓｈｅｒ＇ｓ检验对结果进行统计学比较。结果 ＲＡ患者血清中ＲＡ３３／３６抗体阳性率为３５．６％（１６／４５），ＡＫＡ（１：８０）阳性率为３１．１％（１４     

抗结核LAM、16KD、38KD抗体检测对妊娠结核感染诊断价值评估

目的 探讨抗结核LAM、16KD、38KD抗体检测对妊娠期结核感染诊断价值。方法 采用结核分枝杆菌IgG抗体检测试剂盒（蛋白芯片）检测妊娠结核感染及非结核感染患者的抗LAM、16KD及38KD抗体。结果 21例妊娠结核组LAM、16KD、38KD抗体阳性率（敏感性）分别为81％、76．2％、76．2％，而非结核组（26例）阳性率只有3．9％、7.7％、3．9％，特异性在92％以上。结核组两种和三种抗体阳性率（敏感性）分别为57．2％、52．4％，而非结核组阳性率均为“0”，特异性100％，两组比较差异性有显著性。结论 抗结核LAM、16KD、38KD抗体在妊娠结核病中有较高的敏感性，联合检测抗LAM、16KD、38KD抗体特异性高，方法快速简单，对妊娠结核病诊断有较高的实用价值     

检测日本血吸虫感染者血清中特异性IgG4的诊断价值

为评价日本血吸虫感染者血清中特异性IgG4的诊断和疗效价值,本研究以SEA为抗原,胶体金．抗人IgG4单抗结合物为检测标记物,以金标免疫渗滤法（DIGFA）检测急性和慢性血吸虫病患者治疗前后血清中特异性IgG4抗体。结果显示,急性和慢性血吸虫病病人血清中IgG4阳性率分别为90．9％（30／33）和98．0％（98／100）;检测非疫区健康者血清及其他寄生虫（包括肺吸虫、华支睾吸虫、囊虫等）感染者血清共235人份,未有阳性出现（特异性为100％）;检测急性血吸虫病病人治疗后6个月和12个月血清,IgG4抗体的阴转率分别为52．0％（13／25）和87．5％（21／24）,均明显高于IgG阴转率;检测血吸虫病病人治后6个月血清,慢性病人与急性病人IgG4抗体阴转率无差异。结果表明DIGFA法检测病人血清特异性IgG4诊断血吸虫病敏感性高,与IgG相比有更高的特异性,具有一定的疗效考核价值。     

应用双抗原夹心ELISA法筛查献血员梅毒螺旋体抗体

目的：优选一种适宜于献血员梅毒筛查的试验方法。方法：采用检测梅毒特异性抗体的双抗原夹心ELISA法对献血员进行抗体检测，并与RPR检测结果进行比较，对两种方法检测结果不一致的标本，再用TPHA法进行确证。结果：ELISA法阳性检出率0．36％(41／1271)、RPR法阳性检出率0．26％(29／11271)。ELISA法与TPHA法总符合率97．5％(40／41)、RPR法与TPHA总符合率63．41％(26／41)。结论：ELISA法优于RPR法，具有较高的灵敏度和特异性，适宜于献血员的筛查．有利于控制和减少梅毒的输血传播。     

流式细胞术在母婴血型不合新生儿溶血病检测中的应用

目的建立流式细胞仪检测母婴血型不合新生儿溶血病（HDN）的方法。方法对临床送检的115例拟诊新生儿溶血病标本以流式细胞仪进行直接抗人-IgG试验、血清游离抗体检测及红细胞放散液抗体检测3项试验，选择FITC标记的单克隆二抗作为与红细胞特异性抗体结合的抗体。同时以试管抗球蛋白法进行3项试验作为对照，比较两方法的差异。结果建立了以流式细胞仪检测新生儿溶血病的实验方法：细胞采集比例为54．5％；阴性阈值2％；流式法对ABOHDN和RhHDN的检测阳性率分别为86％和100％。试管法检测阳性率分别为50％和100％。结论流式法具有敏感性高，特异性强，结果易判定，客观、标准等优点，为新生儿溶血病检测提供了一种可靠的诊断依据。     

In-vitro fertilization, gamete- or zygote intra-fallopian transfer for the treatment of male infertility

This retrospective study compares in-vitro fertilization and embryo transfer (IVF-ET), gamete intra-Fallopian (GIFT) and zygote intra-Fallopian transfer (ZIFT) for the treatment of male infertility in 266 couples (n = 318 cycles). The IVF-ET technique revealed a total pregnancy rate of 14.1% per cycle and 29.1% per transfer. The conception rate with GIFT was 17.8%; an abortion rate of 50% was noted. The ZIFT procedure scored a 20.9% total pregnancy rate per cycle and 33.3% per transfer. The cumulative take home baby rates per couple for IVF-ET, GIFT and ZIFT were 13.5, 7.0 and 20.0%, respectively.     

Pregnancy: Cumulative pregnancy rates and pregnancy outcome after in-vitro fertilization: >5000 cycles at one centre

Cumulative pregnancy rates and pregnancy outcome analysis areuseful methods for advising an infertile couple of the probabilityof in-vitro fertilization (IVF) success. All 5209 IVF cyclesin 2391 couples at University Hospital, London, Ontario, Canada,over 10 years were studied. Cumulative pregnancy rates wereestimated using life table analysis. The Cox proportional hazardsmodel was used to estimate the influence of covariates. Oocyteretrieval and embryo transfer were achieved in 84 and 64% ofcycles initiated respectively. There were 644 intra-uterineand 24 ectopic pregnancies (13%/cycle initiated, 15%/oocyteretrieval and 20%/embryo transfer). Cumulative pregnancy ratesfollowing six cycles were: tubal 55%, idiopathic 65%, endometriosis60%, multifactorial 63% and male 40%. There were 68 spontaneousabortions (10.6%) and three induced abortions for congenitalanomalies. The multiple gestation rate was 22%. Caesarean sectionand preterm delivery rates were 35 and 20% respectively, duein part to the high proportion of multiple gestations. Of 15deliveries which resulted in stillbirths and/or neonatal deaths,12 were multiple gestations; 18 pregnancies (3.3%) were complicatedby congenital malformations. No increases in congenital malformationsor spontaneous abortions were identified. Cumulative pregnancyrates were lower in cases of male infertility. Success ratesdid not decline with successive IVF cycles. IVF is an evolvinginfertility treatment.     

Human Fallopian tube epithelial cell co-culture increases fertilization rates in male factor infertility but not in tubal or unexplained infertility

In order to investigate the effect of human Fallopian tube epithelial cell co-culture on fertilization and cleavage rates in tubal, male and unexplained infertility, oocytes collected from 91 patients were randomized to wells containing Fallopian tube epithelial cell monolayers or conventional culture medium, and inseminated with spermatozoa. Fertilization and cleavage were assessed at 18 and 52 h, respectively. Co-culture significantly increased the fertilization rates over the control values in male infertility (41.67 versus 23.43%, P = 0.00005), but not in tubal infertility (69.33 versus 67.93%) or unexplained infertility (65.93 versus 54.36%). Cleavage rates were not different in co-culture and conventional in-vitro fertilization systems in any of the infertility subgroups. The number of blastomeres was significantly higher in the co-culture group on the day of embryo transfer (3.63 +/- 1.12 versus 3.04 +/- 1.26, P < 0.001). Pregnancy rates were similar in all infertility subgroups. There was no significant association between the number of co-cultured embryos transferred and the pregnancy, abortion and multiple pregnancy rates. It was concluded that human Fallopian tube epithelial cell co-culture clearly improves fertilization rates in male infertility but not in tubal or unexplained infertility. Improved fertilization rates in co- culture may be due to positive effect of co-culture on impaired sperm function.      

Multiple follicular recruitment and intrauterine insemination outcomes compared by age and diagnosis.

We studied the outcome of our intrauterine insemination (IUI) programme, evaluating female age and diagnosis. One-hundred-and-twenty-six patients less than 36 years of age (mean 30.91 +/- 3.02 years) completed 306 cycles of multiple follicular recruitment (MFR) and timed IUI; 64 patients greater than or equal to 36 years of age (mean 38.36 +/- 2.08 years) completed 166 cycles (total 190 patients, 472 cycles). The male partners' semen was prepared for IUI with wash and swim-up techniques. Diagnostic groups were: male factor (n = 26), idiopathic (n = 33), endometriosis (n = 19), ovulatory disorder (n = 7), other (n = 19) and combined factors (n = 86). Pregnancy rates (% per couple, % per cycle) [overall (31.58, 12.7)] [less than 36 years (38.10, 15.69)] [greater than 36 years (18.75, 7.23)] were greater in the less than 36 years group (P less than 0.025). The probability of conception after three treatment cycles was 0.402 overall, 0.481 for age less than 36 years and 0.252 for age greater than or equal to 36 years. The probability of conception for male factor and idiopathic infertility patients was 0.469 and 0.411 respectively. An age effect was found on pregnancy rates in the idiopathic group only. In conclusion, MFR + IUI is a valuable treatment especially for male factor patients and patients less than 36 years old, with idiopathic infertility.     

Why do infertile males use psychological couple counselling?

The purpose of the present study was to identify characteristics of male patients that could be relevant for the uptake of psychological couple counselling for infertility. Therefore, 94 male patients who participated in psychological couple counselling were compared to 134 unselected infertility patients who attended an andrological clinic. Counselling users showed higher scores for depression and anxiety as well as a higher number of impaired sperm parameters. Multivariate analysis revealed that beyond the level of depression the number of impaired sperm parameters delivered additional information about the probability of a patient using counselling. For interpretation of these results the former research was broadly reviewed. It is suggested that an increased level of distress, the feeling of being responsible for infertility and few marital difficulties are relevant for the usage of couple counselling by male infertility patients. Practical consequences are discussed.     

荧光定量PCR以及培养法检测男性不育症患者液解脲支原体结果的比较分析

目的 研究解脲支原体(UU)感染在男性不育症患者中的意义以及对其培养法和荧光定量PCR两种方法检测结果进行比较分析.方法对342例男性不育症患者和198例对照组同时进行UU培养和荧光定量PCR检测,培养法同步伴有药物敏感试验的结果.结果在不育症患者中培养法和荧光定量PCR检测UU的阳性率分别为43.0%和55.8%,在对照组中则分别为25.3%和29.8%,经x<'2>检验在男性不育症患者中两种方法检测UU的阳性率均显著高于对照组,P<0.005;荧光定量PCR的阳性率显著高于培养法,P<0.005;药物敏感试验结果显示UU培养法阳性者对克拉霉素敏感性最高,敏感率为97.4%,对环丙沙星耐药性最高,耐药率为62.1%.结论UU检测可对男性不育症患者的病因诊断和临库治疗提供实验依据.荧光定量PCR检测UU的敏感性要高于培养法,但是培养法的药敏试验可及时准确的指导临床选择用药.     

152例男性不育患者细胞遗传学研究

目的研究男性不育患者的遗传缺陷与精子生成障碍的关系。方法采用G显带分析152例患者外周血染色体核型,并采用计算机辅助精液分析,瑞吉染色检测精子凋亡情况,并采用聚合酶链式反应对其中染色体核型正常的患者进行Y染色体微缺失的检测。结果在152例不育患者中,检出异常核型29例,异常核型发生率为19.08%;其中60例染色体核型正常的不育患者精子凋亡率为（18.26±9.34）%,正常组为（3.52±2.11）%,两组比较有显著性差异;53例染色体核型正常的不育患者有Y染色体微缺失6例,缺失率11.3%,正常对照组未检出Y染色体微缺失。结论染色体核型异常、Y染色体微缺失以及精子凋亡是引起男性不育的重要原因。同时采用这三种遗传学检测方法可以更全面的评价男性不育患者的遗传缺陷情况,更好的为患者提供病因诊断、遗传咨询和治疗方案。     

The effectiveness of IVF in unexplained infertility: a systematic Cochrane review. 2002,

BACKGROUND: IVF is an accepted treatment for unexplained infertility. The objective of this review was to determine whether, for unexplained infertility, IVF improves the probability of live birth compared with: (i) expectant management; (ii) clomiphene citrate (CC); (iii) intrauterine insemination (IUI); (iv) IUI with controlled ovarian stimulation; and (v) gamete intra-Fallopian transfer (GIFT). METHODS: This was based on a Cochrane review. Randomized controlled trials (RCTs) which compared the effectiveness of IVF with expectant management, CC, IUI with or without controlled ovarian stimulation and GIFT were included. Patients included couples with unexplained infertility. Live birth rate per woman/couple was the main outcome measure. RESULTS: Nine RCT were identified. Five RCTs were included in the final meta-analysis. There were no comparative data for CC and live birth rates for expectant management or GIFT. There was no significant difference in clinical pregnancy rates between IVF and expectant management. There was no evidence of a difference in live birth rates between IVF and IUI either without (OR 1.96, 95% CI 0.88 to 4.36) or with (OR 1.15, 95% CI 0.55 to 2.42) ovarian stimulation. Clinical pregnancy rates with IVF were significantly higher compared with GIFT (OR 2.14, 95% CI 1.08 to 4.22) as were the multiple pregnancy rates (OR 6.25, 95% CI 1.70 to 23.00). Clinical heterogeneity was present among the studies. There was no evidence of statistical heterogeneity. CONCLUSIONS: The effectiveness of IVF in unexplained infertility remains unproven. Larger trials with adequate power are warranted.     

The best donor.

Oocyte donation has become a common treatment modality for a large spectrum of infertility conditions. The purpose of this study was to assess the success rate of a shared egg donation programme, and to define the profile of a successful 'donor-recipient' couple in view of the limitations imposed by the shared programme. The results of all consecutive cycles of egg donation from 1st January 1995 to 31st December 1996 were analysed. A total of 383 donor cycles were matched with 946 recipient cycles; clinical pregnancy rates were 23. 5 and 16.7% respectively. With the exception of endometriosis, which significantly reduced the pregnancy rate in both groups, similar pregnancy rates were obtained in both groups for all the other infertility aetiologies of the donors. The donor's age had no impact on pregnancy rate of the recipient, but pregnancy rate was significantly decreased in donors >35 years. Recipients >50 years had significantly reduced pregnancy rates and those >45 years a significantly increased abortion rate. Recipients with severe male factor infertility, who had intracytoplasmic sperm injection treatment, showed pregnancy rates equivalent to those recipients who had regular in-vitro fertilization. We conclude that in a shared egg donation programme, the recipients' pregnancy rate and outcome are dependent only on the donors' infertility aetiologies and on recipients' ages.     

Superovulation and timed intercourse: can it provide a reasonable alternative for those unable to afford assisted conception?

Superovulation was performed prospectively with pure folliclestimulating hormone (FSH) to a group of 224 infertile patientswith ovulatory factor (51), male factor (60), mild/moderateendometriosis (24) and unexplained infertility (72). The aimwas to produce three or four leading follicles in order to compensatefor a ‘deficient’ factor. Ovulation was inducedwith human chorionic gonadotrophin (HCG) and monitoring wasperformed entirely by serial transvaginal ultrasound on alternatecycles up to a maximum of six cycles (1120 treatment cycles)with intervening cycles being used as self-controls (932 restcycles). A further control group of 56 patients was matchedfor age, category and duration of infertility and was only scannedserially (336 control cycles). Seventyfour pregnancies wereachieved and 54 delivered, giving a cumulative pregnancy rateper couple of 33% and a cumulative take home baby rate of 24%per couple after a maximum of six cycles of treatment. Whencompared with the rest or control cycles, treatment was significantlyeffective for ovulatory (P< 0.001), mild/moderate endometriosis(P< 0.01) and unexplained infertility (P< 0.01) but notfor male infertility. Furthermore, pregnancy was five timesmore likely during the first four treatment cycles (P=0.00006,odds ratio=5) at the expense of a significant multiple pregnancyrate (18.9%) and mild/moderate ovarian hyperstimulation rate(12%). We conclude that four cycles of superovulation shouldbe routinely offered to couples on waiting lists for assistedconception or to those unable to afford it, in anovulatory,mild/moderate endometriosis and unexplained infertility. Theseresults need confirmation by a prospective multi-centre randomizedstudy