母亲外周血BaP-DNA加合物与孕早期胚胎停育的关系

目的 研究母亲外周血苯并(a)芘(BaP)-DNA加合物与孕早期胚胎停育之间的关系,探讨影响胚胎发育的可能环境因素. 方法 选择门诊诊断胚胎停育的妊娠妇女52例,同期按年龄、孕产次、孕龄进行1∶1配比,选取正常妊娠要求终止妊娠的妇女52例(对照组),人工流产术后抽取外周血2 ml,提取全血基因组DNA并行DNA浓度定量,高效液相色谱法(HPLC)检测母血BaP-DNA加合物的浓度,问卷调查获取母亲个人资料,Logistic 回归模型分析BaP-DNA加合物与胚胎停育的关系. 结果 胚胎停育母亲外周血BaP-DNA加合物的浓度[(6.3±4.7)加合物/108核苷酸]显著高于正常妊娠妇女[(2.4±1.4)加合物/108核苷酸](P<0.01).控制可能的混杂因素后,发现母血BaP-DNA加合物是胚胎停育的危险因素(OR=3.63, 95%CI 1.49～8.87),而孕妇学历为胚胎停育的保护因素(OR=0.55, 95%CI 0.32～0.94).当外周血加合物水平高于5.5加合物/108核苷酸时,妊娠妇女发生胚胎停育的危险性将大大增加(OR=47.22,95%CI 6.06～367.73). 结论 母血较高水平的BaP-DNA加合物是孕早期胚胎停育发生的危险因素,对胚胎发育可能有不良影响.     

围孕期大气中一氧化碳暴露与孕早期稽留流产的关系

目的探讨围孕期暴露于大气污染物一氧化碳（CO）气体与孕早期稽留流产的相关性。方法采用回顾性病例对照研究的方法。从天津市环境监测中心获取2001年至2007年市内6个行政区国控监测点的大气中CO的月平均浓度。以天津市市内六区15家综合性医院和妇产科专科医院计划生育门诊2001年1月至2007年8月诊断为稽留流产的患者为病例组（n=975），同期各医院按照年龄段行1：1配比，随机选取正常妊娠要求行人工流产手术者作为对照组。采用SPSS11．0软件进行统计学分析，探讨围孕期CO的暴露以及年龄、自然流产次数、孕次、产次等因素与孕早期稽留流产的关系。结果大气中CO气体采暖期平均浓度显著高于非采暖期。采暖期稽留流产占所有人工流产的百分比高于非采暖期。病例组孕后一个月CO的暴露水平高于对照组。在中高暴露组与低暴露组、高暴露组与低暴露组比较，稽留流产的发生率均有统计学差异，OR分别为1．609、1．662。结论孕妇孕后一个月暴露于较高浓度的CO，可能会增加稽留流产发生的危险性。暴露浓度越高，发生稽留流产的危险性越大。     

青岛某区胚胎停育病例相关危险因素分析

目的探索胚胎停止发育的相关危险因素,为胎儿的健康发育提供预防策略。方法采用病例对照方法,自制调查表对来院就诊确定为胚胎停止发育的病例93例和胚胎发育正常者93例为对照进行问卷调查,采用x2检验和Logistic回归进行统计分析。结果胚胎停育与孕妇本人的受教育程度、被动吸烟程度、饮食偏食及计划受孕都有相关性。结论胚胎停止发育由多因素作用导致,个人生活习惯和家庭环境起重要作用。     

孕期PM2.5暴露对子代出生体重影响的研究进展

PM2.5是空气污染物的重要组成部分,其对全身各系统器官都会产生不同的危害.孕期PM2.5暴露会导致胚胎先天畸形、早产、胎儿出生体重异常等不良妊娠结局,严重时导致新生儿死亡.大量流行病学研究表明,孕期PM 2.5暴露与子代出生体重变化之间存在相关性.PM 2.5可能通过血管重构、炎症、氧化应激、免疫、表观遗传等机制影响...     

孕早期自发性流产与胚胎停育男性因素病例对照研究

目的 探寻对孕早期自发性流产、胚胎停育具临床诊断价值的精液实验指标.方法 (1)应用非匹配的病例对照研究方法 ,调查病例组[孕早期有自发性流产和(或)胚胎停止发育现症史妇女的配偶315例]与对照组(正常生育男性52例+不育男性116例)精子核蛋白不成熟度、精子形态学、精液常规等多项实验指标水平,Logistic回归分析筛选影响因素;(2)以筛选出指标的临界值将病例组分为正常和异常2组,后者又分为经药物治愈和未经治疗两种状况,跟踪观察各组其配偶自发流产/胚胎停育、分娩状况的差异性.结果 (1)精子核蛋白不成熟度与孕早期自发性流产、胚胎停育有关(OR=1.060,95%CI:1.036～1.086),ROC曲线下面积0.734,临界值为32%;(2)病例组中精子核蛋白不成熟者其配偶自发流产/胚胎停育率、分娩率分别为:未治疗病例61.4%(51/83)、38.6%(32/83),治愈病例13.5%(12/89)、86.5%(77/89),两者相比差异具统计学意义(P<0.0001);病例组中精子核蛋白成熟者其配偶自发流产/胚胎停育率、分娩率为46.1%(47/102)和53.9%(55/102),与核蛋白不成熟未治疗病例配偶妊娠结局(自发流产/胚胎停育率分娩率分别为61.4%和38.6%)比较,差异具统计学意义(P<0.05).结论 精子核蛋白不成熟是孕早期自发性流产、胚胎停育的男性危险因素,但经药物治疗精子不成熟度得以改善后,可明显减少女方自发流产/胚胎停育率和提高分娩率.     

早期胚胎停育绒毛滋养层细胞病理学变化

目的观察早期胚胎停育(MA)胎盘绒毛滋养层细胞的病理学变化。方法选择2011年12月至2013年12月于河北石家庄第六医院门诊就诊的260例MA患者(孕周<12周)作为研究对象(MA组),选择该院自愿行人工流产的正常早孕孕妇(孕周<12周)作为对照组,共396例。取MA组及对照组患者的胎盘绒毛组织送至北京龙迈达科技公司制成组织阵列芯片,样本按≤25岁、26~30岁、31~34岁、≥35岁年龄区间分组,每组随机挑选10对(病例及对照)进行分析。采用免疫组化法检测反映胎盘血管发生的血管内皮生长因子(VEGF)、反映滋养层细胞和间质细胞分布情况的细胞角蛋白(CK19)和波形蛋白(Vimentin)在MA组和对照组患者早孕绒毛滋养层细胞中的表达差异;通过Tunel法检测MA组和对照组患者早孕绒毛滋养层细胞的凋亡情况。结果早期MA组绒毛滋养层细胞中VEGF表达量较对照组显著降低(P<0.01),而MA组绒毛滋养层细胞中CK19及Vimentin表达与对照组无统计学差异(P>0.05));MA组绒毛滋养层细胞的凋亡指数显著高于对照组(P<0.001)。结论胎盘绒毛滋养层细胞中VEGF的低表达及细胞凋亡指数的增加与胚胎停育发生密切相关,提示胎盘血管生成减少和滋养层细胞过度凋亡是造成早期胚胎停育的部分原因。     

宫颈支原体感染与胚胎停止发育的关系

目的探讨宫颈支原体感染与胚胎停止发育的关系,及支原体药物敏感试验结果。方法收集60例正常早孕人工流产妇女(正常组)和60例胚胎停止发育的自然流产妇女(胎停育组)的宫颈分泌物进行解脲支原体和人型支原体培养,比较2组妇女支原体检出的阳性率,并对支原体结果培养阳性者进行司怕沙星、罗红霉素、加替沙星、氧氟沙星药物敏感试验,观察支原体感染与胎停育组胚胎停止发育次数之间的相关性。结果胎停育组解脲支原体阳性45例,阳性率75.0%,人型支原体阳性17例,阳性率28.3%,解脲支原体、人型支原体均阳性13例,阳性率21.7%。正常组解脲支原体阳性23例,阳性率38.3%,人型支原体阳性5例,阳性率8.3%,解脲支原体、人型支原体均阳性2例,阳性率3.3%,2组阳性率比较差异有极显著性(P0.01,P0.05)2组妇女中支原体阳性患者的药物敏感率分别为司怕沙星91.4%,罗红霉素73.2%,加替沙星51.6%,氧氟沙星28.8%。支原体感染与胚胎停止发育次数间无正相关关系。结论宫颈支原体感染与胚胎停止发育有关,是导致胚胎停止发育的原因之一,支原体药物敏感试验以司怕沙星最为敏感。     

胚胎移植后血β-HCG值预示孕早期妊娠结局的价值

目的探讨卵母细胞受精后17d(D3胚胎移植后14d或D5胚胎移植后12d)血β-HCG值与早期妊娠结局的相关性。方法分析我院2012年1月至2015年1月通过IVF/ICSI/FET助孕方式成功受孕并按时返院复查的患者共523例,按照血β-HCG值分组,分析各组早孕期不同妊娠结局的发生率;用ROC曲线分析血β-HCG值预测早孕期各种妊娠结局的意义以及界值。结果随着卵母细胞受精后17d血β-HCG值增加,患者的生化妊娠率由60.0%降至0,多胎率由0增加至13.3%,胚胎停育率由55.6%下降至0,宫外孕率由22.2%下降至0;血β-HCG值预测生化/临床妊娠的界值为213.15U/L,ROC曲线下面积(AUC)为0.917,敏感度0.848,特异度0.906;预测单胎/胎妊娠的界值为986.65U/L,AUC为0.906,敏感度0.828,特异度0.713;预测双胎/三胎的界值为2 206.5U/L,AUC为0.611,敏感度0.333,特异度0.069;预测单胎停育/持续妊娠的界值为270.57U/L,AUC为0.631,敏感度0.889,特异度0.406。结论卵母细胞受精后17d血β-HCG值可以较好预测生化/临床妊娠以及单胎/多胎妊娠;而对于双胎/三胎、单胎停育/持续妊娠的预测价值不大。     

精子DNA甲基化异常与早期自然流产的关系研究

目的:探索精子DNA甲基化水平异常与早期自然流产的关系。方法:随机选取98例符合纳入标准的配偶不明原因流产或胚停育男性为研究对象,另选取健康孕前体检男性46例作对照。行精液常规、精子形态分析,以改良精子染色质扩散法检测精子DNA碎片化指数。精子DNA甲基化水平检测采用甲基化定量试剂盒,运用比色法检测。结果:与对照组相比,早期不明原因流产组大晕环精子百分率[(45.50±26.27)%vs(36.49±23.06)%]显著降低(P=0.038),精子头部异常比例[(77.08±12.21)%vs(81.09±10.89)%]显著增高(P=0.049),精子DNA甲基化水平[(0.47±0.33)vs(0.36±0.26)ng/μl]显著降低(P=0.035);并且精子DNA甲基化水平与大晕环精子百分率呈正相关(r=0.546,P0.01)。多因素回归分析显示,精子头部异常是早期自然流产/胚停育的独立危险因素(OR=1.032,P=0.049),而精子高甲基化水平是早期自然流产/胚停育的保护因素(OR=0.244,P=0.03)。结论:精子DNA甲基化水平异常可能是不明原因早期自然流产或胚停育的原因之一。     

包块型宫角妊娠的诊断与治疗

目的探讨包块型宫角妊娠的诊断与腹腔镜手术治疗的疗效。方法收集2011年6月至2016年7月本院病理确诊的包块型宫角妊娠患者共27例。回顾性分析患者的病例资料及随诊情况。结果 27例患者平均年龄32.0岁,81.5%的患者有人工流产及自然流产史;最常见症状包括停经及不规则阴道流血,伴或不伴有腹痛。超声检查准确率较低仅为55.6%,误诊病例多为妊娠滋养细胞肿瘤。患者行腹腔镜下宫角切开+病灶清除为主的手术,术后血清β-HCG值恢复正常,无术后并发症发生。结论包块型宫角妊娠多表现为清宫手术、化疗、胚胎停育后血β-HCG值不降,同时合并有盆腔包块,常因临床表现的不典型而导致诊断困难或被误诊误治。应注重其与妊娠滋养细胞肿瘤的鉴别。腹腔镜手术在包块型宫角妊娠的鉴别诊断和治疗中安全有效。     

Epidemiology research on relationship between main air pollutants and missed abortion in Tianjin

Objective: To investigate the relationship between air pollutants and missed abortion in early pregnancy, explore the probable environmental risk factors for embryo development and missed abortion.Methods: We collected the number of the induced abortion and the missed abortion patients in each month during 6 recent years from 15 general hospitals or gynecology and obstetrics hospitals in urban area of Tianjin. We obtained the average levels of main air pollutants (SO2、TSP、NO2) from 2001 to 2007 in six national monitoring stations in urban field of Tianjin from Environment Monitoring Centre monthly, and compared the differences of the percentage of missed abortion cases in all the abortion operations of each months between months, seasons and heating and non-heating period. We used SPSS 11.0 statistic software to analyze probable environmental risk factors for missed abortion.Results: Air pollution in Tianjin during heating period was significantly more serious than non-heating period,while the percentage of missed abortion in all abortions was higher. The levels of PM10 and TSP correlated with the percentage of missed abortion cases, and environmental PM10 might be a risk factor of missed abortion. Pregnant in autumn and winter might cause an adverse effect on embryo development.Conclusion: Air pollution might have an adverse effect on normal embryo development in early pregnancy.     

Parental exposure at periconception to environmental adverse factors and early embryo loss in Tianjin, China

<正>Objective:To study the association of environmental adverse factors with early embryo loss,and explore the possible risk factors in daily life. Methods:A questionnaire was administered to 93 new cases of embryo loss(case group) collected in four general hospitals in Tianjin from April 2007 to April 2008 and 93 matched cases of induced abortion(control group) in normal pregnant women who sought the abortion by other reasons.The questionnaire covered information on parental exposure to various environmental factors during and before pregnancy,and the information on daily life.Data were analyzed by single-factor analysis,multiple linear regression and logistic regression analysis.Possible risk factors were identified and odds ratio calculated. Results:Cooking frequently during pregnancy,more daily traffic hours,and decoration history in early pregnancy and paternal exposure to toxic matters three months before pregnancy were associated with early embryo loss, while maternal education was a protective factor. Conclusion:Women exposed to the harmful substances from traffic emissions,cooking and decoration could be at an increased risk of early embryo loss.     

卵巢过度刺激高风险患者全胚冷冻后择期移植妊娠结局分析

目的于体外受精(IVF)超排卵周期取卵后及移植前,对根据血液指标和超声指标诊断为卵巢过度刺激综合征(OHSS)高风险患者,在充分知情同意下由患者自行选择新鲜胚胎移植或全胚冷冻后择期冻胚移植,观察比较两种情况下妊娠结局。方法回顾性分析我中心2012年1月1日至2013年6月30日期间进行IVF且有OHSS高风险的患者共374例,分为鲜胚胎移植组(A组)65例和全胚冷冻后择期冻胚移植组(B组)309例,比较两组妊娠结局的相关指标。结果 A组的妊娠率、种植率、流产率、异位妊娠率分别为41.5%(27/65)、30.0%(39/130)、7.4%(2/27)、3.7%(1/27),B组分别为69.6%(215/309)、50.2%(310/618)、7.0%(15/215)、3.7%(8/215),两组间妊娠率和种植率均有显著性差异(P0.05),而流产率、异位妊娠率则无显著性差异(P0.05)。OHSS发生率A组为10.8%,而B组仅为1.6%,两组间差异有统计学意义。结论对于有OHSS高风险的患者应该果断选择全胚冷冻并择期行冻胚移植,可减少甚至杜绝OHSS的发生,从而提高IVF安全性并可获得更为满意的妊娠结局,且可降低患者的治疗费用。     

Theatre staff members and exposure to halogenated agents

Ninety-eight measurements were made to evaluate the level of pollution by halogenated anaesthetics, in 27 operating rooms of 12 hospitals in the Paris area. Air sampling was made during ordinary work sessions to evaluate the degree of personal pollution to which different members of the operating room staff were exposed. Samples were analysed by gas chromatography. The degree of personal pollution was particularly high in hospitals devoted to paediatric surgery. Anaesthetists were most at risk. Scavenging equipment and a large volume of air in the operating room helped in a reduction in the level of pollution. A high rate of air extraction and the use of a filter appeared to be necessary to reduce pollution.     

体外受精中受精低下周期的促排卵方案及妊娠结局观察

目的 分析体外受精（IVF）周期受精低下的原因及妊娠结局.方法 观察IVF受精低下83周期（受精低下组）,以同期受精正常的1,717个IVF周期为对照组,比较两组的卵裂率、优质胚胎率、种植率、临床妊娠率、流产率;同时观察不同促排方案对受精低下的影响.结果 两组不同促排方案的受精低下比率无显著差异（P〉0.05）;卵裂率、优质胚胎率、种植率、临床妊娠率、流产率也均无显著差异（P〉0.05）.结论 促排卵方案不是影响受精低下的因素,受精低下周期中获得的胚胎质量及发育潜能没有影响.     

体外受精-胚胎移植助孕后双胎自然减胎的妊娠结局

目的探讨体外受精-胚胎移植(IVF-ET)助孕妊娠后双胎自然减为单胎的影响因素以及妊娠结局。方法回顾性分析2010年3月至2012年7月在本院生殖中心行试管婴儿助孕的8 567个周期,双胎妊娠自然减为单胎者为研究组(A组,166例),对照为双胎未发生减胎组(B组,264例)和单胎组(C组,200例)。比较3组间临床相关因素及妊娠结局。结果 A组的妊娠年龄、新鲜周期HCG日内膜厚度/复苏周期排卵日内膜厚度高于B组,差异有统计学意义(P0.05);A组移植胚胎质量低于B组,差异具有统计学意义(P0.05);A组早期妊娠流产率低于B组(3.61%vs.12.50%),差异有统计学意义(P0.05);但A组晚期妊娠流产率高于B组(10.24%vs.4.00%),差异有统计学意义(P0.05)。A组妊娠期高血压的发生率高于C组(11.45%vs.5.50%),差异有统计学意义(P0.05)。A组妊娠期糖尿病的发生率高于C组(4.82%vs.2.50%),但差异无统计学意义(P0.05)。A组与C组比较,低体重儿、早产儿出生率及新生儿体重、出生孕周差异均无统计学意义(P0.05)。结论妊娠年龄大于35岁、内膜厚度小于10mm,移植优质胚胎数目比率越低,双胎妊娠发生自然减胎的可能性越大。双胎自然减为单胎的孕妇较正常单胎妊娠者发生妊娠并发症的风险增加。     

不同BMI水平新鲜胚胎移植和全胚冷冻-首次冻融胚胎移植妊娠结局比较

目的比较不同体重指数(BMI)水平患者新鲜胚胎移植和全胚冷冻-首次冻融胚胎移植(FET)的妊娠结局。方法回顾性分析2009年1月至2018年5月于郑州大学第一附属医院生殖医学中心行首次新鲜胚胎移植(13019个周期)和全胚冷冻后首次FET(3546个周期)患者的临床资料。将研究对象按不同BMI分为正常体重组(18.5~23.9 kg/m2)、超重组(23.9~27.9 kg/m2)和肥胖组(≥28 kg/m2)。分析不同BMI水平下鲜胚移植组和FET组患者的临床特征和妊娠结局,采用多元Logistic回归分析矫正影响妊娠结局的混杂因素;主要结局指标包括临床妊娠率、活产率、流产率。结果矫正各种混杂因素后,正常体重组中,FET组的临床妊娠率、活产率显著低于鲜胚移植组,而流产风险显著高于鲜胚移植组[P<0.05;临床妊娠率:aOR=0.80(95%CI:0.71-0.91);活产率:aOR=0.77(95%CI:0.68-0.86);流产率:aOR=1.28(95%CI:1.05-1.58)];超重组中,FET组的临床妊娠率、活产率显著低于鲜胚移植组,流产风险显著高于鲜胚移植组[P<0.05;临床妊娠率:aOR=0.76(95%CI:0.61-0.94);活产率:aOR=0.74(95%CI:0.60-0.92);流产率:aOR=1.23(95%CI:0.87-0.96)];肥胖组中,鲜胚移植组和FET组间临床妊娠率、活产率及流产率比较均无显著性差异(P>0.05)。结论对于正常体重和超重人群,在无影响新鲜胚胎移植因素存在时,尽量选择新鲜胚胎移植;肥胖人群中两种移植方式则无明显差异。     

Association between air pollution and general practitioner visits for respiratory diseases in Hong Kong

BACKGROUND: Few studies have explored the relation between air pollution and general practitioner (GP) consultations in Asia. Clinic attendance data from a network of GPs were studied, and the relationship between daily GP consultations for upper respiratory tract infections (URTI) and non-URTI respiratory diseases and daily air pollutant concentrations measured in their respective districts was examined. METHODS: A time series study was performed in 2000-2002 using data on daily patient consultations in 13 GP clinics distributed over eight districts. A Poisson regression model was constructed using the generalised additive model approach for each GP clinic, and associations with daily numbers of first visits for URTI were sought for daily concentrations of the following air pollutants: SO(2), NO(2), O(3), PM(10,) and PM(2.5). A summary relative risk of first visits to the GP for URTI per unit increase in concentration for each air pollutant was derived using a random effect model. First visits for non-URTI respiratory diseases were analysed in three GP clinics. RESULTS: Significant associations were observed between first visits for URTI and an increase in the concentrations of NO(2), O(3), PM(10), and PM(2.5). The excess risk was highest for NO(2) (3.0%), followed by O(3) (2.5%), PM(2.5) (2.1%), and PM(10) (2.0%). Similar associations with these air pollutants were found for non-URTI respiratory diseases. CONCLUSIONS: These results provide further evidence that air pollution contributes to GP visits for URTI and non-URTI respiratory diseases in the community.