农村妇女子宫肌瘤患病现状及危险因素分析

目的调查农村妇女子宫肌瘤的患病现状，分析其危险因素。方法按经济水平分层整群随机抽样，对4个抽样点已婚育龄妇女进行子宫肌瘤的现患状况调查；使用Logistic回归分析其危险因素。结果农村妇女子宫肌瘤的患病率为3．13％，不同地区、不同文化程度的农村已婚育龄妇女子宫肌瘤的患病率差异无统计学意义；长期服用避孕药、人工流产、宫颈糜烂、年龄大是子宫肌瘤发病的危险因素。结论农村已婚育龄妇女子宫肌瘤的患病率较高，其发病与长期服用避孕药、人工流产、宫颈糜烂、年龄大有关。     

社区女性患子宫肌瘤影响因素分析

目的了解社区女性子宫肌瘤的影响因素,为制定相关卫生政策提供参考。方法应用自填式问卷的方法,对北京市6个区（县）48个村（居委会）20周岁以上成年女性进行问卷调查。结果本研究共调查成年女性3058人,其中自我报告患子宫肌瘤276人,作为病例组;无子宫肌瘤2782人,作为对照组。单因素Logistic回归分析,16个因素与子宫肌瘤患病相关。多因素非条件Logistic回归分析,5个因素进入回归方程。已婚（OR=2.31,95%CI：1.18-4.51）,初潮年龄≤14岁（OR=1.53,95%CI：1.06-2.18）,宫颈炎（OR=2.46,95%CI：1.46-4.13）,便秘（OR=1.52,95%CI：1.00-2.31）,急迫性尿失禁（OR=2.81,95%CI：1.09-7.25）为子宫肌瘤发生的影响因素。结论子宫肌瘤影响因素复杂,有针对性的健康教育工作亟待开展。     

子宫肌瘤家族聚集性及遗传方式的研究

目的探索子宫肌瘤家族聚集性及遗传方式。方法采用遗传流行病学病例对照研究方法,对274个家系(137例子宫肌瘤先证家系和137例对照家系)进行研究。结果病例组一级亲属总的子宫肌瘤患病率为1303%,显著高于对照组的802%(χ2=419,P<005);分离比为00443,远低于025,不符合单基因遗传疾病的特征;遗传度估算显示,该病一级亲属中遗传度为2584%。结论子宫肌瘤发病呈家族聚集性,在子宫肌瘤病因中,遗传因素起一定作用。     

ADC值在子宫内膜癌与子宫粘膜下肌瘤鉴别诊断中的价值

目的 探讨表观扩散系数(ADC)对子宫内膜癌与子宫粘膜下肌瘤鉴别诊断的价值.方法 对经手术病理证实的19例子宫内膜癌和7例子宫粘膜下肌瘤的ADC图像进行回顾性分析,全部病例均行扩散加权成像(DWI)、常规磁共振成像(MRI)平扫,17例子宫内膜癌和5例子宫粘膜下肌瘤行增强扫描,ADC值测定将感兴趣区(ROI)置于DWI呈高信号且在ADC图上呈相对低信号部位,取病灶最小ADC值,对同一病例于髂腰肌处以同样大小ROI测量3个ADC值,取其平均值.相对ADC值(rADC)取病灶最小ADC值与髂腰肌平均ADC值的比值,对两组病例的ADC值和rADC值分别行两独立样本近似t检验和t检验.结果 子宫内膜癌测得的最小ADC值范围为0.54~0.88×10-3 mm2/s[(0.72±0.09)×10-3 mm2/s],rADC值范围为0.36~0.68(0.55±0.10);子宫粘膜下肌瘤测得的最小ADC值范围为1.00~1.40×10-3mm2/s[(1.18±0.16)×10-3mm2/s],rADC值范围为0.61~1.12(0.92±0.17).子宫内膜癌与子宫粘膜下肌瘤最小ADC值范围没有重叠.子宫内膜癌与子宫粘膜下肌瘤间的最小ADC值及rADC值差异均有统计学意义(t值分别为-7.301、-6.925,均P=0.000).结论 ADC值的测量可以准确鉴别子宫内膜癌与子宫粘膜下肌瘤.     

Familial aggregation of red blood cell cation transport systems in Japanese families

The rate of lithium, sodium, and potassium transport in red blood cells is thought to be associated with essential hypertension. In order to investigate the contribution of genetic and environmental factors to cation transport, their correlation was analyzed in 60 parent-offspring pairs and 17 husband-wife pairs in Toyama City, Japan. Lithium-sodium countertransport and sodium-potassium cotransport rates were significantly correlated in parent-offspring pairs (r = 0.52, p less than 0.01 and r = 0.46, p less than 0.01, respectively) but not in husband-wife pairs. Sodium pump rates were significantly correlated in both pairs (r = 0.48, p less than 0.01 in parent-offspring pairs, r = 0.46, p less than 0.05 in husband-wife pairs). Therefore, lithium-sodium countertransport and sodium-potassium cotransport were found to have a substantial genetic component and the sodium pump to have a substantial environmental component. Sodium pump rates were significantly correlated with sodium/creatinine (r = 0.21, p less than 0.05) and sodium/potassium (r = 0.32, p less than 0.01) in casual urine.     

北京地区已婚妇女子宫肌瘤患病状况及危险因素调查

目的 研究北京地区25 ～ 54岁已婚妇女子宫肌瘤患病率及其危险因素.方法 于2007年3月～2008年9月采用多阶段抽样方法,在北京地区抽取10个区县53个社区/村的2 378名25 ～ 54岁已婚妇女为研究对象,进行妇科体检和超声检查,并进行问卷调查.结果 北京地区25 ～ 54岁已婚妇女子宫肌瘤患病率为11.1％;25 ～34、35 ～ 39、40 ～54岁组已婚妇女子宫肌瘤患病率分别为2.9％、9.9％和17.3％;多因素Logistic回归分析显示,年龄和一级血亲具恶性肿瘤史与子宫肌瘤有关.结论 40～ 54岁已婚妇女是子宫肌瘤的高发人群,一级血亲具恶性肿瘤史为子宫肌瘤的危险因素.     

Embolization of uterine artery: a new treatment for uterine myomas

Uterine myomas are a common cause of menorrhagia and other complaints, and a common indication for hysterectomy. For several years now, bilateral uterine artery embolisation has been applied as an alternative to surgery. The effectiveness of this treatment modality in controlling abnormal bleeding patterns and in reducing uterine size, as described in early reports, seems to be confirmed in larger series of patients. However, the disadvantages have also become apparent, with subsequent ovarian failure and sepsis being the most worrisome complications. Data from randomised clinical trials comparing uterine embolisation versus hysterectomy in the treatment of uterine myomas are still lacking.     

绝经过渡期功能失调性子宫出血78例临床治疗分析

目的:研究绝经过渡期功能失调性子宫出血的临床特点,探讨有效治疗方式。方法:回顾性分析2006年4月～2007年7月,经本院门诊治疗的78例绝经过渡期功能失调性子宫出血患者的临床资料。结果:患者平均年龄(46.97±2.23)岁(42～54岁),出血时间11～180天,出现中重度贫血11例,选择刮宫手术治疗32例,反复多次手术治疗4例,应用药物治疗时间为(2.34±1.73)周期(1～10周期),选择曼月乐治疗2例。结论:绝经过渡期功能失调性子宫出血是下丘脑-垂体-卵巢轴失调导致的无排卵性出血,治疗方法不能仅仅局限于止血,而应进行内分泌药物调节和长期随访观察。     

不同子宫动脉介入栓塞方案治疗子宫肌瘤的疗效及安全性分析

目的观察不同子宫动脉介入栓塞(UAE)方案治疗子宫肌瘤的疗效及对子宫血供、卵巢功能的影响。方法回顾性分析2016年5月至2019年5月于丽水市人民医院和杭州市第一人民医院接受子宫动脉介入栓塞治疗的80例子宫肌瘤患者的临床资料,按照治疗方法分为平阳霉素碘化油乳剂(PLE)组39例,聚乙烯醇(PVA)组41例。比较两组临床疗效、超声影像学指标、子宫肌瘤内部血供[平均流速(Vm)、收缩期峰值血流速度(Vs)、最粗供血动脉管径、阻力指数(RI)]、卵巢功能[促卵泡生长激素(FSH)、雌二醇(E2)、孕酮(P)、促黄体生成素(LH)]水平、术后6个月内复发率及术后综合征。结果术后3个月,PVA组总有效率为92.68%,PLE组为89.74%,差异无统计学意义(P>0.05);术后6个月,两组患者子宫体积、子宫肌瘤体积较术前均显著下降(t值分别为59.216、22.361、46.388、22.393,均P<0.05),而两组术后比较差异无统计学意义(均P>0.05);术后6个月,两组Vm、Vs、最粗供血动脉管径水平均较术前显著下降(t值分别为15.022、26.973、16.932、14.620、26.535、12.462,均P<0.05),而两组RI水平均较术前显著上升(t值分别为39.333、39.254,均P<0.05),两组术后Vm、Vs、最粗供血动脉管径、RI水平比较差异均无统计学意义(均P>0.05);术后6个月,两组患者FSH、E2、P、LH水平较术前比较均无明显差异(均P>0.05),且两组术后比较差异无统计学意义(均P>0.05);PVA组术后6个月复发率及术后综合征总发生率均明显低于PLE组(χ²值分别为4.782、7.179,均P<0.05),而两组盆腔感染、闭经、恶心、呕吐、发热、下腹坠痛等术后综合征发生率单独比较均无统计学意义(均P>0.05)。结论PLE或PVA作为介入治疗的插管栓塞材料均可有效改善子宫肌瘤患者子宫体积、子宫肌瘤体积,促进子宫肌瘤内部血供的恢复,并对卵巢功能无明显影响。其中PVA材料术后综合征总发生率及短期内复发率更低,临床可根据实际需求进行选择。     

DSA引导下多水平栓塞在子宫肌瘤栓塞治疗中的作用

目的：评价应用直径300-500μm的聚乙烯醇（polyvinyl alcohol,PVA）颗粒单纯子宫动脉栓塞与采用直径300-500μm及500-700μm PVA颗粒的多水平子宫动脉栓塞对子宫肌瘤患者的疗效和安全性。方法：将50例症状型子宫肌瘤患者随机分为A、B 2组,A组应用300-500μm直径的PVA颗粒栓塞至子宫动脉血流停滞、螺旋状动脉不显影;B组应用300-500μm直径的PVA颗粒栓塞至子宫动脉血流变慢后再应用500-700μm直径的PVA颗粒栓塞子宫动脉,直到子宫动脉主干血流停滞、螺旋状动脉不显影,并比较2组症状缓解、疗效和并发症情况。结果：（1）临床症状变化情况比较：A、B 2组的临床症状（经期时间、月经量、贫血、痛经、下腹坠胀、尿频和排尿困难）比较,差异无统计学意义（P〉0.05）;（2）疗效比较：栓塞治疗后6个月复查,结果显示A组肌瘤平均体积由87.45 cm3缩小为48.65 cm3,B组肌瘤平均体积由91.87 cm3缩小为38.25 cm3,组内术前与术后比较均有显著差异（P〈0.001）,组间术后比较有显著差异（P〈0.05）;（3）并发症比较：2组并发症发生率没有显著差异（P〉0.05）。结论：与单纯应用直径300-500μm的PVA颗粒相比较,应用直径300-500μm及500-700μm PVA颗粒的多水平子宫动脉栓塞,可显著提高子宫肌瘤坏死缩小程度,而并发症的发生率无显著差异性,提示子宫肌瘤的多水平栓塞治疗技术是有效、安全的。     

Cost-effectiveness of treatments for dysfunctional uterine bleeding in women who need contraception

OBJECTIVE: This study aims to compare the cost-effectiveness of oral contraceptives (OCs), the levonorgestrel-releasing intrauterine system (LNG-IUS) and surgical management in treating dysfunctional uterine bleeding (DUB) in women not desiring additional children. METHOD: A Markov model was constructed from the perspective of the health services payers for a 5-year period. Treatment costs, DUB treatment success rates and contraception success rates were obtained through a literature review. RESULTS: In women not responding to an initial trial of OCs, surgical management was more effective than the LNG-IUS (95.5% vs. 92%) but at higher cost (US$4853 vs. US$2796 per woman). Among responders to OCs, continuing treatment with the LNG-IUS instead of OCs was more effective (92% vs. 90.4%) and less expensive (US$2796 vs. US$4711). For women na?ve to medical therapy, the LNG-IUS and OCs had similar effectiveness, but cost for the LNG-IUS was lower (US$2796 vs. US$4895). In all scenarios, surgery followed if medical therapy failed; rates of primary method failure were 62.5% with OCs and 34% with the LNG-IUS at 12 months. CONCLUSIONS: Treatment strategies employing the LNG-IUS are the most cost-effective in managing DUB, regardless of whether a woman has previously tried OC therapy.     

绝经过渡期子宫不规则出血的相关性研究

目的:探讨绝经过渡期子宫不规则出血的原因及诊断措施。方法:回顾性总结了2001年1月~2003年12月的36个月内,因绝经前子宫不规则出血及月经紊乱而行诊断性刮宫(诊刮)术的1 282例患者,将其临床表现及诊刮所得病理结果进行分析。结果:1 282例中,功能失调性子宫出血(功血)占50.62%(649例),子宫内膜良性病变占16.69%(214例),炎症性疾病占10.84%(139例),节育环位置异常占7.64%(98例),妊娠相关疾病占6.94%(89例),药物治疗占5.23%(67例),恶性病变占0.39%(5例),不典型性增生占1.64%(21例)。病理结果:刮出物中仅见黏液、凝血块等占0.31%(4例),子宫内膜为增殖期内膜占55.54%(712例),分泌期占6.08%(78例),混合型占9.82%(126例),萎缩型占3.20%(41例);炎症并呈息肉状增长占16.07(206例);妊娠物(蜕膜及滋养细胞)占6.94%(89例);不典型增生过长占1.64%(21例);恶性病变占0.39%(5例)。结论:绝经过渡期子宫不规则出血的主要原因为功血、子宫内膜良性病变、炎症性疾病、宫内节育器、妊娠相关疾病等。对于绝经过渡期子宫不规则出血,阴道超声(TVS)是首选的,而诊刮术依然是必行的检查手段。     

宫腔纱条填塞治疗剖宫产术中大出血36例分析

目的:探讨宫腔纱条填塞对于剖宫产出血的疗效和价值。方法:36例剖宫产术中出血在常规手法按摩、宫缩剂应用无效的情况下,均行宫腔填塞纱条。结果:本组患者均有效控制出血,成功保留子宫。术后积极预防感染,无感染发生。结论:剖宫产术中大出血采用宫腔纱条填塞是一个安全有效且简易的方法,值得基层医院推广应用。     

射频消融术治疗子宫良性病变的临床研究

目的 探讨射频消融术治疗子宫肌瘤、子宫腺肌瘤、功能失调性子宫出血(功血)等子宫良性病变的疗效.方法 对三所医院的1069例妇科射频治疗病人进行回访,比较其治疗前、后临床表现及B超的变化.结果 子宫肌瘤有效率为94.74%,子宫腺肌瘤为88.31%,功血为96.91%,宫颈糜烂为100.0%.结论 射频热凝固治疗子宫肌瘤(＜6.0cm)、子宫腺肌瘤、功血和宫颈糜烂时间短,见效快,疗效高,患者住院时间短,治疗费用低.     

Familial aggregation of morbid obesity

Recent studies have shown major gene effects for obesity in randomly ascertained families. To investigate the familial aggregation of a specific subset of obesity, which is particularly prone to medical complications, families with morbid obesity were studied. This condition occurs in 1%-2% of the population and is defined as 45.5 kg (100 pounds) or more over ideal weight. First-degree relatives of 221 morbidly obese probands (1560 adults) were identified, and height and weight (current and greatest) were obtained from each family member. Morbid obesity occurred in the family members of the probands 8 times more often than in the general population. Of the morbidly obese probands, 48% had one or more first-degree relatives who were also morbidly obese compared to a 6% population estimate. By the ages of 20-24, 12% of the morbidly obese probands were already 45.5 kg or more overweight, and 45% were 22.7 kg (50 pounds) or more overweight. There was little difference in the prevalence of familial morbid obesity by the gender of the probands: 47% of the male probands and 48% of the female probands had another morbidly obese relative, while 67% and 53% of the early onset (before age 25) male and female probands, respectively, had one or more first-degree relatives who were also morbidly obese. In addition to the extreme degree of familial aggregation, the prevalence of morbid obesity in parent-offspring sets was calculated within the morbidly obese families. Morbidly obese families who have one or two morbidly obese parents have a 2.6 times increased risk (p<0.002) of having one or more morbidly obese adult offspring, compared to families who have neither parent morbidly obese. Evidence for trimodality of the body mass index distribution was found for each gender (p = 0.0006 for male relatives and p = 0.075 for female relatives). The strong familial aggregation of morbid obesity indicates the need for further understanding of the genetic determinants of this extreme clinical disorder and how environmental factors affect the genetic expression of the trait.     

子宫畸形致青春期子宫内膜异位症临床分析

目的:探讨子宫畸形致青春期子宫内膜异位症的发病原因、诊断方法及治疗原则。方法:2002年6月~2004年12月间我院经宫腔镜结合超声对6例青春期少女进行检查、诊断,经手术及病理证实为子宫畸形合并子宫内膜异位症,对其临床和病理资料进行回顾性分析。结果:①临床表现:6例患者均以原发性痛经为主要表现,其中1例先天无阴道患者表现为周期性腹痛。②宫腔镜结合超声检查:6例病例中诊断盲角子宫3例,残角子宫3例,其中5例合并与病侧子宫同侧的卵巢子宫内膜异位囊肿。③手术方式:以切除残角或盲角子宫为基本术式,盲角子宫者行大部盲角子宫切除术,术中完全切除盲角子宫内子宫内膜,合并卵巢巧克力囊肿者均行囊肿核除术、保留正常卵巢组织及另侧子宫,最终旨在保留正常生育功能。结论:宫腔镜结合B超检查可在术前早期明确诊断青春期少女子宫畸形合并子宫内膜异位症,早期诊断和早期治疗对保证青春期少女的生育功能意义重大。     

藏区妇女子宫脱垂38例盆底康复治疗的临床疗效分析

目的探讨盆底康复治疗对藏区妇女子宫脱垂的临床疗效。方法选择2014年5月至2015年5月在中航工业三六三医院就诊的来自于藏区的38例子宫脱垂患者作为研究对象,按分层区组设计随机分为治疗组20例和对照组18例,治疗组行盆底康复治疗,对照组行单纯盆底肌肉锻炼。测定治疗前后的盆底肌Ⅰ类、Ⅱ类肌纤维的肌力值及脱垂分度的变化,评价其效果。结果治疗组治疗后盆底肌Ⅰ类、Ⅱ类肌纤维肌力值及脱垂分度改善情况均优于对照组,差异有统计学意义(P0.05)。结论藏区妇女子宫脱垂盆底康复治疗效果优于单纯盆底肌肉锻炼,值得临床推广。     

Familial aggregation of ischemic stroke in young women: the Stroke Prevention in Young Women Study

BACKGROUND AND PURPOSE: Stroke occurs infrequently in young adults. While a familial basis for older onset stroke is well established, the extent of familial clustering in young-onset stroke is unknown. To address this issue, we compared the frequency of stroke in relatives of stroke cases to that in relatives of controls across different ages and by stroke subtype. METHODS: Through a population-based case-control study of stroke, we identified 487 women aged 15-49 years with ischemic stroke and 615 women without stroke matched by age and geographic region. Family history of stroke was collected for 5,749 relatives (parents and siblings) of case and control probands by standardized interview. RESULTS: Strokes were reported in 149 relatives of case patients and 119 relatives of controls. Siblings of stroke case patients had more than four times the risk of stroke compared to siblings of controls (OR, 4.17; 95% CI, 1.9-8.8) and mothers of stroke case patients had twice the risk of stroke compared to mothers of control subjects (OR, 2.02; 95% CI, 1.4-3.0). The association between stroke in probands and family history of stroke was strongest among women aged 15-24 years (OR, 2.5; 95% CI, 0.4-15.1), and diminished with increasing proband age (OR, 1.6; 95% CI, 0.8-3.3 among women 25-34 years and OR, 1.5; 95% CI, 1.1-1.9 among women 35-49 years; P<0.0001 for trend). CONCLUSIONS: We conclude that young-onset stroke aggregates in families and that the magnitude of aggregation increases with decreasing proband age.     

Familial aggregation of energy intake in children

BACKGROUND: Uncompensated overnutrition promotes obesity, but the controls of children's eating behavior are poorly understood. Insights may be achieved by testing whether the eating patterns of children are associated with demographic variables or whether they aggregate among family members. OBJECTIVE: We tested whether children's total energy intake and macronutrient intake and their ability to compensate for earlier energy intake were associated with sociodemographic variables and anthropometric indexes. We also tested whether these behavioral traits aggregate among siblings. DESIGN: Thirty-two sibling pairs aged 3-7 y consumed a multi-item lunch preceded by a low-energy (12.55 kJ) or high-energy (627.60 kJ) preload drink. Mixed-models regression tested the associations between children's energy intake, demographic variables, and anthropometric measures. An intraclass correlation coefficient quantified the family correlation of the measures of children's eating. RESULTS: Children consumed significantly more total energy after consuming the low-energy preload ( +/- SD: 2237.39 +/- 1176.45 kJ) than after consuming the high-energy preload (1601.18 +/- 930.65 kJ). Compensation ability was unrelated to the children's age, sex, or ethnicity. Total energy and macronutrient intake, but not compensation propensity, were associated among siblings. CONCLUSIONS: The familial association of total energy and macronutrient intakes, independent of anthropometric measures, suggests genetic or home environmental influences specific to these behaviors. Short-term energy compensation, although very accurate within this sample, showed no significant familial correlation.