含消炎痛IUD对家兔子宫内膜影响的酶组织化学观察

本文采用酶组织化学方法观察了含消炎痛IUD对家兔子宫内膜几种酶的影响,并与全铜、硅胶及铜加消炎痛IUD进行了比较.结果表明:(1)含消炎痛IUD组子宫内膜NSE、SDII和ATPase三种酶活性增强;全铜IUD组则上述三种酶活性明显下降;加消炎痛的含铜IUD组子宫内膜酶活性低于含消炎痛IUD组,但高于硅胶对照组.(2)全铜IUD组子宫内膜损伤较明显.由此可见,含消炎痛IUD对子宫内膜上皮功能及结构的损害均小于含铜IUD.     

子宫颈上皮内瘤变Ⅲ级患者的术后随诊及其影响因素

目的探讨宫颈上皮内瘤变Ⅲ级（CINⅢ）患者的术后随诊情况及其影响因素。方法回顾性分析1999年1月1日至2004年6月30日北京协和医院收治的293例CINⅢ患者的临床资料,将有液基薄层细胞学（TCT）检查者定义为有效随诊,分析CINⅢ患者的术后随诊情况及其影响因素。结果293例患者中,有效随诊率为66．2％（194／293）。有效随诊的194例患者中18例（9．3％）TCT检查异常。有效随诊患者中,首选宫颈锥切术患者的有效随诊率[70．5％（177／251）]明显高于首选子宫全切除术者[40．5％（17／42）;P〈0．05];接受妇科肿瘤专业医生手术患者的有效随诊率[71．9％（133／185）]明显高于非妇科肿瘤专业医生手术者[56．5％（61／108）;P〈0．01];年龄≥40岁患者的有效随诊率[58．5％（76／130）]明显低于〈40岁者[72．4％（118／163）;P〈0．05];但根据患者的户籍是否在就诊地点,其有效随诊率[外地患者、北京患者的有效随诊率分别为65．9％（58／88）、66．3％（136／205）]比较,差异无统计学意义（P=0．100）。结论年龄≥40岁、接受子宫全切除术和非妇科肿瘤医生诊治明显影响患者的有效随诊率。CINⅢ患者术后的有效随诊率取决于临床医生和患者对本病的认识程度。     

血清降钙素原、C反应蛋白、白细胞介素-6水平在小儿骨关节感染中的水平变化及临床意义

目的 探讨血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)在小儿骨关节感染中的水平变化及临床意义.方法 选择2015年12月至2017年12月郑州大学附属儿童医院收治住院的骨关节感染患儿90例为观察组,同期选取健康体检儿童90例为对照组.所有小儿均检测血清PCT、CRP、IL-6水平.统计两组血...     

子宫内膜异位症不孕者腹腔巨噬细胞释放IL－1对精子穿卵的影响

免疫与不孕的关系普遍受到关注。我们已报道了子宫内膜异位症不孕者腹腔巨噬细胞及其释放ＩＬ－１的改变。本研究进一步检测了具有高活性的子宫内膜异位症不孕患者腹腔巨噬细胞培养上清对精子穿卵作用的影响。经与正常生育妇女相应的指标对比，发现二者有显著性差异。研究表明，含高活性ＩＬ－１的巨噬细胞培养上清有抑制精子穿卵作用，子宫内膜异位症不孕可能与ＩＬ－１作用有关。     

左乙拉西坦治疗小儿癫痫的疗效和安全性分析

评价左乙拉西坦（LEV）治疗小儿癫痫的疗效和安全性。方法　2007年8月至2008年8月武汉市儿童医院神经内科病房和门诊收治的56例癫痫患儿口服 LEV片。其中32例单药治疗;24例添加治疗,即在原有抗癫痫药物剂量及用法不变的基础上添加LEV口服。起始剂量为5.2～20.8 mg/（kg·d）,2次/d;目标剂量 为14.4～41.6 mg/（kg·d）,2次/d。随访时间为3～12个月。结果　LEV单药治疗有效率为68.8%,无发作率为40.6%,添加治疗有效率为41.7%,无发作率为8.3% 。两组比较差异有统计学意义（P＜0.05）。LEV副反应较少,主要为胃肠不适、头晕、嗜睡、易激惹等。结论　LEV治疗儿童癫痫有效,单药治疗疗效高于添加治 疗,患儿对其有较好的耐受性。     

子宫内膜异位症不孕者腹腔巨噬细胞释放IL－1对精子穿卵的影响

免疫与不孕的关系普遍受到关注。我们已报道了子宫内膜异位症不孕者腹腔巨噬细胞及其释放ＩＬ－１的改变。本研究进一步检测了具有高活性的子宫内膜异位症不孕患者腹腔巨噬细胞培养上清对精子穿卵作用的影响。经与正常生育妇女相应的指标对比，发现二者有显著性差异。研究表明，含高活性ＩＬ－１的巨噬细胞培养上清有抑制精子穿卵作用，子宫内膜异位症不孕可能与ＩＬ－１作用有关。     

腹部手术后盆腹腔粘连发生及相关因素分析

目的:分析前次腹部手术后盆腹腔粘连的发生及相关因素。方法:2002年1月至2005年4月就诊于北京协和医院、有腹部手术史及因各种妇科疾病需行腹腔镜手术的患者170例。记录既往的手术相关情况以及腹腔镜手术中盆腹腔的粘连情况,对粘连进行分级并分析其相关因素。结果:腹壁切口下方粘连总的发生率为40.6%(69/170)。腹腔镜切口粘连发生率为8.7%(2/23)较横切口的46.4%(13/28)、纵切口的42%(34/81)、其他类型切口的52.6%(20/38)相比较低,其差异有显著性(P=0.003,P=0.003,P<0.001)。多次手术是切口下粘连的危险因素(χ2=8.699,P=0.013)。手术野粘连率为77%(131/170)。有不孕史、PID史以及子宫内膜异位症(EM)史者粘连的发生率分别为96.3%,100%及94.4%。与无上述病史的手术者比较,手术野严重粘连的发生率显著增高(P<0.001,P=0.008,P<0.001)。结论:有腹部手术史的患者,切口下方及手术野粘连发生率较高。切口下方粘连与手术方式及手术次数相关。腹腔镜手术切口下方的粘连发生率最低。多次手术史切口下方的粘连尤其是肠粘连发生率较高。手术野粘连与腹壁切口种类无关,与手术种类有关,其中EM、不孕及PID手术史是手术野粘连的危险因素。     

子宫内膜异位症患者γδT细胞及NK细胞的功能分析

目的 :分析子宫内膜异位症患者中γδT细胞和天然杀伤 (NK)细胞功能的变化 ,并探讨患者腹腔液对正常人γδT细胞和NK细胞功能的影响。方法 :采用免疫荧光细胞检测及细胞毒活性检测法分析 2 2例子宫内膜异位症患者外周血、腹腔液中的γδT细胞及NK细胞的表型与功能。结果 :子宫内膜异位症 (疾病组 )患者外周血、腹腔液中CD56+细胞与正常对照组无明显差异 ,而疾病组腹腔液中γδ+T细胞分别高于外周血和正常对照组。疾病组腹腔液中的γδT细胞及NK细胞的功能低于外周血及正常对照组。疾病组的腹腔液对正常人外周血γδT细胞及NK细胞的功能具有负相调节作用。结论 :子宫内膜异位症患者的γδT细胞及NK细胞的功能低下 ,处于被抑制状态 ,提示子宫内膜异位症患者的腹腔中存在γδT细胞及NK细胞功能的抑制因子。     

多巴胺和多巴酚丁胺治疗小儿重症肺炎合并心力衰竭的疗效观察

目的观察多巴胺和多巴酚丁胺治疗小儿重症肺炎合并心力衰竭的治疗效果。方法 2015年1月至2016年1月湖南省儿童医院儿科ICU病房收治的重症肺炎合并心力衰竭患儿70例,随机分为观察组和对照组各35例。对照组采用强心剂、抗生素、氧疗等常规治疗措施,观察组在常规治疗基础上给予多巴胺、多巴酚丁胺治疗。治疗前后对患儿的肌钙蛋白、肌酸激酶同工酶(CK-MB)、B型纳尿肽(BNP)水平检测,观察两组治疗效果。结果观察组总有效率为97.2%(34/35),显著高于对照组77.2%(27/35),差异有统计学意义(P0.05)。观察组BNP、肌钙蛋白、CK-MB水平显著低于对照组,差异有统计学意义(P0.05);观察组患儿症状消失时间、住院时间均低于对照组,差异有统计学意义(P0.05)。结论对合并心力衰竭的重症肺炎患儿在常规对症治疗基础上,用多巴胺、多巴酚丁胺联合治疗能更好调整患儿相关临床指标,缓解患儿症状时间更短,缩短住院时间,保障患儿治疗依从性和其家庭经济负担。     

PTN和MK在子宫内膜异位症中的表达及意义

目的:探讨pleiotrophin(PTN)和midkine(MK)mRNA在子宫内膜异位症(EMs)中的表达及意义。方法:采用病例对照研究方法,以35例EMs患者在位和异位子宫内膜(研究组)以及25例非EMs妇女子宫内膜(对照组)为样本,应用半定量逆转录聚合酶链反应(RT-PCR)检测PTN、MK mRNA的表达。结果:研究组在位内膜中PTN和MK表达均明显高于对照组(P<0.01);异位内膜PTN mRNA表达高于对照组(P<0.05),差异有统计学意义。EMs在位内膜中PTN、MK mRNA表达与内异症的临床期别呈正相关。无论增殖期或分泌期,EMs在位内膜中PTN、MK表达均高于对照组(均P<0.05)。结论:EMs患者在位子宫内膜组织中PTN和MK表达的变化可能与子宫内膜异位症的发生、发展有关。     

子宫内膜异位症患者辅助性T细胞亚群免疫状态的研究

目的　探讨辅助性T细胞 (Th)亚群在子宫内膜异位症 (内异症 )发病中的作用。方法　采用酶联免疫吸附法检测 30例内异症患者 (内异症组 )及 2 0例非内异症患者 (对照 1组 )血清及腹腔液中白细胞介素 (IL) 2、6的水平 ;用免疫组化技术分别检测IL 2、IL 6在内异症组患者异位内膜组织和 10例子宫肌瘤患者 (对照 2组 )的正常子宫内膜组织中的表达。结果　内异症组患者血清及腹腔液中位数IL 6水平分别为 5 3、2 1ng/L ,对照 1组患者血清及腹腔液中位数IL 6水平分别为 2 5、0 9ng/L ,两组妇女血清和腹腔液中IL 6水平分别比较 ,差异均有统计学意义 (P <0 0 5 ) ;内异症组Ⅲ～Ⅳ期患者血清及腹腔液中位数IL 6水平分别为 13 6、4 1ng/L ,Ⅰ～Ⅱ期患者血清及腹腔液中位数IL 6水平分别为 3 7、1 6ng/L ,Ⅲ～Ⅳ期患者与Ⅰ～Ⅱ期患者血清及腹腔液中位数IL 6水平比较 ,差异均有统计学意义 (P <0 0 5 ) ;内异症组IL 2 /IL 6比值在血清及腹腔液中分别为 0 7、1 1,均分别低于对照组的 0 8、6 2 ,差异也有统计学意义 (P <0 0 5 )。内异症组患者腹腔液与血清IL 6水平呈正相关 (r =0 74 5 ,P <0 0 1) ,血清及腹腔液中IL 6水平与IL 2 /IL 6比值均呈负相关 (r =- 0 4 0 6 ,P <0 0 5 ;r =- 0 4 80 ,P <0 0 5 )     

系统性红斑狼疮患儿血清铁蛋白变化及其与病情活动的相关性研究

目的　研究系统性红斑狼疮（SLE）患儿血清铁蛋白（SF）变化及临床意义。方法　研究对象为2004—2009年在南昌大学第二附属医院住院的58例SLE患儿,采用化学发光法检测患儿治疗前和治疗后及30名健康体检儿童的SF。结果　SLE患儿SF显著高于对照组,且活动期SF显著高于静止期。SLE患儿治疗后SF明显下降。SLE患儿SF与抗ds-DNA抗体SLE疾病活动性指标（SLEDAI）评分均呈正相关。结论　SLE患儿的SF较健康儿童显著升高,SF与病情活动性呈正相关,可作为诊断儿童SLE有价值的实验室指标。     

Correlation of cyclin D1 and cyclin D3 overexpression with the loss of PTEN expression in endometrial carcinoma

Cyclins D1 and D3 play key roles in cell cycle progression. The downregulation of cyclin D3 was associated with phosphatase and tensin homolog deleted on chromosome ten-(PTEN)-induced cell cycle arrest. We attempted to determine whether cyclin D1 and D3 overexpression is correlated with PTEN inactivation in endometrioid endometrial cancer (EEC). The expression of PTEN, cyclin D1, and cyclin D3 were determined by immunohistochemical analysis in 105 EEC specimens. Forty-three percent of the EEC demonstrated loss of PTEN expression. Cyclin D3 was overexpressed in only 18% of the EEC specimens and was not associated with tumor grade. Cyclin D1 was overexpressed in 64% of the specimens and was more common in moderate or high-grade tumors (P = 0.002 and P = 0.02, respectively). The overexpression of cyclin D3 was not correlated with loss of PTEN in the EEC. The overexpression of cyclin D1 was much higher in grade 1 tumors with negative PTEN than tumors with positive PTEN expression (67% vs 26%). The overexpression of cyclin D3 was neither frequent nor correlated with the loss of PTEN expression. The overexpression of cyclin D1 was higher in the low-grade tumors with negative PTEN expression than tumors with positive PTEN expression. Overexpression of cyclin D1 is frequent in moderate or high-grade EECs and likely results from multiple mechanisms.     

Taquicardia supraventricular fetal, diagnóstico y tratamiento prenatal

We report two cases of supraventricular tachycardia, diagnosed and treated in the prenatal period. The first case concerns a fetus diagnosed with supraventricular tachycardia in week 31 of gestation. The mother was treated with digoxin with subsequent addition of propranolol. Although cardioversion was not achieved, the fetus showed no signs of cardiac decompensation. The second case involved a fetus diagnosed with supraventricular tachycardia with hydrops and polyhydramnios at week 28+3 of gestation. The mother was treated with digoxin and flecainide was subsequently added, achieving sinus rhythm.     

青春期少女卵巢上皮性肿瘤的临床特点及治疗

目的探讨青春期少女卵巢上皮性肿瘤的临床特点及治疗方法。方法回顾性分析北京协和医院1983年1月-2002年10月间收治的全部13～19岁卵巢上皮性肿瘤患者29例。其中,良性肿瘤20例、交界性肿瘤4例、恶性肿瘤5例。结果患者平均年龄16．5岁,其中13-14岁3例(10％)、15．16岁9例(31％)、17-19岁17例(59％)。临床表现主要为腹痛、腹胀、下腹部巨大肿物。病理类型：黏液性肿瘤22例,浆液性肿瘤6例,子宫内膜样肿瘤1例。手术病理分期：交界性或恶性肿瘤患者9例中,Ⅰ期8例,Ⅲc期1例。治疗：良性肿瘤20例中,开腹行一侧附件切除术9例,腹腔镜下行卵巢囊肿剔除术11例;9例交界性或恶性肿瘤患者全部施行了肿瘤细胞减灭术和全面的分期手术,其中8例I期患者保留了生育功能,1例Ⅲc期患者未保留生育功能;5例恶性肿瘤患者中,4例接受了4-6个疗程以顺铂为主的化疗。随访期间良、恶性肿瘤无一例复发。结论青春期少女卵巢上皮性肿瘤的发生率随年龄的增长而增加;黏液性肿瘤是最常见的病理类型。对于多数良性肿瘤患者可以考虑腹腔镜下行肿瘤剔除术;对于交界性或恶性肿瘤患者应兼顾治愈肿瘤和保留生育功能,治疗方案应个体化。     

Histochemical study on lectin binding in surface epithelial tumor of the ovary

The lectin binding to cells of inclusion cyst and surface epithelial tumor of the ovary was studied by lectin histochemistry. The RCA-1 only bound to inclusion cyst. All lectins bound to serous cystadenoma but PNA UEA-1, WGA and RCA-1 bound to mucinous cystadenoma. The binding of PNA was identified in association with serous cystadenocarcinoma in 5 of 7 cases (71.4%) and with clear cell adenocarcinoma in 5 of 5 cases (100%). The binding of UEA-1 was identified in association with endometrioid adenocarcinoma in 4 of 5 cases (80%) and with mucinous cystadenocarcinoma in 3 of 5 cases (60%). The binding of SBA was identified in association with clear differentiation in 6 of 7 cases (85.7%), with moderate differentiation in 8 of 12 cases (66.7%) and with poor differentiation in 0 of 3 cases (0%). The binding of DBA was identified in association with clear differentiation in 5 of 7 cases (71.4%), with moderate differentiation 5 of 12 cases (41.7%), and with poor differentiation in 0 of 3 cases (0%). The PNA and UEA-1 had shown relative correlation with the histological type. The intensity of SBA and DBA binding was greater in clear differentiation than in poor differentiation. There was close correlation between SBA and DBA binding patterns and histological grading. The results of this study suggested that the lectin histochemical study was useful in detecting the histological type and grade. The results were also consistent with studies demonstrating a change in cellular carbohydrate composition following malignant transformation.     

单纯性肥胖外周血单核/巨噬细胞趋化因子与胰岛素抵抗的相关性研究

了解单纯性肥胖儿童外周血单核/巨噬细胞趋化因子与胰岛素抵抗相关参数的关系。方法　2006年5月至2008年5月广西医科大学第一附属医院儿科70 例确诊为单纯性肥胖儿童作为研究对象,30名健康体检儿童作为健康对照组。流式细胞仪测定外周血单核细胞CD68阳性率;酶联免疫吸附（ELISA）法测定血浆巨 噬细胞炎性蛋白-1α（MIP-1α）、单核细胞趋化蛋白-1（MCP-1）水平;放射免疫分析（RIA）法测定血浆脂联素（ADPN）、血浆胰岛素（Ins）浓度,计算体质 指数（BMI）,按HOMA模型计算胰岛素抵抗指数（InRI）,并与相关变量进行Pearson相关分析或偏相关分析。结果　单纯性肥胖组血浆MIP-1α、MCP-1水平高于 健康对照组,两组比较差异有统计学意义（P < 0.05）。两组外周血CD68阳性率比较差异无统计学意义（P > 0.05）。两组InRI比较差异有统计学意义 （P < 0.05）。单纯性肥胖组血浆MIP-1α、MCP-1水平分别与BMI、腰围（WC）和InRI呈正相关 （P < 0.05）。血ADPN分别与BMI、WC和InRI呈负相关（P < 0.05）。外 周血单个核细胞CD68阳性率与BMI、WC和InRI无相关性（ P > 0.05）。结论　单纯性肥胖患儿体内存在低程度炎症反应,肥胖儿童外周血单核/巨噬细胞趋化因子 与胰岛素抵抗及中心性肥胖相关,可以作为肥胖相关疾病的早期预测指标之一。     

C—反应性蛋白测定用于妇科恶性肿瘤诊断的初步观察

通过检测51例妇科良性肿瘤及32例妇科恶性肿瘤患者血清C—反应性蛋白(CRP),发现妇科恶性肿瘤病人血清CRP含量明显增高。良性肿瘤病人血清CRP均为阴性,CRP含量的变化反映妇科恶性肿瘤的严重程度,CRP含量越高妇科恶性肿瘤患者期别越晚。其中卵巢癌病人C—反应性蛋白的阳性检测率100％,但3例恶性葡萄胎病人CRP为阴性,其原因有待于进一步探讨。本文提示:CRP的检测可用于妇科恶性肿瘤的辅助诊断、良恶性肿瘤的鉴别、恶性肿瘤的预后及恶性肿瘤病人化疗疗效的预测。     

A comparison of ovarian metastasis between squamous cell carcinoma and adenocarcinoma of the uterine cervix

OBJECTIVE: The purpose of our study was to investigate a possible difference in ovarian metastasis between squamous cell carcinoma and adenocarcinoma of the uterine cervix and to confirm clinicopathological variables associated with the metastases. METHODS: Clinical and pathological variables of 1064 patients with invasive squamous cell carcinoma and 240 with adenocarcinoma were studied. RESULTS: Ovarian metastasis was found in 14 patients (1.3%) with squamous cell carcinoma and 15 (6.3%) with adenocarcinoma. The mean age of patients with ovarian metastasis of squamous cell carcinoma was 57.4 years, compared to 50.2 years for adenocarcinoma. Ovarian metastasis of adenocarcinoma was more likely to be visible (40.0%) and present in both ovaries (66.7%), while these two characteristics occurred in only 21.4 and 36.7% of patients with squamous cell carcinoma. A logistic regression analysis with clinical variables indicated that clinical stage beyond IIb was a significant variable of squamous cell carcinoma, and more than 30-mm tumor size was significant in adenocarcinoma. CONCLUSION: The incidence of ovarian metastasis of adenocarcinoma of the uterine cervix was significantly higher than that of squamous cell carcinoma. The incidence of adenocarcinoma was associated more closely with tumor size than clinical stage, whereas it was more associated with clinical stage in squamous cell carcinoma. The results thus suggested that the differences in ovarian metastases were caused by the different characteristics of the two types of carcinoma.     

Postmenopausal endometriosis

The frequency of postmenopausal endometriosis (ovarian endometriosis and adenomyosis) was 2.2%. The mean of the menopausal ages in 11 patients with ovarian endometriosis was 50.3 yr and the average time elapsed since menopause, 7.3 yr. The corresponding values in 8 patients with adenomyosis were 52.1 and 8.8 yr. Carcinoma was a common associated finding in patients with ovarian endometriosis. Increased estrogen activity was observed more frequently in patients with adenomyosis than in those with ovarian endometriosis. Only one of the patients had received estrogen therapy. Hormone-producing tumors in the ovaries or adrenal glands were not confirmed. 70% of the patients were obese and the signs of increased estrogen activity could be explained by extraglandular estrogen formation.