高泌乳素血症80例临床分析

目的 探讨高泌乳素血症(HP)的病因及临床特点.方法 对80例HP患者的临床表现、实验室等辅助检查及治疗进行回顾性分析.结果80例HP病因中,垂体泌乳素瘤30例(37.5%),多囊卵巢综合征12例(15.0%),口服避孕药4例(5.0%),甲状腺功能低下7例(8.8%),空蝶鞍1例(1.2%),原因不明26例(32.5%).治疗后血清泌乳素水平下降早于泌乳症状改善,而月经及排卵功能的恢复明显滞后.结论 多种原因可引起HP,溴隐亭为HP治疗的首选,月经改善及排卵功能恢复可作为溴隐亭减量的指标.     

显微外科手术治疗泌乳素腺瘤的临床效果探讨

[目的]评估泌乳素(Prolactin,PRL)腺瘤显微外科手术治疗效果及长期缓解预测指标。[方法]收集358例PRL腺瘤患者病例资料,并进行长期随访。[结果]术前PRL>200μg/L者术后缓解率(37.4%)明显低于PRL<100μg/L和100~200μg/L者(89.2%和80.3%);侵袭性腺瘤术后缓解率(34.9%)明显低于微腺瘤和非侵袭性大腺瘤(93.6%和82.8%)。术后1周PRL≤10μg/L者长期缓解率高达96.0%。[结论]术前PRL>200μg/L和侵袭性腺瘤患者,手术效果较差,术后常需进行药物治疗或放疗;术后1周PRL≤10μg/L可做为PRL腺瘤长期缓解的预测指标。     

妊娠合并垂体泌乳素腺瘤11例临床分析

目的:探讨垂体泌乳素腺瘤患者在妊娠期间的安全性及孕期治疗此病对妊娠结局的影响。方法:回顾性分析安徽医科大学第一附属医院1988～2008年间收治的11例妊娠合并垂体泌乳素腺瘤(垂体微腺瘤9例,大腺瘤2例)患者孕前、孕期、分娩及分娩后的母儿预后情况。结果:垂体腺瘤在孕期体积增大出现压迫症状2例(大腺瘤与微腺瘤各1例),妊娠并发子痫前期(轻度)1例,妊娠期糖耐量异常1例,妊娠期肝内胆汁淤积症3例,巨大儿1例,早产1例。分娩方式均为剖宫产。新生儿及随访未见异常。结论:垂体微腺瘤在孕期停药是相对安全的,而腺瘤孕期发生体积增大的风险性较高。垂体泌乳素腺瘤并不增加妊娠的并发症,亦未发现新生儿出生缺陷。     

手术和旋转式伽玛刀治疗垂体微腺瘤的疗效分析

目的 探讨手术和旋转式伽玛刀治疗垂体微腺瘤的疗效对比.方法 对52例垂体微腺瘤患者分别采用手术治疗(25例,手术组)和伽玛刀治疗(27例,伽玛刀组),对两组疗效进行分析.结果 手术组临床症状体征改善或恢复正常19例(76.0%),激索水平下降或正常18例,占激素有异常者78.3%(18/23),症状体征及激素水平改善时间2～4周,平均20.3 d;伽玛刀组临床症状体征改善或恢复正常23例(85.2%),激素水平下降或正常22例,占激素有异常者88.0%(22/25),症状体征及激素水平改善时间4～6个月,平均5.1个月.两者比较差异均无统计学意义(P值均>0.05).手术组2例继发脑脊液漏,1例因术后颅内感染死亡;伽玛刀组2例出现反应性脑水肿,1例出现甲状腺功能低下,无死亡病例.结论 手术治疗垂体微腺瘤的症状体征改善率及内分泌激素水平好转率所需时间明显短于伽玛刀治疗,且影像学复查结果也好于伽玛刀治疗.伽玛刀治疗效果略高于手术治疗,不良反应明显下降,但治疗后激素水平下降缓慢,需服用药物辅助治疗.对垂体微腺瘤的治疗,手术和伽玛刀治疗均是安全有效的方法.     

饮食因素所致特发性高泌乳素血症41例分析

对４１名饮食因素导致的乳房肿痛患者进行了全面的身体检查，并采用放射免疫法检测了血清泌乳素（ＰＲＬ）、促卵泡素（ＦＳＨ）、黄体生成素（ＬＨ）、雌二醇（Ｅ２）、孕酮（Ｐ）、睾酮（Ｔ）、促甲状腺激素（ＴＳＨ）的浓度，随后用溴隐亭进行试验性治疗。结果表明：所有患者除乳房肿痛外，泌乳素均有升高；其他激素无明显改变。溴隐亭可使其泌乳素水平下降，乳房肿痛减轻。根据该病特点将其与常见的高泌乳素血症及乳房疾病进行了鉴别，并认为该病为非器质性病变，脱离致病源后可自然转归。     

高泌乳素血症伴不孕症49例治疗探讨

目的:探讨高泌乳素血症伴不孕症治疗方案及效果。方法:2002年1月～2007年6月本院生殖医学专科收治的高泌乳素血症伴不孕症患者49例,采用分组治疗:A组26例(其中2例为垂体巨腺瘤,已行开颅垂体瘤切除术),采用溴隐亭口服治疗;B组23例(其中1例为垂体微腺瘤),采用溴隐亭阴道给药治疗。用药半个月、1个月、1个半月后观察泌乳素(PRL)变化情况。对PRL值降至25ng/ml以下者采用CC/HMG/HCG方案促排卵,观察妊娠情况。结果:经半个月、1个月或1个半月溴隐亭口服或阴道给药治疗后,各组血PRL值较治疗前明显降低(P0.05或P0.01);A组与B组比较,PRL值治疗前后差异均无统计学意义;A组25例、B组21例PRL降至25ng/ml以下,给予CC/HMG/HCG方案促排卵后,分别有18例和14例妊娠。结论:溴隐亭口服与阴道给药两种治疗方案在降低高泌乳素血症伴不孕症患者PRL水平方面疗效无明显差异,溴隐亭阴道给药是治疗高泌乳素血症伴不孕症可选方案之一。     

溴隐亭治疗高泌乳素血症的临床观察

高泌乳素(PRL)血症是多种病因所致的血清泌乳素浓度超过正常(正常妇女血清PRL浓度为1~23ug/L,男性1~20ug/L),临床上女性可表现为溢乳症或溢乳—闭经症;男性呈性功能低下或阳萎。采用澳隐亭治疗可以使溢乳症状消失,降低泌乳素水平,恢复月经和生育功能;男性恢复性功能。现就近四年中20例患者治疗结果分析报告如下。     

二溴氯丙烷作业女工垂体微腺瘤3例报告

国内某氯碱厂于1976年1月～1982年7月间生产二溴氯丙烷(dibromochloropropaneDBCP)乳剂,每年生产5 0 0～70 0t,成品浓度为80 %～82 %。期间接触DBCP女工2 0名,2 0 0 1年体检时发现垂体微腺瘤3例,现报告如下。1　病例报告　　高某,女,48岁,从事DBCP生产6 5a。头晕、头痛、失眠、乏力2 0余年,加重3a伴性功能减退。无避孕药及雌激素服用史。月经193～52 8～40 量少,自1987年始极不规律,经常停经3～6个月。2 6岁结婚,生1男性,健康。查:皮肤粘膜无异常,无毛发脱落,双乳无泌乳。视野无缩小,双肺呼吸音清,无口罗音。心律68次/min ,律齐。肝脾…     

视线模糊应提防垂体腺瘤

数据证明,在促进垂体腺瘤患者就诊的症状中,有近1/3是视线模糊,也就是医学上所言的视力视野障碍,但是由于症状呈现眼部,经常使患者在几经辗转后,才得知自己患有垂体腺瘤。垂体腺是人体的内分泌腺,本身会分泌激素,还有一些下丘脑激素也通过垂体产生,调节人体的代谢和生理机能。垂体腺瘤一般指发生在垂体前叶     

非意愿妊娠情况分析

目的:通过对常州市育龄妇女非意愿妊娠的现状调查,分析中止非意愿妊娠的理想方式,探讨降低非意愿妊娠的有效措施,保护广大育龄妇女的生殖健康。方法:根据常州市区所有从事计划生育手术单位的月报表,对2002～2005年间的73346例人工流产进行回顾性分析。结果:药物流产构成比由2002年的33.92%上升至2005年的48.08%(P<0.01),人工流产负压吸引术构成比由2002年的60.27%下降至2005年的48.08%(P<0.01)。终止妊娠手术原因前三位分别为未婚先孕(36.09%)、其它(24.02%)及无措施(21.36%),未婚先孕者流产由2002年的30.52%上升至2005年的39.84%(P<0.01)。结论:常州市区各医院计划生育手术以负压吸引术和药流术为主,药流数逐年上升;减少非意愿妊娠的重点是加强青少年生殖健康教育,以及宣传普及避孕知识,合理应用紧急避孕方法。     

遵义地区292例育龄期妇女多囊卵巢综合征临床分析

目的:探讨遵义地区育龄期妇女多囊卵巢综合征(PCOS)患者的患病特征,为早期、科学合理诊治提供理论依据。方法:选取2007年11月~2009年9月遵义医学院附属医院就诊的育龄期妇女PCOS患者292例,同期因输卵管因素或者男方因素导致不孕就诊的育龄期妇女201例设为对照组。分析PCOS患者的一般症状、血清学特征、超声声像学特征及部分子宫内膜病理情况。结果:①遵义地区育龄期妇女PCOS患者常见临床征象依次为:超声显像示卵巢多囊性变(95.89%)、月经紊乱(89.38%)、不孕症(77.74%)、LH/FSH比值≥2(49.32%)、痤疮(36.99%)、肥胖(31.51%)、多毛(9.59%,F-G总分≥6分)。②多毛诊断标准以F-G总分≥2分作为临界值,本地PCOS患者多毛的发生率为30.82%。③PCOS患者LH、E2、T及LH/FSH水平均高于对照组,差异有统计学意义(P<0.01)。结论:①不同地区人群PCOS的临床表现和生化特征存在差异。对于遵义地区人群来说,月经不调和超声显像示卵巢多囊性变是育龄期妇女PCOS患者的主要临床特征。②LH/FSH≥2应作为筛查遵义地区PCOS患者的指标之一。③对于多毛的诊断标准,F-G总分≥2分可能更适合于遵义地区人群。     

神经导航在经蝶垂体腺瘤显微切除术中的应用

目的探讨神经导航系统在经蝶垂体腺瘤显微切除术中的应用价值。方法对21例垂体腺瘤患者实施导航指引的经蝶入路手术。结果神经导航系统能准确指引手术进行,术中无一例损伤颈内动脉等重要结构,术后患者临床症状均有所改善,并发症少。结合术中镜下所见、术后复查影像及随访资料,肿瘤全切率达90.5%,复发率仅4.8%。结论经蝶入路的垂体瘤导航手术能提供实时的三维解剖信息,准确指导手术进行,安全性好,肿瘤全切除率高,并发症少。     

育龄妇女和孕妇阴道微生态环境的比较研究

目的:对比育龄妇女和孕妇阴道内微生态状况。方法:分别取800例育龄妇女和孕妇的阴道分泌物标本,涂片后用革兰染色,显微镜下计数后进行Nugent评分分析。结果:育龄妇女和孕妇假丝酵母菌感染的阳性率分别为20.4%和8.9%,滴虫感染的阳性率分别为4.6%和1.1%,细菌性阴道病(BV)阳性率分别为33.9%和8.8%,乳酸杆菌的含量分别为63.6%和84.5%,两组之间差异均有统计学意义(P<0.05)。结论:相较于育龄妇女,孕妇的阴道微生态状况更健康,对假丝酵母菌、滴虫和细菌性阴道病等常规疾病感染的抵抗力更强。     

孕妇和育龄妇女阴道微生态及影响因素分析

目的探讨孕妇和育龄妇女阴道微生态的状况并分析相关影响因素,为临床预防和控制妇女阴道菌群失衡提供依据。方法选择某医院门诊2011年1月至2012年12月育龄妇女1500例,为育龄组,妊娠妇女1200例为妊娠组,对阴道分泌物微生态及相关指标进行检测。结果妊娠组菌群正常为62．50％（750／1200）,高于育龄组的55．93％（839／1500）,差异有统计学意义（P〈0．05）;妊娠组细菌性阴道病检出率8．50％（348／1200）,低于育龄组的11．93％（179／1500）（P〈0．05）;妊娠组pH为4．22±0．77,低于育龄组的4.62±0．84（P〈0．05）;妊娠组H,0,和白细胞酯酶阳性率分别为（2．51±0．49）μmol／L和8．42％（101／1200）,育龄组为（2．28±0．41）μmol／L和11．20％（165／1500）,差异有统计学意义（P〈0．05）;妊娠组FSH和E2分别为（13．58±3．63）U／L和（421．09±42．47）pmol／L,均高于育龄组（P〈0．05）;妊娠组乳酸杆菌检出率为39．58％（475／1200）,高于育龄组的34．87％（523／1500）（P〈0．05）;妊娠组大肠埃希菌和支原体分别为11．33％（136／1200）和10．08％（121／1200）,均低于育龄组（P〈0．05）;妊娠组乳酸杆菌强度大于育龄组（P〈0．01）。结论妊娠组雌激素水平较育龄组高,阴道乳酸杆菌数量多于育龄组,pH值升高,阴道微生态好于育龄组。     

Habitual caffeine intake in women of childbearing age

Background For women, delayed conception and recurrent pregnant loss are just a few of the health implications associated with a caffeine‐rich diet (Mol. Hum. Reprod., 11, 357). At present there is a deficit of prospective research measuring current habitual intakes of caffeine in UK women. The purpose of the current study was to collect up‐to‐date baseline data to assess caffeine intake and knowledge in a group of women (aged 16–45 years). Methods Seventy Caucasian subjects (mean age 30.4 ± 8.7 years) were recruited from business offices within the Manchester area. Each participant completed a 3‐day food diary and lifestyle questionnaire. Results The mean intake of caffeine was 173.95 mg day^?1 (±128.39 mg day^?1). Eighteen per cent of subjects exceeded caffeine guidelines and consumed 300 mg caffeine or more each day. Subjects consuming over 300 mg day^?1 were more likely to be older (P = 0.016) and smokers (P = 0.000). Individuals given previous advice about caffeine and health, had lower intakes (P = 0.002). Conclusions Many women are unaware of health perturbations associated with caffeine consumption. A diet abundant in caffeine may result in delayed conception, infertility and increased risk of osteoporosis, cardiovascular disease and cancer later in life. Such information needs to be conveyed to the public sector. Future research is also required to devise specific caffeine guidelines, particularly safe upper limits.     

Iodine status of UK women of childbearing age

Background: Iodine deficiency in pregnant women can lead to impaired foetal brain development, linked to reduced intelligence quotient scores and impaired motor skills in the offspring (Haddow et al., 1999). As a result, the WHO (2007) has raised iodine requirements during pregnancy to 250 μg day^?1 (compared was 150 μg day^?1 for non‐pregnant adults). It is important that women meet this requirement to provide an adequate supply of thyroid hormones to the foetus. Historically, the UK was considered to have a sufficient iodine intake (Lee et al., 1994) but concern has recently been expressed about the iodine status of UK women (Kibirige et al., 2004). This study aimed to assess a cohort of UK women of childbearing age to identify the extent of any inadequacy in iodine intake. Methods: Twenty‐six women of childbearing age were recruited from the student and staff population of a university.Twenty‐four hour urine collections were obtained and total volumes measured. Iodide concentrations were measured using inductively coupled plasma mass spectrometry (ICP‐MS), considered the ‘gold standard’ technique (Vanderpas, 2006). Twenty‐four hour iodide excretion was calculated and used to assess the individual risk of deficiency using cut‐off values defined by Thomson et al. (1997). Iodine intake was estimated by extrapolation of 24‐h urinary iodide excretion (assuming 90% excretion rate) and this was compared to the reference Nutrient Intake (RNI) for adults and pregnant women. Ethical approval was obtained from The University Ethics Committee Results: The median value for urinary iodide concentration was 66 μg L^?1 (IQR 42), classifying the group as mildly deficient (WHO et al., 2001). Twenty‐four iodide excretion showed that five (19%) subjects were mildly iodine deficient as urinary iodide excretion was between 50 and 100 μg in 24 h. Iodine intake (estimated from urinary iodide excretion) indicated that seven subjects (27%) did not meet the adult requirement of 150 μg day^?1 and, should these subjects become pregnant, 17 subjects (65%) would not meet the 250 μg day^?1 requirement. Discussion: The findings of this small study give cause for concern as almost a fifth of individuals were classified as mildly deficient in iodine. This could have serious consequences if these women were to become pregnant. Various limitations of the study (selection of subjects and season) suggest that this is likely to be a best‐case scenario. It may be prudent to advise pregnant women to increase their intake of iodine‐rich foods during pregnancy. Conclusions: This study needs to be repeated in larger and more diverse cohorts to assess the prevalence of iodine insufficiency in the UK and the subsequent risk to foetal development. References Haddow, J.E., Palomaki, G.E., Allan, W.C. et al. (1999) Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N. Engl. J. Med. 341, 549–555. Kibirige, M.S., Hutchison, S., Owen, C.J. & Delves, H.T. (2004) Prevalence of maternal dietary iodine insufficiency in the north east of England: implications for the fetus. Arch. Dis. Child. Fetal. Neonatal. Ed. 89, 436–439. Lee, S.M., Lewis, J., Buss, D.H. et al. (1994) Iodine in British foods and diets. Br. J. Nutr. 72, 435–446. Thomson, C.D., Colls, A.J., Conaglen, J.V., Macormack, M., Stiles, M. & Mann, J. (1997) Iodine status of New Zealand residents as assessed by urinary iodide excretion and thyroid hormones. Br. J. Nutr. 78, 901–912. Vanderpas, J. (2006) Nutritional epidemiology and thyroid hormone metabolism. Annu. Rev. Nutr. 26, 293–322. WHO, ICCIDD & UNICEF. (2001) Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. A guide for Programme Managers, 2nd edn [Online] ed: World Health Organization. Available at http://www.who.int/reproductive‐health/docs/iodine_deficiency.pdf (accessed on 18 January 2007). WHO Secretariat (2007) Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2‐years‐old: conclusions and recommendations of the Technical Consultation. Public Health Nutr. 10, 1606–1611.     

Asthma education and outcomes for women of childbearing age

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Expectant mothers make decisions every day that affect their children as much as choosing the best name or preschool. Taking folic acid before pregnancy and prenatal vitamins during pregnancy, quitting smoking, and finding the right provider for prenatal and delivery care have a direct impact on a woman's health and that of her unborn child. However, an expectant mother must make another important decision—whether to continue taking her medications as prescribed by her physician. A recent survey indicates that many women made this determination without benefit of discussion with their physicians.     

重庆市育龄妇女生殖健康知识调查

目的 探讨重庆市育龄妇女生殖健康知识和服务现状,以改善育龄妇女生殖健康服务。方法 将重庆市各区县按照计划生育工作状况分为3类地区,采用配额抽样方法对2 075名15~49岁育龄妇女进行结构式问卷调查,对育龄妇女的生殖健康状况进行分析。结果 35.2%的妇女不知道紧急避孕;18.3%的妇女有人工流产史;30.9%的妇女2005年以来未进行生殖系统健康体检;32.7%的妇女不清楚软下疳是否为性病,29%的妇女认为宫颈糜烂是性病;69%的妇女认为蚊叮虫咬能传染艾滋病;79.4%的妇女近2年来收到过计划生育/生殖健康宣传品。结论 育龄妇女生殖健康及艾滋病知识缺乏,应加强对育龄妇女生殖健康的教育与干预,增强计划生育/生殖健康服务效果。     

428例育龄期妇女阴道感染情况调查

目的分析育龄期妇女阴道感染情况及相关危险因素,为女性阴道感染防治提供依据。方法通过生理盐水涂片法、生化检测428例育龄期妇女阴道分泌物,统计阴道感染率及其感染类型,分析清洁度分级、年龄、流产与否、初次性交年龄等对阴道感染的影响和育龄期妇女阴道感染危险因素。结果阴道感染280例,感染率65.42%。混合感染占12.50%;单一感染中细菌性阴道病(BV)最多,占34.28%;其次是外阴阴道假丝酵母菌(VVC),占28.57%。阴道清洁度Ⅰ~Ⅱ度感染率显著低于Ⅲ~Ⅳ度(P<0.05);不同年龄段妇女阴道感染率比较差异有统计学意义(P<0.05);Logistic回归分析显示,育龄期妇女阴道感染独立危险因素包括年龄>30岁、初次性交年龄≤23岁、流产次数≥2次、分娩次数≥2次、性伴侣≥2个、不使用避孕套。结论育龄期妇女阴道感染率较高,其中细菌性阴道病比较常见,其发生与女性初次性交年龄小、流产次数多、不使用避孕套等有关,需加强健康宣教及阴道感染普查。