女性不孕症内分泌检测及临床意义

下丘脑 -垂体 -卵巢轴的功能正常 ,是维持女性生育功能的基本条件之一。月经的正常生理、卵子的发育成熟、受精、早期胚胎的着床发育 ,均有赖于体内正常内分泌环境。检测女性不孕患者的内分泌状态 ,对不孕症的病因诊断和治疗以及预后判断均有重要意义。本文重点讨论女性不孕症患者血液内分泌激素水平检测及其临床意义。1　女性不孕症常见内分泌异常①下丘脑功能障碍 :精神过度紧张等可导致下丘脑促性腺激素释放激素 (ＧｎＲＨ)脉冲式分泌功能障碍 ,导致垂体促性腺激素 (Ｇｎ)分泌异常 ,无周期性的ＬＨ释放 ,ＬＨ和ＦＳＨ下降 ,同时 ,下丘脑…     

肥胖与女性生殖内分泌

肥胖(obesity)指人体因各种原因引起的脂肪组织过多，是一种由遗传和环境因素，包括激素内环境异常，共同作用引起的体内脂肪积聚过多。随着生活水平的提高及生活方式的改变，全球肥胖症发生率迅速增加，并呈年轻化趋势。肥胖对全身各系统都可能产生不良的影响。在女性，肥胖可导致月经失调、不孕、流产及乳腺癌、子宫内膜癌等；此与肥胖引起生殖内分泌紊乱有关。     

内皮素与女性生殖内分泌调节

<正>1988年Yanagisawa从培养的猪主动脉内皮细胞中分离到一种缩血管多肽,命名为内皮素(Endothelin,ET),此后,有关ET的研究逐渐增多,并扩展至各系统。现已知ET广泛分布于体     

激活素与女性生殖内分泌

激活素是一个大分子糖蛋白，主要由性腺分泌、广泛存在于各种组织和器官中，激活素能特异地促进垂体分泌ＦＳＨ，对卵巢甾体激素合成有调节作用，可作为卵泡生长发育信号，并涉及妊娠分娩发动机制，也是一种巢肿瘤标记物，激活素的研究，有助于更深入地了解生殖内分泌。     

β—内啡肽在女性生殖内分泌中的调节作用

近年研究表明，β－内啡肽是调节ＧｎＲＨ分泌及月经周期的一种重要神经肽，在女性生殖不同阶段如青春期，月经周期及更年期具有不同的生理作用，在几种分泌疾病如多囊卵巢综合征，下丘脑月经失调，经前期综合征中发生明显的病理变化。     

2022年女性生殖内分泌领域研究进展

<正>生殖内分泌关系女性一生,是人类生命科学领域最为神秘复杂的学科,也是妇产科领域中发展速度最快,最有潜力的亚专科。生殖内分泌所涵盖的疾病谱贯穿女性的生命全周期,包括青春期发育和性发育异常、月经相关疾病、绝经相关疾病及其治疗、不孕和辅助生殖技术（试管婴儿）、反复流产等。我国经济稳定发展,国际地位亦不断提高,人民对于更高生活质量的追求日益迫切。以人为本,关爱人民群众全生命周期的健康是我们每一个医务工作者的初心和使命。2022年,在医学领域,包括女性生殖内分泌在内的各个方面均取得了长足的进步。     

环境内分泌干扰物对女性生殖健康影响的研究进展

环境化学物对人类健康和生态环境影响一直是各国科学家和公众的关注焦点.近年发现它们除有致癌、致突变、致畸等作用,可能也干扰体内激素,引起内分泌紊乱,而且有些效应的化合物被统称为环境内分泌干扰物(EEDs).EEDs与女性生殖健康关系非常密切.EEDs可通过模拟或拮抗内源性激素,影响内源性激素的合成、代谢和生物利用度等干扰生殖内分泌系统,与不良妊娠结局和妊娠并发症、子宫内膜异位症、卵巢早衰、生殖系统肿瘤、性早熟、月经紊乱等发生有一定的关系.     

环境内分泌干扰物对女性生殖健康影响的研究进展

环境化学物对人类健康和生态环境影响一直是各国科学家和公众的关注焦点。近年发现它们除有致癌、致突变、致畸等作用，可能也干扰体内激素，引起内分泌紊乱，而且有些效应的化合物被统称为环境内分泌干扰物(EEDs)。EEDs与女性生殖健康关系非常密切。EEDs可通过模拟或拮抗内源性激素，影响内源性激素的合成、代谢和生物利用度等干扰生殖内分泌系统，与不良妊娠结局和妊娠并发症、子宫内膜异位症、卵巢早衰、生殖系统肿瘤、性早熟、月经紊乱等发生有一定的关系。     

女性生殖内分泌功能检测的方法学进展

女性生殖内分泌功能检测的内容包括相关激素分子的分泌量及其生物学效应的检查、鉴别病变部位的功能试验及对相关激素和相应受体的基因突变的检测等。在临床工作中则是以激素的定量、生物学效应的检测为主 ,本文重点简介生殖激素定量检测方法及被检激素种类的发展。1　卵巢甾体激素及垂体促性腺激素定量测定方法的发展激素分子 ,尤其是雌激素分子 (10 -12 ｇ·ｍＬ-1) ,以极微量的浓度存在于血循环中 ,所以发展对微量物质的特异性定量检测技术是生殖内分泌疾病研究和临床治疗的限速步骤。激素定量测定有以下几种。1.1　生物测定　早期性激素…     

腹腔镜对女性不孕症的诊断和治疗

腹腔镜的应用,特别是联合宫腔镜、输卵管美蓝通液术,提高了对女性不孕症诊断的准确性。近年来出现的经阴道注水腹腔镜技术相对于传统腹腔镜检查有其优越性。针对不同的病因,腹腔镜可进行盆腔粘连分解术、输卵管造口术、子宫内膜异位灶破坏及切除术、卵巢多点穿刺电灼术等多种手术治疗。其具有早期、迅速明确病因,融诊断、治疗于一体,缩短诊疗时间,为术后进一步治疗提供正确的方向等优点。但腹腔镜手术并非根治性治疗,术后应积极采取各种辅助措施,增加妊娠率,以免延误最佳妊娠时机。     

A Complete Gonadal Dysgenesis Case with Mental Retardation,Congenital Hip Dislocation,Severe Vertebra Rotoscoliosis,Pectus Excavatus,and Spina Bifida Occulta

Background46,XY, or Swyer syndrome, is a complete gonadal dysgenesis. Patients usually presents with primary amenorrhea with underdeveloped secondary sex characteristics. Phenotypes of these patients are female. In this report, a Swyer syndrome case is reported with novel clinical features that are classified as connective tissue disorders. This case and the 2 other previously reported Swyer syndrome cases with ascendant aortic aneurysm and diaphragmatic hernia are suggest that the Y chromosome has an important role in the structure of connective tissue.CaseHere we report a case of a 17-year-old with clinical features of 46,XY complete gonadal dysgenesis including external female genitalia, hypoplastic uterus, hypergonadotrophic hypogonadism, incomplete secondary sex characterics, primary amenorrhea, and normal male karyotype. In addition, she had mild mental retardation, severe rotoscoliosis, pectus excavatus, spina bifida occulta, hip dislocation, and long, slender extremities. She had a rudimentary uterus and streak gonads; after giving her cyclic estrogen and progesterone pills, she was able to menstruate.Summary and ConclusionIn this report, a Swyer syndrome case was discussed regarding clinical features, especially those are not characteristic for Swyer syndrome after a review of the literature.     

A Defective Child is Born A Study of Mothers of Newborns with Spina Bifida and Hydrocephalus

Eleven mothers of children born with spina bifida and/or hydrocephalus gave firsthand information about the problems they had during their first 7 postpartum days. Among the most heavily reported concerns were the fear that they had done something prenatally to cause the babies' defects and the pressure they felt to be brave and put up u good front. The study also revealed that while each of the mothers had fears und concerns typically attributed to mothers of defective newborns, only 3 of them were counseled regarding these feelings and only 6 were referred to community agencies for continuing assistance. Among other findings were that the majority of the respondents recommended placement in nonprivate rooms and that most of the women found comments like "You can always have another baby" to be useless and, in some cases, harmful. Recommendations made by the participants in the study may be valuable in planning the care of other mothers in similar circumstances.     

Abnormal Uterine Bleeding in Women with Infertility

Purpose of Review

Abnormal uterine bleeding (AUB) is a common gynecologic complaint of reproductive-age women that necessitates careful evaluation due to potential underlying structural and systemic abnormalities. The majority of studies on AUB and infertility examine these topics separately, despite emerging evidence that many etiologies of AUB influence fertility. This review aims to provide an updated perspective on the diagnosis and management of AUB in the context of the infertility evaluation.

Recent Findings

The FIGO PALM-COEIN classification of AUB allows for the precise identification of systemic and structural causes to guide management. Pelvic ultrasound continues to be an accessible first-line imaging technique with high sensitivity for detecting structural etiologies of abnormal bleeding, particularly when used with color Doppler or 3D imaging. Notably, recent studies suggest that many of the endometrial pathologies that lead to AUB can also negatively impact endometrial receptivity, perhaps contributing to infertility in some women.

Summary

While the impact of systemic causes of AUB, such as ovulatory dysfunction, on infertility is widely recognized, the extents to which endometrial disorders and discrete structural lesions affect fertility are not entirely understood. More research is needed to assess the impact of structural abnormalities and their treatment on subsequent fertility outcomes in women with AUB.

     

Fecundity of Infertile Women with Minimal or Mild Endometriosis And Women with Unexplained Infertility

Objective: To assess whether infertile women with minimal or mild endometriosis have lower fecundity than women with unexplained infertility.

Design: Prospective cohort study.

Setting: Twenty-three infertility clinics across Canada.

Patient(s): Three hundred thirty-one infertile women aged 20–39 years.

Intervention(s): Diagnostic laparoscopy for infertility. Infertile women with minimal or mild endometriosis (n = 168) were compared with women with unexplained infertility (n = 263). Both groups were managed expectantly. The women were followed up for 36 weeks after the laparoscopy or, for those who became pregnant, for up to 20 weeks of the pregnancy.

Main Outcome Measure(s): Fecundity refers to the probability of becoming pregnant in the first 36 weeks after laparoscopy and carrying the pregnancy for ≥20 weeks. The fecundity rate is the number of pregnancies per 100 person-months.

Result(s): Fecundity was 18.2% in infertile women with minimal or mild endometriosis and 23.7% in women without endometriosis (log-rank test). The fecundity rate was 2.52 per 100 person-months in women with endometriosis and 3.48 per 100 person-months in women with unexplained infertility. The crude and adjusted fecundity rate ratios were 0.72 and 0.83 (95% confidence interval = 0.53–1.32), respectively.

Conclusion(s): The fecundity of infertile women with minimal or mild endometriosis is not significantly lower than that of women with unexplained infertility.     

彝族地区不孕妇女与衣原体感染关系的研究

本文对87例原发不孕及53例继发不孕彝族妇女宫颈细胞沙眼衣原体（CT）抗原进行了检测,结果表明,原发、继发不孕组CT抗原阳性发生率分别为32．2％和35．8％,组间CT阳性检出率无显著性意义（P＞0．05）,但与生育组相比分别存在着显著差异（P＜0．01）。不孕年限长短与CT发生率之间无明显差异（P＞0．05）。研究结果提示,生殖道CT感染与女性不孕之间存在着明显的关系,而与不孕时间的长短无关。研究中还发现CT抗原阳性检出率与抗精子抗体、子宫颈炎严重程度之间存在着高度相互依存关系,宫颈炎越严重,CT阳性率越高。     

不明原因不孕女性血浆中顶体蛋白酶抗体(AcrAb)及精子蛋白17抗体(Sp17Ab)的水平

目的:探讨抗精子蛋白17抗体(Sp17Ab)、抗顶体蛋白酶抗体(AcrAb)在不孕症发病中的作用。方法:采用ELISA方法对12例不明原因不孕患者(A组)、20例其它原因引起不孕的患者(B组)及25例正常的育龄妇女(C组)血浆中AcrAb、Sp17Ab进行检测。结果:①AcrAb、Sp17Ab水平A组(3.28±1.08μg/L,7.89±2.22μg/L)明显高于B组(1.50±0.44μg/L,3.58±0.93μg/L)及C组(1.50±0.48μg/L,3.54±0.63μg/L),差异均具有统计学意义(P<0.01);B组、C组间无统计学差异(P>0.05);②女性血浆中AcrAb与Sp17Ab水平无相关性(r=0.565,P>0.05)。结论:不孕患者血浆中AcrAb、Sp17Ab水平变化与不明原因不孕患者发病有关。     

育龄女性垂体泌乳素微腺瘤手术前后内分泌改变及疗效分析

目的:探讨育龄女性中垂体泌乳素微腺瘤患者微创手术治疗的疗效。方法:回顾性分析显微手术治疗的育龄女性垂体泌乳素微腺瘤24例,对手术前后内分泌改变及疗效进行分析。结果:本组24例全部手术全切除肿瘤,术后复查血清PRL,下降至正常水平23例。术后当月月经恢复正常6例;术后6月月经恢复正常18例。其中1例术后d3恢复月经,且术后3个月经B超查证实怀孕。13例溢乳患者均于治疗后2-16周内停止溢乳。结论:显微手术切除可作为育龄女性中症状性垂体泌乳素微腺瘤的首选治疗方法。     

Prevalence of Endometriosis and Peritoneal Pockets in Women with Infertility and/or Pelvic Pain

ObjectiveTo evaluate the prevalence of endometriosis and peritoneal pockets and to analyze whether these pockets are associated with pain.MethodsAnalysis of prospectively registered data of all women undergoing laparoscopy for infertility or pelvic pain between 1988 and 2011 at KU Leuven University Hospital.ResultsOf 4497 women, 191 had 238 pockets, with a prevalence of 4.7% in women with infertility only, 4.9% in women with infertility and pelvic pain, and 3.5% in women with pelvic pain only (P = 0.045 for all infertility vs. pelvic pain only). Prevalence did not vary by age. Pockets were associated with endometriosis (P < 0.0001), which was found in 77% of women with pockets. Among women with infertility only, the prevalence of endometriosis was higher in women with pockets (P = 0.0001) than in women without. The prevalence of endometriosis was similar in women with infertility and pelvic pain or pelvic pain only. Pelvic pain as an indication for surgery was associated simultaneously (through logistic regression) with endometriosis (P < 0.0001) and pockets (P = 0.040). Pelvic pain severity was associated simultaneously with pockets (P = 0.0026) and the severity of subtle (P = 0.001), typical (P = 0.030), cystic ovarian (P = 0.051), and deep endometriosis (P < 0.0001). Pelvic pain severity was not associated with endometriosis in the pockets or the diameter or location of pockets.ConclusionsThe prevalence of pockets was low, at between 3.5% and 5%. Women with infertility only and pockets had more endometriosis than women without. Severe pelvic pain and pelvic pain as an indication for surgery were associated with the presence of pockets as well as the presence and severity of endometriosis.     

子宫腺肌病与不孕的相关性研究

子宫腺肌病（adenomyosis）好发于生育年龄女性,其引起的月经异常、痛经和不孕严重影响患者身体健康,尤其是子宫腺肌病引起的不孕症状严重影响患者的家庭生活,对于有保留生育要求的患者,其治疗是妇科和生殖科医生面临的一大难题。子宫腺肌病引起不孕的机制尚不清楚,其发生原因可能与宫腔形态改变、子宫结合带（uterine junctional zone）异常、子宫内膜改变、炎性介质和氧化应激,以及免疫功能失调等因素有关。综述子宫腺肌病与不孕的相关性研究。