解脲脲原体感染与精子DNA完整性的相关性的研究

目的:探讨不育男性解脲脲原体(Uu)感染与精子核DNA完整性及精液各参数的相关性。方法:95例不育症患者的精液用Uu培养液进行解脲脲原体的培养,按WHO的标准,用计算机辅助精液分析系统(CASA)进行精液各参数的分析,然后通过精子低渗肿胀实验,吖啶橙(AO)荧光染色检测精子膜的完整性和精子核DNA的完整性。结果:Uu阳性40例,Uu阴性55例,Uu阳性组与阴性组比较,精子核DNA完整性与精子的密度、a+b级精子百分率以及精子的肿胀率都有显著性差异(P<0.01,P<0.05)。同时Uu阳性组与阴性组的精子核DNA完整性与精子的肿胀率存在显著的正相关性(r=0.438,P=0.014;r=0.438,P=0.01)。结论:Uu感染能够降低精子膜的完整性以及精子核DNA的完整性,这可能是Uu致男性不育的又一因素。     

精子DNA碎片指数与体外受精-胚胎移植临床结局的相关研究

目的探讨精子DNA碎片指数(DFI)对体外受精-胚胎移植(IVF-ET)临床结局的影响。方法选自2017年1月至2019年2月在本院生殖中心行IVF-ET新鲜及解冻周期移植的不孕症患者1 885例,通过检测男方精液常规与DFI,比较精液参数、不同年龄、不同受精方式等临床资料,观察其临床结局。结果①精液参数中,DFI30组精子密度、(a+b)活力、畸形率、流产率与其他两组≤15/15～30比较有统计学意义(P 0.05);②年龄≥35岁组DFI值、流产率、临床妊娠率,与其他两组(21～29)岁、(30～34)岁比较有统计学意义(P 0.05);③ICSI组DFI值、流产率,与其他两组IVF/RICSI比较,差异有统计学意义(P 0.05),但三组间临床妊娠率比较,差异无统计学意义P0.05。结论 DFI30能引起精子密度、(a+b)活力下降,精子畸形率增高,虽不显著影响临床妊娠率,却会增加流产率。     

重组β2糖蛋白Ⅰ对弱精子症体外精子活力的影响

目的:探讨重组β2糖蛋白Ⅰ(rβ2GPⅠ)在弱精子症治疗中的应用价值。方法:将100例弱精子症患者的精液标本每份分为4份,1份为正常生理盐水对照组,其余3份分别与5μmol/L(低剂量组)、10μmol/L(中剂量组)和20μmol/L(高剂量组)的rβ2GPⅠ于37℃孵育2 h,计算机辅助精液分析系统(CASA)进行精液常规分析。结果:低、中、高剂量组a+b级精子百分率均显著高于对照组(P均0.05);中、低剂量组间a+b级精子百分率差异无统计学意义(P0.05);高剂量组的a+b级精子百分率显著高于中、低剂量组(P0.05);中、高剂量组的精子平均直线运动速度(VSL)、平均侧摆幅值(ALH)、运动的直线性(LIN)、运动的摆动性(WOB)和运动的前向性(STR)均显著高于对照组(P0.05);高剂量组的精子VSL、ALH、LIN、WOB和STR显著高于中、低剂量组(P0.05)。结论:rβ2GPⅠ能够以浓度依赖的方式提高体外精子的活力,为临床弱精子症的治疗提供了新的思路和方法。     

溶脲脲原体感染与精子顶体反应

本实验对精液溶脲脲原体培养阳性的不育男性和其它不明原因不育男性及正常生育男性分别进行了精子明胶膜顶体反应和透射电镜观察。结果发现：在精液溶脲脲原体培养阳性的不育男性组中，严重感染者精子顶体反应率比其它不明原因不育组和正常生育男性组低，经统计学处理有显著意义（Ｐ１＜０．０１，Ｐ２＜０．０１）。电镜观察显示：溶脲脲原体感染者精子膜上有溶脲脲原体颗粒附着，出现精子膜和顶体膜缺损及破坏现象。本实验证实：溶脲脲原体感染可引起精子膜包括顶体膜的破损，精子顶体反应降低或消失。     

麒麟丸联合左卡尼汀治疗特发性少弱精子症临床疗效观察

目的:探讨麒麟丸联合左卡尼汀治疗特发性少弱精子症的效果。方法:将特发性少弱精子症患者按照数学表法随机分为研究组与对照组各50例。对照组给予左卡尼汀口服溶液;研究组给予麒麟丸联合左卡尼汀,观察治疗前、后患者的精子质量。结果:治疗前对照组与研究组精子浓度[(13.12±3.58)×10~6/mL vs(12.34±3.59)×10~6/mL]、a级精子活动率(12.03%±5.21%vs 12.31%±5.43%)、a+b级精子比例(21.11%±5.32%vs 22.56%±4.69%)相比较,组间无统计学差异(P0.05);治疗后对照组与研究组精子浓度[(14.06±3.61)×10~6/mL vs(19.18±6.19)×10~6/mL]、精子活动率(68.13%±11.35%vs 78.62%±18.37%)、a级精子活动率(16.24%±7.98%vs 24.67%±8.36%)、a+b级精子比例(29.69%±8.15%vs 45.27%±12.53%)相比较,治疗组显著优于对照组(P0.05)。结论:麒麟丸联合左卡尼汀对改善精子浓度、a级精子活动率、a+b级精子比例有更好的临床疗效。     

精子核成熟度与精液参数关系研究

目的:研究精子核成熟度与精液参数关系。方法:49例精液标本,其中生育组15例,不育组34例。应用精子质量自动检测系统(CASA)进行精子密度、活力分析,伊红染色进行活率分析,联苯胺染色评价精液白细胞,采用精子形态检测系统下人工修正方法分析精子形态,用苯胺蓝染色评价精子核成熟度。结果:不育组苯胺蓝染色阳性率显著高于生育组(P<0.05)。形态异常精子组中头部异常、颈部异常、尾部异常、无定型、其它畸形精子组苯胺蓝染色阳性率均显著高于形态正常精子组(P<0.05)。苯胺蓝染色阳性精子率与形态正常精子率、活力、活率均呈显著负相关(P<0.05);苯胺蓝染色阳性精子率与精子密度、精液白细胞浓度均无显著相关性。结论:精子核成熟度异常可导致男性生育力下降,精子核成熟度是评价男性生育力重要参考指标。     

微流控芯片优选人类精子研究

目的:探讨微流控芯片技术对精子的优选能力。方法:自行设计和制造微流控芯片,利用芯片对40例人精液标本进行精子分选实验,优化其分选条件,观察芯片处理前后精液各参数变化。同时对其中30例精液标本(A组:a+b级精子<20%组,n=15;B组:a+b级精子≥20%组,n=15)同时用芯片法和密度梯度离心法分选,比较2种方法分离前后精子活力、形态等参数的变化。结果:①优选后精子活力和精子正常形态率都可见显著提高(P<0.001;P<0.01)。②在精子活动力优选上A、B组芯片法均明显优于密度梯度离心法(P<0.01),尤其在A组这种优势更为明显(P<0.001)。而在精子形态优选上,2种方法无显著差异(P>0.05)。结论:微流控芯片技术在优选精子中具有较高的分选效率,且具有操作简单、分选时间短,对精子损伤小的特点,在辅助生殖技术中特别是体外受精中将有良好的应用前景。     

生育与不育男性生育力指数的比较

目的:评估生育力指数(FI)在判断男性生育能力中的作用。方法:对不育组(n=124)和生育组(n=62)进行精液常规检查,并计算FI[FI=精子密度(106/ml)×精子活动力×精子正常形态率]。结果:生育组FI为13.23(24.16),高于不育组的5.69(10.62)(t=5.657,P=0.001)。生育组FI(P2.5,P97.5)的范围为2.06-56.85。结论:FI较单个精液参数更能客观反映男性生育能力,当FI<2.0时男性生育概率将下降。     

染色体多态性对男性生精能力及生育结局的研究

目的探讨染色体多态性对男性生精能力和生育结局的影响。方法选择3 203例男性不育者(不育组)和4 893例捐精初筛合格者(捐精组)进行回顾性队列研究,其中根据精液精子数量将不孕组患者分为精子正常组、少精子症组、无精子症组。检查并比较各组的精液常规、染色体核型、Y染色体微缺失。对有多态性的捐精者和患者进行随访,了解他们的生育结局。结果不育组和捐精组多态性发生率分别为4.62%和3.78%,差异无统计学意义(P0.05)。不育组的Y异染色质长度减少(Yqh-)发生率(0.59%)高于捐精组(0.27%),差异有统计学意义(P=0.022),且随着精子数量减少Yqh-发生率明显增加(精子数量正常组为0.15%,少精子症组为0.22%,无精子症组为0.99%),差异有统计学意义(精子正常组与无精子症组P=0.033;少精子症组与无精子症组P=0.027)。携带有Yqh-的患者Y染色体微缺失检出率为56.25%(9/16),显著高于其它类型人群(P0.001)。不育组中弱精子者和畸形精子者的多态性发生率分别为3.92%、3.96%,同捐精组(3.78%)相比,差异无统计学意义(P0.05)。随访捐精组和不育组有多态性人群的配偶,结果其自然流产率分别为6.25%(3/48)和6.67%(2/30),差异无统计学意义(P0.05),且无1例发生子代出生缺陷。结论除Yqh-部分伴随无精子因子(AZF)缺失可导致精子发生障碍,使男性生育力下降,其它类型多态对男性生育无明显影响。     

不明原因重复性自然流产妇女配偶精子DNA完整性

目的:探讨精子DNA完整性与重复性自然流产(RSA)的关系。方法:85例不明原因RSA妇女配偶(RSA组)和50例已生育的成年健康男性(对照组)的精液,应用精子染色质扩散实验(SCD)检测精子DNA完整性。将RSA组根据1年后怀孕结果分为3个亚组:怀孕组(30例)、流产组(26例)、未孕组(29例)。结果:RSA妇女配偶DNA损伤精子的百分率(14.6±6.9)%与对照组的(12.9±3.8)%相比无统计学差异(P0.05)。DNA损伤精子百分率大于20%视为精子DNA完整性异常,则有17.6%的RSA患者配偶的精子DNA完整性异常,6%的正常生育男性精子DNA完整性异常,但差异无统计学意义(P0.05)。怀孕组、流产组、未孕组配偶的DNA损伤精子百分率分别为(12.4±5.3)%,(14.6±6.5)%和(16.8±8.1)%,未孕组与对照组比较,差异有统计学意义(P0.05),怀孕组、流产组与对照组比较,差异无统计学意义(P0.05)。结论:精子DNA完整性异常与RSA继发不育有关,有必要筛查RSA患者配偶的精子DNA完整性。     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症（EMs）发病机制尚未完全阐明。大量研究表明,免疫因素在EMs的发病机制中起重要作用。EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变。Toll样受体（TLRs）识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应。TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深入认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段。     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.     

Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis

The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.     

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p?<?0.001 and p?=?0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p?<?0.001 and p?<?0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.     

绒毛膜羊膜炎与胎儿及新生儿疾病

绒毛膜羊膜炎是产科炎症反应,但与新生儿预后关系密切。母体的宫内炎症反应可以直接导致胎儿和婴儿患病率和死亡率增加,胎儿炎症反应综合征（FIRS）也不可忽视。早期识别和快速诊断有助于减少母儿的近期合并症,改善新生儿的远期预后。产科和儿科共同关注,整合信息,是早期发现、实施有效干预的临床重点之一。