子宫内膜异位症患者血清对氧磷酶-1的表达及临床意义

子宫内膜异位症(endometriosis,内异症)的发病机理尚未完全清楚.近年国外学者提出,氧化应激(oxidative stress)在内异症及妇产科其他疾病如不孕症和妊娠相关疾病(主要是先兆子痫、妊娠期糖尿病及习惯性流产等)的发病机理中可能起重要作用[1].     

酶联免疫吸附试验测定子宫内膜IgG抗体诊断子宫内膜异位症价值的评价

目的评价酶联免疫吸附试验(ELISA)测定子宫内膜IgG抗体诊断子宫内膜异位症(endometriosis,EMs)的临床价值。方法采集空腹血清91份,分三组,EMs组39例,正常对照组15例,良性疾病对照组37例,用酶联免吸附法对三组血清中子宫内膜IgG抗体进行测定。结果EMs组阳性率76.92％,正常对照组阳性率(33.33％)与EMs组比较有显著性差异(P＜0.005),疾病对照组阳性率(62.16％)与EMs组比较差异不明显(P＞0.05)。ELISA法测定血清子宫内膜IgG抗体诊断EMs敏感性76.92％,特异性46.15％。结论ELISA法虽敏感、有效、简单,但不能作为一种最有价值的诊断EMs的辅助方法。     

子宫内膜异位症的诊断与治疗现状

子宫内膜异位症的诊断与治疗现状石一复子宫内膜异位症（内异症），是指具有不同程度功能的子宫内膜出现在子宫腔以外的部位。在临床，此病的发生有增多的趋势。目前，虽诊断和治疗方法甚多，但总的看来治疗效果并不理想，对此病仍有“较容易识别，但治疗并无良策，少数甚...     

肠道子宫内膜异位症诊断及治疗

摘要：肠道子宫内膜异位症是指子宫内膜异位症病灶侵入或生长于部分或全部肠壁的浆肌层,主要表现是痛经、性交痛、排便痛。肠道子宫内膜异位症可以位于整个消化道的许多部位,但以乙状结肠和直肠交界处最常见。直肠气钡双重造影、经阴道超声、直肠内镜超声、磁共振成像(MRI)、多层螺旋CT等有助于明确诊断。药物治疗可以暂时控制症状,但不能使患者长期获益。根治性子宫内膜异位症病灶切除,包括肠道子宫内膜异位症病灶切除,是治疗肠道子宫内膜异位症的有效方法。肠道子宫内膜异位结节切除方法有表面病灶切除术,病灶碟形切除术和肠管节段性切除吻合术。尽管手术切除肠道子宫内膜异位症病灶还存在争议,但是越来越多的研究显示创伤性的手术改善了肠道子宫内膜异位症患者的症状及生存质量,增加了患者受孕机会。     

气管子宫内膜异位症自愈1例

患者 4 6岁 ,女 ,已婚。因间断性咳嗽、咯血 5年 ,加重 3天于 2 0 0 0年 8月入我院。患者于 1994年 6月无明显原因出现咳嗽、咯血 ,无胸痛及胸闷 ,间断发作 ,开始咯血量少 ,后渐增多。曾多次在院外经抗炎、止血治疗 ,疗效欠佳 ,易复发 ,且咳嗽、咯血症状多发生在月经期前后。追问病史患者于 1993年 3月因“妊娠 5 0天”在院外行“人工流产术” ,手术顺利 ,无呛咳 ,术后月经正常 ,无痛经。初步诊断 :气管子宫内膜异位症。暂给予抗炎、止血处理。于入院当天在一阵剧烈咳嗽后咯血约 10 0ｍｌ,咯出的血块中有一段长约 5 0ｍｍ膜片状物 ,考虑可能…     

直肠阴道隔子宫内膜异位症的诊断及治疗

目的 探讨直肠阴道隔子宫内膜异位症(内异症)的临床诊断及治疗。方法 回顾分析我院自1992年至2002年收治的10例直肠阴道隔内异症患者的临床资料。结果 临床表现,年龄36—47岁,平均40岁;肛门坠痛6例,性交痛3例,痛经8例,慢性盆腔痛5例;三合诊时均可触及直肠阴道隔结节,平均直径3cm。血清CAl25水平升高者2例。阴道或腹部超声检查均末检出异位病灶。术前4例接受促性腺激素释放激素激动剂3．75mg/28d,共3次的治疗,可短期缓解疼痛,2例病灶体积减小。10例均行手术治疗,其中开腹手术7例、阴式手术1例、腹腔镜联合阴式手术2例。切除病灶经病理检查证实为直肠阴道隔内异症。随诊最长时间5年,完整切除病灶者预后良好,未能完整切除病灶者症状、病灶持续存在。结论 直肠阴道隔内异症以肛门坠痛、性交痛为主要表现,必须进行三合诊检查。B超的辅助诊断意义不大,修订的美国生育协会标准分期不能反映疾病的严重程度。手术是主要的治疗手段。     

子宫内膜异位症非手术诊断方法探讨

目的:评价子宫内膜异位症常见临床指标用于非手术诊断的价值。方法:因痛经、不育或盆腔包块住院行腹腔镜手术的育龄患者331例,术前纪录患者年龄、病程、初潮年龄、月经周期、月经期天数、结婚年龄或第一次性交年龄、孕产次、剖宫产史、继发性痛经、慢性盆腔疼痛、性交痛以及不育,阳性体征(宫骶韧带触痛结节、子宫直肠窝触痛结节或附件包块,具有三者之一者即为阳性),超声波检查(包块内部为无回声区并有散在或密集的光点为阳性),血清CA125值。计算各项临床指标单独及联合应用包括平行试验?系列试验诊断内异症的敏感性?特异性?阳性预测率及阴性预测率,并用Logistic回归方法计算诊断卵巢型及腹膜型内异症的公式。结果:单独应用各项临床指标诊断内异症的敏感性较低。超声波?血清CA125以及性交痛对内异症的预测率达90%以上,其他临床指标预测内异症的准确性较差。临床各项指标联合平行试验可明显提高诊断的敏感性(89%),各项指标联合系列试验则可明显提高诊断的特异性。任何3项临床指标联合,诊断内异症的预测率基本达到100%。卵巢型内异症的诊断公式为:1/[1+e-(-2.270+1.304*盆腔痛性结节+1.158*继发痛经+2.168*B超囊内光点+2.580*CA125异常)],腹膜型内异症的诊断公式为:1/[1+e-(-1.631+1.788*盆腔痛性结节+0.789*继发痛经+2.384*CA125异常)]。以结果>0.5为异常,此公式诊断卵巢型及腹膜型内异症的准确性分别为85.9%和84.5%。结论:疼痛症状、不育、盆腔体征、超声波以及血清CA125联合应用是内异症较准确的非手术诊断方法。     

子宫内膜异位症的诊断及治疗

具有生长功能的子宫内膜组织（腺体和间质）出现在子宫体以外部位时称为子宫内膜异位症，是生育年龄妇女最常见的疾病之一。它是一种良性疾病，却有着一些类似恶性疾病的生物学特征，如局部侵犯，远处播散、易复发等。有时候病变微小却可引起严重的临床症状如痛经和持续盆腔疼痛等，而有些病变广泛、巨大卵巢子宫内膜异位囊肿的患者却没有任何临床症状。目前其发病机制尚未彻底阐明，而在其诊断及治疗方面也存在着一些不同的观点。     

Meis1在子宫内膜异位症不孕患者子宫内膜中的表达研究

目的:初步探索HOXA10的辅因子(Meis1)与子宫内膜异位症(EMs)患者不孕和发病的相关性。方法:采用免疫组织化学方法进行组织学定位并进行半定量分析,采用Westernblot-ting方法在蛋白水平上进行定量分析,检测EMs不孕患者异位和在位子宫内膜中Meis1的表达水平。结果:免疫组织化学结果显示,Meis1在异位内膜和在位内膜中仅有弱表达,而在正常同期内膜中呈较明显的阳性表达,差异显著(P<0.01);比较Meis1在分泌中期在位内膜与正常内膜中的表达,差异亦有显著性(P<0.01)。Westernblotting显示,Meis1在分泌中期在位内膜中仅有弱表达,而在同期正常内膜中呈高表达(P<0.001)。结论:Meis1在EMs患者分泌中期在位内膜中低表达,可能是影响子宫内膜容受性的建立,从而影响胚胎着床导致不孕的重要因素之一。同时,Meis1在异位内膜中的低表达说明异位内膜可能对体内雌、孕激素正常调控具有抵抗性,异位内膜细胞具备了对抗凋亡的能力,提示Meis1可能参与了EMs的发生与发展。     

盆腔子宫内膜异位症病灶分布特点及其腹腔镜诊断准确性的评价

目的 探讨盆腔子宫内膜异位症（内异症）病灶的分布特点以及腹腔镜用于诊断不同部位、不同类型内异症病灶的准确率及其与病理诊断的符合率。方法 对62例腹腔镜诊断的内异症病灶行切除术,对肉眼正常的腹膜随机进行活检,并均送病理检查。以病理诊断为标准,计算腹腔镜诊断不同类型、不同部位以及不同颜色内异症病灶的阳性预测值、阴性预测值及敏感度、特异度。结果 62例患者中,55例有卵巢子宫内膜异位囊肿。取得219份内异症腹膜病灶组织、54份肉眼正常腹膜组织以及71个卵巢子宫内膜异位囊肿;盆腔后半部腹膜内异症病灶占80．8％（177／219）,左侧（58．0％,127／219）多于右侧（42．0％,92／219）。盆腔腹膜内异症病灶中蓝色病灶最常见,占39．3％（86／219）。腹腔镜诊断腹膜内异症与病理诊断比较,阳性预测值为67．6％,敏感度为93．7％,阴性预测值为81．4％,特异度为38．3％。其中以蓝色病灶和左侧宫骶韧带处病灶的病理诊断阳性率最高,分别为94．2％及84．7％。卵巢子宫内膜异位囊肿中,左侧占43．6％（24／55）,右侧占27．3％（15／55）,双侧占29．1％（16／55）,其中80．3％（57／71）的卵巢子宫内膜异位囊肿被病理诊断证实。肉眼正常腹膜活检54份标本中,10例（18．5％）病理检查阳性。结论 盆腔内异症病灶的分布呈非对称性,盆腔后部多于前部,左侧多于右侧;腹腔镜下所见的蓝色病灶及宫骶韧带病灶的病理诊断阳性率较高。     

Correlation between laparoscopic and histopathologic diagnosis of endometriosis

Objective

To review the histopathologic diagnosis of biopsies taken following visualization of endometriosis at laparoscopy and to correlate visual with microscopic diagnoses.

Methods

A retrospective review was undertaken of medical charts with a diagnosis of endometriosis at Aga Khan University Hospital, Nairobi, Kenya, between January 2001 and October 2010. Eligibility included visual diagnosis of endometriosis at laparoscopy, with a clear record of site, size, morphology, and number of lesions. The histopathologic diagnosis of the biopsies sampled was sought. Correlation was undertaken using κ statistics for diagnostic variability.

Results

Of the 204 relevant records, 152 (74.5%) met the eligibility criteria; from these cases, 239 specimens were submitted for histology. The most common symptom was chronic pelvic pain (108 [71.1%]). Most biopsies were obtained from the ovary and posterior cul-de-sac. Histopathologic diagnosis was confirmed in (152 [63.8%]) specimens and correlated with Asian race, multiparity, and chronic pelvic pain. Neither the site of the lesion nor the stage of disease influenced the histopathologic diagnosis.

Conclusion

Laparoscopic visualization of endometriosis does not always correlate with histopathologic diagnosis; several other lesions may mimic endometriosis on histopathologic examination.     

Nutrient intake, anthropometric data and correlations with the systemic antioxidant capacity of women with pelvic endometriosis

Objective

Endometriosis is a multifactorial disease of uncertain etiology. There is currently insufficient evidence to assess the participation of nutritional and anthropometric aspects and their association with systemic oxidative stress.

Study design

Twenty-five women with endometriosis and twenty controls were selected and evaluated to determine calorie and nutrient intake, to obtain data on body composition and analyze antioxidant capacity by measuring total serum thiol levels using DTNB (5,5′-dithiobis-(2-nitrobenzoic acid).

Results

Mean total daily calorie intake in the women in the endometriosis group was significantly higher than that of the women in the control group (p = 0.005). With respect to nutrient intake, the only statistically significant difference found referred to a higher intake of fiber in the endometriosis group and of polyunsaturated fatty acids in the control group (p < 0.05).

Conclusions

Nutrient intake by the women in the endometriosis group was similar to that of women in the control group, the only differences being a higher intake of fiber in the endometriosis group and of polyunsaturated fatty acids in the control group. Antioxidant capacity was lower in the women with endometriosis but there was no correlation with nutrient intake or overweight.     

Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis

Deeply infiltrating endometriosis is the clinical form of the disease that is generally associated with conditions of more intense pain and may require more complex surgical management, consequently resulting in greater risks to the patient. In recent years, various investigators have confirmed the usefulness of methods such as magnetic resonance imaging (MRI), transrectal ultrasound and transvaginal ultrasound (TVUS) for the diagnosis of deep endometriotic lesions. The objectives of the present study are to describe the method used to perform TVUS for the detection of deeply infiltrating endometriosis, and to discuss the clinical benefits that the data obtained may offer clinicians providing care for patients suspected of having this type of endometriosis.     

Ultrasound diagnosis of endometriosis and adenomyosis: State of the art

Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma according to robust prospective data together with guidelines as to adequate reporting of the location of deep infiltrating endometriosis will be given. The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed. The available data in the literature on ultrasound diagnosis of pelvic endometriosis and adenomyosis, their clinical relevance, and their limitations are discussed.     

The value of serological markers in the diagnosis and prognosis of endometriosis: a prospective case-control study

Objective

We analyzed selected well-known and less well-known serum markers that have been proposed for diagnosis and severity assessment of endometriosis, in a case-control study.

Study design

This prospective study was carried out in a Clinical Department of Gynecology in Iasi, Romania. Study participants included endometriosis patients, and controls in whom laparoscopy had excluded endometriosis. Each case and control was investigated for serum levels of CA125, TNF, IL-1, IL-6 and IL-8. The data were correlated with clinical symptoms and revised American Fertility Society (rAFS) score and stage, and interpreted by Mann-Whitney U-test and ANOVA regression analysis.

Results

Over the course of 1 year, 24 cases of endometriosis and 24 controls of matched age were selected. The rAFS stages were: stage I, 12.5%; stage II, 16.7%; stage III, 58.3%; and stage IV, 12.5%. CA125 levels were over the cut-off of 35 IU/l in 54% of patients (versus 8% of controls), averaging 67.5 (CI95: ±17.5). The sensitivity and specificity were 54% and 91%, respectively, with a p value of <0.001 (statistically significant). For IL-6, 71% of cases and 87% of controls were above the cut-off of 2 pg/ml, with an average of 11.83 ± 7. The sensitivity and specificity were 71% and 12%, respectively, but the difference was not statistically significant, p = 0.071. Other tested serum markers had no discrimination value. A correlation with severity of endometriosis was seen for CA125 (p = 0.03) but not for IL-6, by ANOVA.

Conclusion

CA125 correlated with endometriosis screening and severity, indicating its superiority as a marker for further, larger studies.     

血清低分子量差异蛋白质组在食管癌诊断和分期中的作用研究

目的:研究食管癌癌变过程中血清低分子量蛋白的细微变化,探索食管癌发生的机制、寻找食管癌早期诊断的生物标志物和方法。方法:应用表面激光解析电离飞行时间质谱技术对食管癌患者和健康对照血清进行蛋白质谱指纹图谱检测,通过Biomarker Wizard软件筛选差异蛋白,使用人工神经网络软件建立食管癌早期诊断模型并用盲法验证其诊断效果;将食管癌早期和中晚期食管癌患者血清质谱图进行比对分析,寻找各期差异蛋白,并建立分期诊断模型。结果:发现食管癌和正常人差异蛋白5种,早期食管癌和中晚期食管癌差异蛋白3种。通过早期食管癌组和健康对照组建立早期诊断模型的灵敏度87.88%,特异度91.43%,准确度89.71%,经过盲法验证结果为灵敏度95.83%,特异度89.13%,准确度91.43%。建立的分期诊断模型中,早期食管癌和中晚期筛选的差异蛋白建立的分期诊断模型灵敏度75.76%,特异度79.17%,准确度77.19%。结论:表面增强激光解析离子化飞行时间质谱(SELDI-TOF-MS)联合人工神经网络技术操作较为简便,在食管癌的诊断和分期上具有可行性。     

青春期子宫内膜异位症43例临床分析

目的探讨青春期子宫内膜异位症的临床特征、诊断和治疗方法。方法对1990～2003年中山大学附属第一、二、三医院及广东省人民医院收治的43例青春期子宫内膜异位症患者的临床资料进行回顾性分析。结果青春期子宫内膜异位症患者诊断时,距离初潮年龄平均间隔时间为4．6年,发病距离就诊时间平均为1年。就诊时的主要症状为盆腔包块18例,占42％;痛经15例,占35％;慢性腹痛10例,占23％;急性腹痛4例,占9％。根据1985年美国生育协会修订的子宫内膜异位症分期(ASF-r)标准,23例(53％)为Ⅲ期,8例(19％)为Ⅰ期,3例(7％)为Ⅱ期,9例(21％)为Ⅳ期。其中9例伴有生殖道畸形,占21％;12例(28％)患者进行了腹腔镜诊断和治疗。结论青春期子宫内膜异位症多发生于初潮后的5年内,主要症状为盆腔包块和痛经。青春期子宫内膜异位症患者的临床症状与成年人相似,腹腔镜是子宫内膜异位症的确诊手段,手术仍是其主要治疗手段。