卵巢早衰的免疫学研究进展

卵巢早衰(POF)因病因复杂、机制不明,成为一个临床上难治的疾病.大部分卵巢早衰的发病机制不明,已知POF的病因包括医源性因素(如化疗、放疗及外科手术)、自身免疫性因素、遗传因素、感染因素、酶学障碍等.目前越来越多的研究表明,自身免疫是POF的一个重要致病因素,证据表明约20％的POF与自身免疫失调有关,包括HLA-DR抗原的异常表达、抗卵巢抗体等自身抗体等.认为血清抑制素水平、自身抗体可作为POF的预测指标,及时对其行 糖皮质激素和雄激素、调节性T细胞的免疫治疗,可以延缓甚至逆转POF.     

特发性卵巢早衰发病相关因素分析

目的:探讨特发性卵巢早衰(POF)与人们的生活方式、行为习惯、工作生活环境等因素的关系,为POF的预防及治疗提供科学依据.方法:选择于我院诊治的特发性POF患者105例(特发性POF组)和月经规则、性激素检查在正常范围内的年龄匹配的110例健康妇女(对照组)为调查对象,根据填写的《卵巢早衰发病相关因素调查问卷》对两组的临床特征进行比较,并采用单因素、多因素Logistic回归法分析特发性POF的相关危险因素.结果:对单因素分析有统计学意义的9个变量进行多因素Logistic回归分析,结果显示:引起特发性POF的危险因素有使用染发剂(OR =5.641,95％ CI 2.441—13.035)、经常因小事烦恼(OR =4.811,95％CI 1.950～11.873)、经常感到疲倦(OR=8.827,95％ CI 2.758—28.249)、有害物质接触史(OR=9.095,95％CI 1.012 ～ 81.759)；特发性POF的保护因素是经常锻炼(OR=0.439,95％ CI 0.200—0.964).结论:养成良好的生活习惯、尽量避免接触有害物质、调节情绪、保持心态平衡和经常锻炼可能有利于降低特发性POF的发病率.     

卵巢早衰的病因

卵巢早衰(POF)的病因包括遗传、免疫、代谢、病毒感染以及医源性等因素.涉及X染色体长臂的畸变、X染色体及常染色体的某种基因突变都与POF相关.某些病例卵巢组织炎性改变,自身抗体特别是抗自身类固醇生成细胞抗体(st-c-Abs)的发现,淋巴细胞亚群比例异常等现象提示POF的发病可能与免疫因素相关.半乳糖血症、某些病毒感染后、放化疗后及体外受精(IVF)助孕周期中对促性腺激素刺激反应低下的患者数年后患POF的现象也提示POF与代谢、病毒感染以及医源性因素相关.对POF病因的探究已成为生殖领域关注热点,并将有助于谮对症治疗和满足患者生育要求.     

雄激素受体基因CAG多态性与卵巢早衰的关系

目的:探讨雄激素受体(AR)基因CAG重复序列与特发性卵巢早衰(POF)发病的关系.方法:选择特发性POF患者85例为研究组,健康女性80例为对照组.提取两组患者的外周血DNA,PCR扩增并采用琼脂糖凝胶电泳获取目的基因,进行基因测序,检测每例AR基因CAG重复序列的重复次数.结果:POF组与对照组的最大频率等位基因分别为n=23及n=22;(CAG)n重复次数分别为22.73±3.24、22.03±3.06,差异具有显著性(P＜0.05);POF组(CAG)n长片段(n≥23)的发生频率显著高于对照组(P＜0.05).结论:POF患者AR基因CAG重复次数增多,CAG长片段的发生频率增高.AR基因CAG重复序列次数多态性可能与中国汉族女性的POF发病有关.     

卵巢早衰的遗传学研究进展

卵巢早衰(POF)是一种临床高度异质且病因复杂的疾病,遗传因素是其重要的发病原因。遗传因素主要包括X染色体、常染色体异常、微小RNA表达异常等。全基因组关联研究(GWAS)、高通量测序(NGS)技术等迅猛发展,可对基因标志物或核苷酸多态性进行统计分析,发现其间的内部联系,揭示新的致病基因,为POF的遗传学基础研究提供崭新的平台。     

100例卵巢早衰相关因素的调查分析

目的:探讨卵巢早衰(POF)的发病与生活方式、生活习惯、个性特征等相关因素的关系,分析卵巢早衰的危险因素和保护因素,为卵巢早衰的预防、保健、临床治疗提供科学依据.方法:对100例POF患者(POF组)和100例正常绝经的妇女(对照组)进行详细的病史采集及A型行为量表问卷调查,并进行相关因素分析.结果:危险因素包括A型行为、被动吸烟、腮腺炎病史、经常出差、青春期穿紧身内衣、不良情绪、装修异味、接触毒物史、月经初潮早等;保护因素有经常锻炼、经常食豆制品及蔬菜、母乳喂养等.结论:养成良好生活方式、健康心态、避免接触有害的环境,早预防、早发现及早治疗以延缓疾病的发展.     

卵巢早衰的病因

卵巢早衰(POF)的病因包括遗传、免疫、代谢、病毒感染以及医源性等因素。涉及X染色体长臂的畸变、X染色体及常染色体的某种基因突变都与POF相关。某些病例卵巢组织炎性改变，自身抗体特别是抗自身类固醇生成细胞抗体(st-c-Ahs)的发现，淋巴细胞亚群比例异常等现象提示POF的发病可能与免疫因素相关。半乳糖血症、某些病毒感染后、放化疗后及体外受精(IVF)助孕周期中对促性腺激素刺激反应低下的患者数年后患POF的现象也提示POF与代谢、病毒感染以及医源性因素相关。对POF病因的探究已成为生殖领域关注热点，并将有助于对症治疗和满足患者生育要求。     

抑制素基因多态性与卵巢早衰的关系

卵巢早衰(POF)作为一种异质性疾病,其病因与发病机制目前尚未明确。近年来有研究证明,低水平的血清抑制素与POF相关,抑制素基因成为POF潜在的致病候选基因。来源于不同种群的研究显示,抑制素基因INHα的单核苷酸多态性(SNPs)与POF存在相关性,对此方面的研究文献进展作综述,以期为POF的早期筛查及早期诊断提供依据,并更好地预防POF的不良结局。     

卵巢早衰患者外周血CD4~+CD25~+Treg细胞的变化及意义

目的:探讨CD4+CD25+调节性T细胞(即CD4+CD25+Treg细胞)在卵巢早衰发病机制中的作用。方法:流式细胞仪定量检测卵巢早衰(premature ovarian failure,POF)患者、卵巢储备功能下降(diminished ovarian reserve,DOR)患者及健康对照组外周血CD4+T、CD8+T细胞及CD4+CD25+Treg细胞数量,应用3H-thymidine掺入法测定POF患者及对照组外周血CD4+CD25+Treg细胞对效应性T细胞的增殖抑制功能。结果:与对照组相比,POF患者及DOR患者CD4+CD25+Treg细胞比例降低(P<0.01)、POF患者CD4+T/CD8+T细胞比值增高(P<0.05),DOR患者CD4+T/CD8+T细胞比值无明显变化(P>0.05);POF患者免疫抑制功能无明显降低(P>0.05)。结论:CD4+CD25+Treg细胞比例降低与T细胞亚群失衡可能是POF的发病机制。     

卵巢功能早衰的免疫学发病机制及免疫治疗的研究进展

卵巢功能早衰（POF）是指女性在40岁以前发生自然绝经,发病率呈逐年升高的趋势,且有低龄化倾向,可导致不孕不育,雌激素水平低下,对骨骼、心血管系统等也会造成一定影响。POF病因复杂、机制不明,除了部分遗传因素、自身免疫性因素、感染因素、酶缺陷及医源性因素等可明确病因以外,大部分无明确病因可循（即特发性POF）,是临床治疗的一个难题。近期研究表明,自身免疫是POF的重要发病机制之一。自身抗体的产生及细胞免疫功能异常均参与POF的发生。目前的治疗方法疗效均不理想,阐明POF的分子免疫学发病机制及与神经内分泌间的内在联系,将是寻求预防、治疗POF有效方法的关键。     

Co-existent ovarian mucinous cystadenocarcinoma and ovarian choriocarcinoma

We present the case of a 63-year-old woman with an ovarian neoplasm in which mucinous cystadenocarcinoma and choriocarcinoma coexisted. Blood levels of β-hCG were elevated and bilateral ovarian stromal luteinization was seen. The rarity of this association and its clinical and pathologic implications are discussed. Received: 15 February 2001 / Accepted: 29 May 2001     

Benign or malignant ovarian neoplasms and ovarian endometriomas

STUDY OBJECTIVE: To investigate clinical features and biologic behavior of ovarian cancer that might be closely related to endometrioma and/or endometriosis. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: All 324 women who were operated for endometriomas and/or ovarian tumors 5 cm or greater in diameter between January 1988 and December 1997. INTERVENTION: One hundred twelve women underwent laparoscopic surgery and 212 had laparotomy. MEASUREMENTS AND MAIN RESULTS: All tissues were evaluated histologically. Clinical examinations including ultrasound and serum tumor makers were performed in all patients preoperatively. No malignancies were found at laparoscopic surgery (76 endometriomas, 36 ovarian tumors). The frequency of endometriosis in benign, borderline malignant, and malignant tumors was 9.7%, 12.5%, and 11.4%, respectively. Endometriosis was present most frequently (40%) in women with endometrioid adenocarcinoma. It was present in 81 patients with endometriomas and 25 with ovarian neoplasms. Of these, nine women (8.5%) had malignant tumors, including borderline malignancy. Among patients with malignant tumors, those without endometriosis were significantly older (mean +/- SD age 54.9 +/- 16.2 yrs) than those with endometriosis elsewhere in the pelvis (45.9 +/- 8.9 yrs). CONCLUSION: Endometriosis may be closely related to ovarian tumors such as endometrioid adenocarcinoma. Surgeons should be aware of this possibility, and candidates for laparoscopic surgery should be carefully selected based on preoperative evaluations.     

Influence of ovarian cysts during controlled ovarian hyperstimulation

BACKGROUND: The use of gonadotrophin-releasing hormone agonist and purified follicular stimulating hormone increases the incidence of ovarian cysts during in vitro fertilization-embryo transfer cycles. The aetiopathogenesis and the effects of ovarian cysts on controlled ovarian hyperstimulation is unclear; most authors observed no-detrimental influence of ovarian cysts in controlled ovarian hyperstimulation cycles for IVF. The aim of this study was the evaluation of the real incidence and effects of ovarian cysts during in vitro fertilization-embryo transfer cycles. METHODS: Design: retrospective study. Setting: reproductive medicine units. Patients: 130 women. Interventions: r-FSH--225 U.I. was administered to 130 women i.m. after a long protocol of down regulation with GnRH-a (Triptoreline 3.75). The drug administration was personalized on the basis of: pre-existent patients pathologies; E2 blood levels; ultrasound evaluation of the follicular development. Main outcome measures: E2 levels, number and quality of oocytes retrieved, fertilization rate, number of embryos developed, pregnancy rate. RESULTS: At the end of stimulation ovarian cyst was observed in eighteen cases. There was no difference, between the cycles with or without cysts, in the follicular development, number and quality of eggs retrieved, fertilization rate, number and quality of the transferred embryos, pregnancy and miscarriage rate. CONCLUSIONS: The conclusion is drawn that the incidence of ovarian cysts during COH can be reduced observing some simple rules like: to exclude from the stimulation protocols patients with follicles of more than 12 mm diameters as observed at the preliminary ultrasound control; to personalize the therapeutic regime with the pre-existent patients pathologies; ultrasound evaluation of the follicular development; determination of the E2 serum levels, every two days.     

Genetic alterations in ovarian borderline tumours and ovarian carcinomas

OBJECTIVE: To evaluate the benefits associated with routine uterine curettage following complete second trimester termination of pregnancy by extraovular prostaglandin E2. STUDY DESIGN: Fifty-five patients between 15 and 24 weeks' gestation who had undergone complete termination of pregnancy by continuous extraovular instillation of prostaglandin E2 (PGE2), were randomly assigned into either no further intervention (n=25), or uterine curettage under general anesthesia (n=30). The need for late uterine curettage, clinical and ultrasonographic parameters at 1 and 42 days follow-up, as well as the incidence of the minor and major complications, were compared between groups. RESULTS: Baseline and post-abortion clinical and ultrasonographic characteristics were similar in both groups. Mean (+/- Standard error of the mean) number of post-abortion bleeding days in the curettage group was 8.9+/-1.8 versus 10.1+/-2.6 days in the non-curettage group (P=NS). No patient in the former group, compared to three patients in the latter group, needed late uterine curettage, (P=NS). Major and minor complications rates in the curettage and in the no-curettage groups were not significantly different. Considerably more patients in the curettage group needed analgesic agents following the abortion compared to the no-curettage group (60% vs. 3.3%, respectively; P<0.001). CONCLUSIONS: Routine uterine curettage in patients undergoing complete second trimester termination of pregnancy by extraovular instillation of PGE2, exerts no benefit.     

A case of primary ovarian adenomyoma mimicking ovarian malignancy

Adenomyoma is a benign tumor composed of smooth muscle and benign endometrium. These tumors typically originate within the uterus. An extrauterine adenomyoma is an extremely rare entity. After an extensive literature search, only four cases of primary ovarian adenomyoma appear to have thus far been reported. Here, we report a case of ovarian adenomyoma in a 39-year-old woman mimicking malignant neoplasma of the ovary, along with a brief literature review.     

卵巢储备功能与卵巢反应性评估

辅助生殖技术（ART）的成功率依赖于正确的卵巢刺激方案,而卵巢刺激方案的决定依靠准确的卵巢储备功能和卵巢反应性的评估,主要包括年龄、基础性激素水平、基础窦卵泡数（AFC）、抗苗勒管激素（AMH）等,但是目前尚无能够独立评价卵巢储备功能和卵巢反应性的特异性标志物,仍需联合应用评估。     

Functional ovarian cysts in patients cured of ovarian neoplasms

Twenty-seven patients with ovarian cancer underwent unilateral salpingo-oophorectomy and were followed for 12-215 months (mean 80) after completion of therapy. Of these, nine patients who received pelvic irradiation subsequently developed ovarian failure. Of the remaining 18 patients who maintained ovarian function, 13 (72%) developed a functional ovarian cyst during the follow-up period. Of these 13 patients, eight were observed until the functional cyst regressed, four were treated with oral contraceptives (OCs) to suppress ovarian function, and one underwent oophorectomy for a large corpus luteum cyst. We recommend that OC pills be considered for suppression of ovarian function in postmenarcheal girls after completion of therapy for ovarian neoplasms. Routine use of OCs may simplify the follow-up of these patients by preventing the formation of functional ovarian cysts. In postmenarcheal patients not treated with OCs, the finding of a unilocular ovarian cyst should be considered to represent a functional cyst, and a trial of OCs for 3 months may result in spontaneous regression. Persistent cysts must be operatively removed.