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。     

宫颈支原体感染与胎膜早破的关系探讨

目的探讨宫颈支原体感染与胎膜早破的关系及其对妊娠结局的影响。方法对北京市海淀区妇幼保健院2004年6月至2005年6月收治的93例胎膜早破孕妇(观察组)和96例孕足月、无胎膜早破住院待产孕妇(对照组)的宫颈分泌物,进行人型支原体(Mh)、解脲支原体(Uu)培养,并对其妊娠结局进行分析。结果观察组Mh感染率(6.45%)高于对照组(4.17%),但差异无统计学意义(P>0.05);观察组Uu感染率66.67%与对照组感染率55.21%比较,差异无统计学意义(P>0.05),观察组按是否早产再分两组,早产胎膜早破组产妇解脲支原体感染率为100%,明显高于足月胎膜早破组产妇61.73%,差异有统计学意义(P<0.05),早产胎膜早破组人型支原体感染率16.67%与足月胎膜早破产妇感染率2.47%比较,差异无统计学意义(P>0.05),但解脲支原体阳性孕妇分娩新生儿高胆红素血症明显增多,差异有统计学意义(P<0.05)。结论孕妇Mh、Uu感染与胎膜早破相关性不明显;Uu感染对早产的胎膜早破有明显影响,可能是导致早产胎膜早破的重要原因,并可能与新生儿高胆红素血症有关。     

人粒细胞集落刺激因子(G-CSF)宫腔灌注改善子宫内膜容受性的临床研究

目的:探讨人粒细胞集落刺激因子(G-CSF)宫腔灌注对于子宫内膜状况欠佳患者的子宫内膜容受性的影响。方法:将进行体外受精-胚胎移植(IVF-ET)的子宫内膜厚度不足或基底低回声、反复种植失败的患者按2∶1随机分为G-CSF组和对照组,进行前瞻性研究,G-CSF组(n=60)行IVF-ET前进行1~6次G-CSF宫腔灌注,对照组(n=30)则不给予G-CSF,观察子宫内膜厚度、回声、基底回声、血流动力学等指标。结果:与对照组相比,G-CSF组在早卵泡期、晚卵泡期的子宫内膜厚度增加明显,基底回声优于对照组,差异有统计学意义(P0.05);围排卵期内膜厚度与对照组相比无统计学差异(P0.05),基底回声优于对照组,差异有统计学意义(P0.05)。早卵泡期、晚卵泡期及围排卵期G-CSF组子宫内膜基底区(EMI)动脉搏动指数(PI)均高于对照组,G-CSF组早卵泡期及围排卵期阻力指数(RI)高于对照组,差异均有统计学意义(P0.05);晚卵泡期RI与对照组无统计学差异(P0.05)。在已行ET的患者中,G-CSF组的妊娠率为62.5%(35/56),显著高于对照组的33.3%(9/27),差异有统计学意义(P0.05)。结论:G-CSF宫腔灌注可改善子宫内膜的厚度及基底回声,对于内膜较薄、基底低回声及胚胎反复种植失败的患者具有较好的临床治疗效果,妊娠率较高。     

HPV多重感染与宫颈病变关系的初步研究

目的探讨人乳头状瘤病毒(HPV)多重感染在不同级别宫颈病变中的分布情况及多重感染亚型间的相互作用。方法采用PCR-反向点杂交人乳头状瘤基因分型技术对300例(慢性宫颈炎症组121例、CIN158例、CIN2 42例、CIN3 20例、宫颈鳞癌组SCC 8例、正常对照组51例)就诊患者进行HPV分型检测。运用?2趋势检验比较HPV在不同病变中的总感染率、多重感染率,分析HPV亚型在多重感染中的分布及变化。结果正常对照组、慢性宫颈炎、CIN1、CIN2、CIN3、SCC组的HPV多重感染率分别为3.92%、9.92%、15.52%、19.05%、15.00%、12.50%。不同宫颈病变相对于正常对照组,多重感染率明显升高(P0.05),宫颈癌组多重感染率与正常对照组比较差异无统计学意义(P0.05);多重感染中以二重感染最常见,二重感染最常见的HPV亚型组合是HPV16+51型。结论 CIN1、CIN2、CIN3及宫颈癌中HPV的感染率均高于正常和宫颈慢性炎症组,高危型HPV多重感染(高危与高危)增加宫颈上皮内病变风险,但与宫颈癌的发生无明显相关性。     

白细胞介素1β肿瘤坏死因子α与黄体功能不全所致不孕的相关性探讨

目的　探讨生殖道局部细胞免疫与黄体功能不全患者不孕的关系。方法　 1999年 11月至 2 0 0 0年 9月用放射免疫法 (RIA)检测 2 1例黄体功能不全 (LPD)患者排卵期血清、宫颈黏液中白细胞介素 1β(IL 1β)、肿瘤坏死因子α(TNF α)的表达 ,用化学发光免疫分析仪测定黄体期血清孕酮水平 ,并与对照组 18例比较。结果　两组黄体中期血清孕酮比较差异有显著性意义 (P <0 0 1)。排卵期LPD组血清IL 1β、TNF α与对照组比较差异无显著性意义 (P >0 0 5 ,P >0 0 5 ) ,而LPD组宫颈黏液中IL 1β、TNF α与对照组比较差异有显著性意义 (P<0 0 5 ,P <0 0 1) ,且LPD组宫颈黏液IL 1β、TNF α与黄体中期血清孕酮均呈负相关 (r =- 0 890 ,P <0 0 1;r =- 0 85 1,P <0 0 1) ,宫颈黏液IL 1β与TNF α水平呈正相关 (r =0 799,P <0 0 1)。结论　排卵期生殖道局部细胞免疫激活状态可能是黄体功能不全患者不孕的发病环节中的主要免疫因素之一 ,并可能间接地影响黄体发育导致黄体功能不全。     

壳聚糖宫颈抗菌膜治疗持续性宫颈炎的疗效观察

目的分析应用壳聚糖宫颈抗菌膜治疗持续性宫颈炎的疗效。方法选取我院2014年7月~2015年1月收治的持续性宫颈炎患者78例,将其随机分为对照组32例和观察组46例,对照组用干扰素α-2b凝胶治疗,观察组用壳聚糖宫颈抗菌膜治疗,对比两组患者的疗效。结果对照组患者的总有效率为81%,低于观察组的96%,差异有统计学意义(P0.05),对照组患者不良反应发生率为16%,高于观察组的2%,差异有统计学意义(P0.05)。结论应用壳聚糖宫颈抗菌膜治疗持续性宫颈炎,疗效明显,不良反应少,可以广泛推广应用。     

不孕妇女宫颈沙眼衣原体感染的临床观察

目的 :探讨宫颈沙眼衣原体 (CT)感染对生育的影响。方法 :应用聚合酶链反应 (PCR)技术 ,对 2 16对不孕夫妇宫颈分泌物、尿道分泌物进行 CT- DNA检测 ,并观察宫颈 CT感染对围排卵期宫颈粘液葡萄糖含量及性交后试验的影响。结果 :2 16对不孕夫妇衣原体感染的阳性率分别为 :女性 32 .4 % ,男性 30 .1%。宫颈 CT感染妇女围排卵期性交后试验与未感染妇女比较 ,每高倍视野的活精数明显减少 (P<0 .0 5 ) ,围排卵期宫颈粘液葡萄糖含量明显减少 (P<0 .0 1)。经治疗后宫颈 CT转阴的妇女 ,围排卵期性交后试验每高倍视野的活精数明显高于治疗前 (P<0 .0 5 ) ,宫颈粘液的葡萄糖含量亦明显高于治疗前 (P<0 .0 1)。治疗后宫颈 CT持续阳性妇女 ,围排卵期性交后试验与治疗前比较 ,每高倍视野的活精数无明显变化 (P>0 .0 5 ) ,宫颈粘液的葡萄糖含量亦无明显变化 (P>0 .0 5 )。结论 :宫颈 CT- DNA感染是不孕的一个重要因素 ,导致不孕的原因 ,可能与患者宫颈粘液葡萄糖含量降低 ,影响精子在宫颈粘液中的活力有关     

1955例武汉市农村妇女HPV感染状况与危险因素分析

目的:探讨武汉市农村妇女HPV在宫颈炎、宫颈上皮内瘤变(CIN)、宫颈癌中的感染分布情况及HPV感染危险因素。方法:在2011年武汉市20万农村妇女宫颈癌初筛阳性患者中随机抽取1955例,采用飞行时间质谱检测法对宫颈刷片进行HPV分型测定,分析HPV在宫颈炎、CIN、宫颈癌中的感染情况。结果:1955例宫颈刷片标本中发现HPV感染1115例,感染率为57.03%。HPV在不同宫颈疾病中的感染率不同,HPV在宫颈炎中的感染率为40.72%,CIN中为89.64%,宫颈癌中为92.86%,差异有统计学意义(P<0.01);HPV感染患者中,单纯高危型及单纯低危型HPV感染所占比例分别为92.74%、3.23%,差异有统计学意义(P<0.01)。1955例患者中HPV 16型感染率最高(18.16%),其次是HPV 58型(13.35%)、HPV52型(11.00%)、HPV 33型(5.68%)。1955例患者中单一亚型感染率为41.43%,双重及多重感染率为15.60%。不同初婚年龄、临床症状、宫颈癌家族史及是否熬夜等患者HPV感染率比较,差异有统计学意义(P<0.05)。结论:武汉市农村妇女高危型HPV感染是宫颈癌及CIN发生的必要因素。初婚年龄较早、有宫颈癌家族史、经常熬夜等为HPV感染的危险因素。     

血清鳞状细胞癌抗原检测对宫颈鳞癌的诊断价值

目的:探讨检测血清鳞状细胞癌抗原(SCCAg)在宫颈鳞癌诊断中的价值。方法:用化学发光法测定32例宫颈鳞癌(宫颈鳞癌组)、21例宫颈上皮内瘤变(CIN组)和30例慢性宫颈炎(慢性宫颈炎组)患者治疗前血清SCCAg值(以≥2.5ng/ml为阳性参考值),并根据最大约登指数计算最佳诊断界值及计算曲线下面积(AUC)。结果:宫颈鳞癌组术前血清SCCAg水平(5.516±1.523ng/ml)明显高于CIN组(0.806±0.152ng/ml)和慢性宫颈炎组(0.412±0.053ng/ml),差异均有统计学意义(t=2.492,P=0.001;t=4.715,P=0.000)。宫颈鳞癌组术前血清SC-CAg阳性率(43.75%)明显高于CIN组(4.76%)和慢性宫颈炎组(0),差异均有统计学意义(χ2=9.498,P=0.000;χ2=35.497,P=0.000);宫颈鳞癌组ⅠB期、ⅡA期、ⅡB期、Ⅳ期术前血清SCCAg阳性率分别是31.25%、40.00%、75.00%、100.00%,但4组比较,差异无统计学意义(χ2=3.2,P=0.362)。血清SCCAg对宫颈鳞癌最佳诊断界值、灵敏度、特异度和ROC曲线下面积分别为1.48ng/ml、44.00%、99.00%、0.727。结论:血清SCCAg是宫颈鳞癌特异度较高的肿瘤标志物,可作为辅助诊断指标,而降低SCCAg诊断界值可能有助于提高诊断率。     

宫颈冷刀锥切术对生育能力及妊娠结局的影响

目的:探讨宫颈冷刀锥切术对患者生育能力的影响及是否产生不良妊娠结局。方法:收集1998年10月至2008年9月收治的因宫颈上皮内瘤变(CIN)或宫颈原位癌于我院实施宫颈冷刀锥切术且有生育要求的患者96例作为观察组,随机抽取同期孕前门诊的100例无宫颈锥切术史的妇女作为对照组。对两组对象的生育能力、妊娠结局及围生儿情况进行分析。结果:①观察组术后妊娠率(89.6%)与对照组(91.0%)相比,差异无统计学意义(P>0.05)。②观察组剖宫产率(34.7%)高于对照组(20.5%)(P<0.05),两组流产率、阴道试产成功率、产钳助产率、平均产程及各项剖宫产指征比较差异均无统计学意义(P>0.05)。③观察组严重早产发生率(8.0%)和早产胎膜早破发生率(10.7%)高于对照组(1.2%和2.4%)(P<0.05),而观察组新生儿出生体重低于对照组(P<0.05);观察组早产及小于胎龄儿发生率与对照组比较差异无统计学意义(P>0.05);④宫颈锥切术距术后初次妊娠时间间隔<6月组、6～12月组及≥12月组的不良妊娠结局比较,3组差异均无统计学意义(P>0.05);⑤将锥切高度<10mm、10～20mm及≥20mm分成3组,流产率、早产率、早产胎膜早破及小于胎龄儿发生率随宫颈锥切的高度递增,但差异无统计学意义(P>0.05)。结论:宫颈锥切术后对患者妊娠能力无明显影响,但可增加不良围生结局发生率;宫颈锥切术距术后妊娠的时间间隔和锥切高度与不良围生结局无明显关系。     

Psychological well-being and coping patterns in infertile men

OBJECTIVE: To determine whether differences existed in mood and coping styles among fertile men, oligoasthenospermic men, or euspermic men whose wives were undergoing ovulation stimulation with clomiphene and IUI. DESIGN: A cross-sectional research design. SETTING: Hospital-based academic fertility clinic. PATIENT(S): 30 fertile men with currently pregnant wives, 30 euspermic and 30 oligoasthenospermic men in couples undergoing ovulation stimulation with clomiphene and IUI. INTERVENTION(S): Measures of psychological well-being and coping were administered. MAIN OUTCOME MEASURE(S): Biodemographic information, and psychometric measures of mood and coping. RESULT(S): There were no significant differences among the groups on any of the measures except the Family Inventory of Life Events (FILE), in which fertile men reported higher stress levels. FILE scores in all groups were moderate, indicating typical levels of family stress. CONCLUSION(S): Mood and coping in the three groups were similar. This study suggests that men's psychological adjustment to their own infertility and to unexplained infertility is generally healthy.     

Genital cancer among wives of men with penile cancer. A study between 1958 and 1982

Summary. Previous studies have suggested an association between penile cancer and cervical cancer but the results have been difficult to interpret. The current study includes 1064 cases of penile cancer reported to the National Swedish Cancer Registry between 1958 and 1980. One matched control for each living case was chosen randomly from the Swedish Population Registry, and for cases who had died, from the National Death Registry. Details about the men, their marriages and each wife or wives were obtained from the population registry in the parish in which the men lived or had died. The personal identification number and name of each wife or wives were matched against the cancer registry. All genital cancers, including 15 cervical cancers, were distributed equally among the wives of the cases and those of the controls. The expected rate of cancers among the population of wives of cases was also calculated and there was no difference between the observed and the expected number of women with cancer. The results did not show an association between penile cancer in men and cervical cancer in their sexual partners.     

Genital cancer among wives of men with penile cancer. A study between 1958 and 1982

Previous studies have suggested an association between penile cancer and cervical cancer but the results have been difficult to interpret. The current study includes 1064 cases of penile cancer reported to the National Swedish Cancer Registry between 1958 and 1980. One matched control for each living case was chosen randomly from the Swedish Population Registry, and for cases who had died, from the National Death Registry. Details about the men, their marriages and each wife or wives were obtained from the population registry in the parish in which the men lived or had died. The personal identification number and name of each wife or wives were matched against the cancer registry. All genital cancers, including 15 cervical cancers, were distributed equally among the wives of the cases and those of the controls. The expected rate of cancers among the population of wives of cases was also calculated and there was no difference between the observed and the expected number of women with cancer. The results did not show an association between penile cancer in men and cervical cancer in their sexual partners.     

The taming of the shrew: batterers' constructions of their wives' narratives

Constructing a life story is a need shared by all humans to give their lives meaning and coherence. This article explores some of the narrative devices that batterers use to achieve a sense of coherence when telling their stories and justifying their violent behavior. A central theme that emerged from these stories centered on the men's perception of their wives as the embodiment of their own emotions and inner world. Two narrative strategies were identified in this context: (a) The construction of a "couple narrative" that focused on an idealized marital relationship rather than "allowing" the wife her story and (b) constructing a story around the theme of "she's not the same woman I married," which portrays the wife as "a shrew" and the violence as an attempt to discipline her. The stories of 18 batterers were used for this analysis, and two narratives were used to illustrate these strategies.     

Clinical significance of crossed in vitro sperm-cervical mucus penetration test in infertility investigation

To evaluate the clinical significance of in vivo and in vitro testing of sperm ability to penetrate cervical mucus (CM), postcoital testing (PCT) and in vitro sperm-cervical mucus penetration testing were compared in a prospective study. Both in vivo and in vitro tests were standardized and performed after an oral course of estrogen therapy. Crossed in vitro sperm-cervical mucus penetration test, evaluated in 277 couples with CM of patients' wives and additionally with CM and semen of fertile donors, revealed that the male factor contributed to a significantly higher extent to deficient sperm-mucus interaction than the cervical factor. The overall pregnancy rate after 6 months was 23% (64/277). Whereas the outcome of PCT did not significantly predict subsequent fertility (PCT good pregnancy rate 24%/PCT poor 20%), significant differences were found for the sperm-cervical mucus penetration test with CM of patients' wives (pregnancy rate, 30.5% versus 8.5%) and for in vitro testing with donors' CM, but not for the mucus penetration test with donors' spermatozoa. Routine sperm analysis did not prove to be of prognostic value for a subsequent pregnancy. The results suggest that the in vitro sperm-cervical mucus penetration test is a good parameter of sperm function and, in particular, when performed as a cross-matching penetrability test, a valuable adjunct to PCT with regard to fertility prognosis.     

Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples.

OBJECTIVE: To compare the dynamics of fertility-problem stress experienced by wives and husbands in infertile couples with the dynamics of stress from other sources experienced by members of couples presumed to be fertile. DESIGN: Relationships of stress to four marriage factors and four aspects of life quality (subjective well-being) are examined within a causal modeling framework using data from structured interviews. SETTING: Face-to-face interviews were conducted in study participants' homes. PARTICIPANTS: Wives and husbands from 157 couples with primary infertility and from 82 presumed-fertile couples were studied. MAIN OUTCOME MEASURES: Final outcome measures were four multi-item scales assessing life quality with regard to the marriage, own self-efficacy, own health and appearance, and life as a whole. Intervening outcome scales measured four marriage factors: marital conflict, sexual self-esteem, sexual dissatisfaction, and frequency of intercourse. RESULTS AND CONCLUSIONS: Higher levels of stress, regardless of whether that stress was from attempting to solve a fertility problem or another problem, were related to reduced marital functioning and decreased life quality. For husbands, the strengths of the linkages did not depend on the source of the stress. For wives, however, the causal model suggested that fertility-problem stress had stronger negative impacts on sense of sexual identity and self-efficacy than did stress from other problems (P less than 0.05). Stress from any source had more impact on the lives of wives than of husbands, more impact on satisfaction with self and general well-being than on satisfaction with the marriage or health, and affected life quality mostly indirectly through its impacts on the marriage factors.     

Telomerase activity in Papanicolaou smear-negative exfoliated cervical cells and its association with lesions and oncogenic human papillomaviruses

OBJECTIVE: The goal of this study was to evaluate telomerase activity in exfoliated cervical cells and its association with cytology, pathology, and human papillomavirus (HPV). METHODS: Telomerase activity and HPV DNA sequences were examined in the exfoliated cervical cells from a general population of 245 women aged more than 30 years undergoing routine cervical screening by Papanicolaou smear. The women who were found to have telomerase activity or abnormal cytology in their exfoliated cervical cells were examined for cervical lesions by colposcopy and biopsy. RESULTS: Cytology for our population (mean, 56 years) revealed only one abnormal smear (1/245, 0.4%), in which a cervical intraepithelial neoplasia grade I (CIN I) lesion was found. The exfoliated cervical cells used to prepare the smear were negative for telomerase and contained low-risk HPV DNA. Telomerase activity was found in 16 exfoliated cell samples (16/245, 6.5%); high-risk HPV DNA was found in 9 of these samples (9/16, 56%) and 9 of the biopsy specimens that could be evaluated from patients testing positive for telomerase revealed CIN I lesions (9/11, 82%). CONCLUSIONS: Telomerase activity is often associated with high-risk HPV infection and it is suggested that telomerase assay can help to detect occult cervical lesions.     

Differences between husbands' and wives' approach to infertility affect marital communication and adjustment

Objective: To test a theoretical model of the effect on marital communication and adjustment of men’s and women’s approach to infertility.

Design: A cross-sectional research design involving interviews, questionnaires, and a marital discussion task.

Setting: Volunteers from practices of fertility specialists.

Patient(s): Forty-eight couples currently seeking infertility treatment.

Intervention(s): None.

Main Outcome Measure(s): Quality of marital communication during a marital discussion task and effect of infertility on the marriage.

Result(s): Having children was more important to wives than husbands; wives were more involved in trying to have a baby, wanted to talk with their partner more about trying to have a baby, and experienced a greater loss of self-esteem than did their husbands. To the extent that husbands saw having children as important, were involved in trying to have a baby, or wanted to talk with their wives about trying to have a baby, the quality of marital communication when discussing infertility was less negative, and in turn, wives perceived a more positive effect of infertility on their marriage.

Conclusion(s): Increases in husbands’ interest and involvement in fertility treatment may lead to positive changes in couple communication about infertility and to a more positive effect of infertility on the marriage.     

Immunohistochemical and quantitative competitive PCR analyses of midkine and pleiotrophin expression in cervical cancer

OBJECTIVE: The aim of this study was to determine midkine (MK) and pleiotrophin (PTN) expression in cervical cancer. METHODS: Prospective study in tertiary teaching hospital. Normal and cancerous cervical tissues were obtained from healthy women (n = 19) and from patients with cervical cancer (n = 42). The expressions of MK and PTN mRNA and protein were examined by quantitative competitive PCR and by immunohistochemistry. MK and PTN mRNA and protein expressions were examined with respect to tumor stage and size. RESULTS: The expressions of midkine and pleiotrophin mRNA in cervical cancer were higher than those in the normal cervix (MK, 175.59 +/- 63.3 vs 1.00 +/- 0.18 fmol, respectively; PTN, 3.18 +/- 1.25 vs. 0.86 +/- 0.12 fmol, respectively, P < 0.05), and their expressions were not correlated with cervical cancer stage or size of the tumor. The expressions of MK and PTN protein in cancerous tissue were higher than those in the normal cervix (P < 0.05). Moreover, the protein expression of MK, but not of PTN, correlated with tumor stage and size. The expressions of MK and PTN were not correlated with vascular density. CONCLUSIONS: Our results suggest that increased midkine mRNA and protein expressions are associated with the carcinogenesis of cervical cancer.