天狼猩红-偏振光法检测子宫内膜异位症中Ⅰ、Ⅲ型胶原

探讨子宫内膜异位症中Ⅰ、Ⅲ型胶原的含量和作用。方法：对子宫内膜异位症（内异症）２０例中的异位内膜组织红色病变期１２例（Ａ组）、黑色病变期８例（Ｂ组）和１１例非子宫内膜异位症患者的在位子宫内膜组织（Ｃ组）用天狼猩红染色,偏振光观察,ｐｈｏｔｏｓｈｏｐ分析,半定量研究Ⅰ、Ⅲ型胶原的含量。结果： Ｉ、Ⅲ型胶原在Ｃ组中含量最低（Ｐ＜０．０５）,Ⅲ型胶原在Ａ组中含量最高（Ｐ＜０．０５）,Ｉ型胶原在Ｂ组中含量最高（Ｐ＜０．０５）。Ｉ、Ⅲ型胶原在增生期和分泌期差异无显著性（Ｐ＞０．０５）。结论：Ⅰ、Ⅲ型胶原的异常沉积可引起内异症患者腹腔内发生异常的免疫反应。     

放置γCuI和TCu 220C宫内节育器前后子宫内膜螺旋动脉形态计量学研究

目的探讨γ型含铜、含消炎痛（γＣｕＩ）宫内节育器（ＩＵＤ）对子宫内膜螺旋动脉形态的影响，及其防治出血副反应的机理。方法取９例放置γＣｕＩＩＵＤ妇女（γＣｕＩ组）、１０例放置ＴＣｕ２２０ＣＩＵＤ妇女（ＴＣｕ２２０Ｃ组）及１０例放置前妇女（放置前组）的晚泌期子宫内膜，连续切片，ＨＥ染色后，光镜下对螺旋动脉行形态计量学分析。结果ＴＣｕ２２０Ｃ组子宫内膜致密层和海绵层螺旋动脉的平均截面积（Ａｒｅａ）、最大直径（Ｄｍａｘ）和最小直径（Ｄｍｉｎ）显著增加（Ｐ＜０．０５）。γＣｕＩ组海绵层螺旋动脉Ａｒｅａ和Ｄｍａｘ与放置前组差异无显著性（Ｐ＞０．０５），致密层Ａｒｅａ和Ｄｍａｘ增加，但程度均小于ＴＣｕ２２０Ｃ组（Ｐ＜０．０５），各层螺旋动脉Ｄｍｉｎ的增加较ＴＣｕ２２０Ｃ组更明显（Ｐ＜０．０５）。结论γＣｕＩＩＵＤ与ＴＣｕ２２０ＣＩＵＤ相比，较少影响子宫内膜功能层螺旋动脉的形态，可能与减少出血性副反应的机理有关。     

消炎痛Vcu200 IUD减少月经过多的机理

自１９９２年１１月至１９９５年６月，对４６例放置无消炎痛ＶＣｕ２００ＩＵＤ及２４例含消炎痛ＶＣｕ２００ＩＵＤ妇女的子宫内膜中６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及纤溶指标包括ｔ－ＰＡ、ＰＡＩ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ的水平进行测定，同时作光、电镜观察置器后ＩＵＤ对子宫内膜的影响。结果：１．无消炎痛ＶＣｕＩＵＤ３月组置器后６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２比值明显高于置器前（Ｐ＜０．０５），ｔ－ＰＡ、ＰＫ、ＰＬＧ、Ｄ－Ｄ及ＦＤＰ均非常明显低于置器前水平（Ｐ＜０．ｏ１～０．００１）。２．无消炎痛ＶＣｕＩＵＤ＞６月组置器后只ｔ－ＰＡ、ＰＫ、ＦＤＰ明显低于置器前水平（Ｐ＜０．０１～０．００１），其余指标均无统计学差异。３．放置合消炎痛ＶＣｕＩＵＤ３个月后６－ｋｅｔｏ－ＰＧＦ１α、ＴＸＢ２及各项纤溶指标与置器前比均无统计学意义。４．子宫内膜形态学变化与置器前相比，表现为血管内血栓形成减少及末梢小血管腔扩大。根据上述结果，置器后内膜中６－ｋｅｔｏ－ＰＧＦ１α／ＴＸＢ２值升高，与ｔ－ＰＡ水平下降可能是置器后月经过多的主要原因，尤以前者起主导作用。本文并对消炎痛ＩＵＤ减少月经过多的作用机理进行了讨论。     

促黄体激素释放激素激动剂的临床应用及对骨代谢的影响

应用促黄体激素释放激素激动剂（ＬＨＲＨ－Ａ）２００μｇ，每日肌内注射，连续３个月为１疗程，治疗轻、中型子宫内膜异位症、子宫肌瘤、子宫腺肌症共２０例。结果：用药结束时，促卵泡成熟激素（ＦＳＨ）、黄体生成素（ＬＨ）、雌二醇（Ｅ＿２）均受抑制，分别为４．８±２．９ＩＵ／Ｌ（Ｐ＞０．０５）、４．０±３．５ＩＵ／（Ｐ＜０．０５）、１６０．３±１１０．７ｐｍｏｌ／Ｌ（Ｐ＜０．００１）。临床上体征改善，痛经消失，副反应轻，易为病人接受。２０例用药前后骨钙素（ｏｓｔｅｏｃａｌｃｉｎ）与尿钙、磷测定比较，差异均无显著性（Ｐ＞０．０５）。双能Ｘ线吸收法（ＤＥＸＡ）测量腰椎２～４骨密度，用药３个月下降２％，停药３个月下降１％，尚属正常范围（Ｐ＞０．０５）；单光子吸收法（ＳＰＡ）测量桡、尺骨骨密度也未见影响（Ｐ＞０．０５）。     

表皮生长因子受体在子宫内膜、早孕蜕膜及滋养细胞中的表达

目的了解表皮生长因子受体（ＥＧＦＲ）在子宫内膜细胞分化及发育中的作用。方法采用免疫组织化学及逆转录聚合酶链反应（ＲＴＰＣＲ）技术测定５８例正常子宫内膜（３２例增生期,２６例分泌期）与２６例早孕蜕膜。结果ＥＧＦＲ存在于正常子宫内膜、早孕蜕膜腺体及间质细胞的细胞膜、核膜及胞浆内,分布均匀。ＥＧＦＲ还位于早孕蜕膜腺体及间质细胞核内。正常子宫内膜ＥＧＦＲ的表达,腺体部分高于间质部分（Ｐ＜０．０５）,ＥＧＦＲ在增生期及分泌期子宫内膜腺体的表达差异无显著性（Ｐ＞０．０５）,但ＥＧＦＲ在早孕蜕膜组织中的表达明显高于增生期及分泌期（Ｐ＜０．０５）。ＥＧＦＲ在间质细胞的表达,早孕蜕膜高于分泌期内膜,而增生期内膜则表达最低（Ｐ＜０．０５）。ＥＧＦＲｍＲＮＡ的表达从弱到强依次为增生期、分泌期、蜕膜、滋养细胞,增生期与分泌期比较,差异无显著性（Ｐ＞０．０５）,早孕蜕膜较分泌期及增生期明显增加（Ｐ＜０．０５）,滋养细胞ＥＧＦＲｍＲＮＡ的表达明显高于增生期、分泌期及早孕蜕膜（Ｐ＜０．０５）。结论ＥＧＦＲ存在于各期子宫内膜中,其表达在正常月经周期中无明显变化,但在早孕蜕膜、滋养细胞中的表达明显高于增生期及分泌期内膜     

子宫乳头状浆液性癌临床生物学行为

回顾性分析近１０年收治的８０例子宫内膜癌。分Ａ组子宫乳头状浆液性癌８例；Ｂ组子宫内膜乳头状腺癌１０例；Ｃ组普通子宫内膜癌６２例。结果：Ａ组临床Ⅲ、Ⅳ期占５０．０％，远高于其他两组，Ｐ＜０．０１。宫外扩散，各组分别占６２．５％，３０．０％，８．１％，Ａ、Ｂ组显著高于Ｃ组，Ｐ＜０．０１。深肌层浸润依次为６２．５％，３０．０％，１６．１％，Ｐ＜０．０５。结论：ＵＰＳＣ与普通内膜癌的临床生物学行为截然不同。子宫内膜乳头状腺癌介于ＵＰＳＣ和普通子宫内膜癌之间。     

上皮性卵巢癌细胞凋亡、P53和Bcl-2表达及其与化疗的关系

目的：研究卵巢癌细胞凋亡、相关基因表达及其与化疗的关系。方法：选择卵巢上皮性癌３２例,行初次手术后给予以铂类为基础的联合化疗４ 疗程以上,１９ 例行二次手术。对２ 次手术标本分别作细胞凋亡原位检测和凋亡指数（ＡＩ）计数,细胞核增殖抗原（ＰＣＮＡ）、Ｐ５３和Ｂｃｌ ２ 基因表达免疫组化染色。结果：化疗有效组ＡＩ显著高于无效组（ｔ＝ ３．１６,Ｐ＜ ０．０５）,化疗前ＡＩ显著高于化疗后（ｔ＝ ２．２８,Ｐ＜ ０．０５）,高ＡＩ组（ＡＩ≥２．０）存活例数显著高于低ＡＩ组（ＡＩ＜ ２．０）（χ２ ＝ ６．４２,Ｐ＜ ０．０５）,平均生存期长于低ＡＩ组,但差异无显著性（ｔ＝ １．１３,Ｐ＞ ０．０５）,ＡＩ和ＰＣＮＡ变化无显著关系（ｔ＝ ０．６４,Ｐ＞ ０．０５）,高ＡＩ组伴有高Ｐ５３和高Ｂｃｌ ２ 表达趋势,但未达显著性水平（ｔ＝ ０．４８,Ｐ＞ ０．０５ 和ｔ＝ ０．７７,Ｐ＞ ０．０５）。结论：卵巢癌对化疗的效应与凋亡有关,高ＡＩ者敏感性较高,且预后良好,凋亡过程可能受Ｐ５３和Ｂｃｌ ２ 基因调控。ＡＩ检测可作为预测卵巢癌对化疗的效应和预后的指标。     

脐动脉及子宫动脉血流速度比值预测胎儿生长迟缓

目的：评价脐动脉及子宫动脉收缩期最大血流速度（Ｓ）与舒张末期血流速度（Ｄ）的比值（Ｓ／Ｄ比值），在孕２４～３０周预测ＩＵＧＲ的临床价值。方法：采用前瞻性双盲研究，对１１８例ＩＵＧＲ高危孕妇，测定脐动脉及子宫动脉Ｓ／Ｄ比值，并进行随访观察。结果：１１８例中有２０例发生ＩＵＧＲ（ＩＵ－ＧＲ组），新生儿体重正常者９８例（正常组）。ＩＵＧＲ组的脐动脉及子宫动脉Ｓ／Ｄ比值均明显高于正常组（Ｐ＜０．０１，Ｐ＜０．０５）。脐动脉Ｓ／Ｄ比值预测ＩＵＧＲ的敏感性、特异性、阳性预测价值，分别为８０．０％，８３．７％和５０．０％，Ｃｏｈｅｎ′ｓｋａｐｐａ指数（Ｋａｐｐａ值）为０．５１。子宫动脉Ｓ／Ｄ比值预测ＩＵＧＲ的敏感性、特异性、阳性预测价值，分别为４０．０％、８４．５％和３４．８％，Ｋａｐｐａ值为０．２３。结论：脐动脉Ｓ／Ｄ比值可作为早期筛选ＩＵＧＲ的指标。     

产后立即放置GyneFix^TMPP型宫内节育器对产褥期的影响

目的探讨产后立即放置ＧｙｎｅＦｉｘＴＭＰＰ型宫内节育器（ＧｙｎｅＦｉｘＴＭＰＰ－ＩＵＤ）对产后出血、血性恶露及产后子宫内膜炎的影响。方法以产后放置ＧｙｎｅＦｉｘＴＭＰＰ－ＩＵＤ者为放器组（１２６例）,产后未放置宫内节育器（ＩＵＤ）者为对照组（１１８例）,分别记录两组研究对象产时、产后２小时、产后２４小时的出血量、血性恶露持续时间及产后子宫内膜炎的发生率。结果与产后出血及产褥期感染有关的因素两组间差异均无显著性（Ｐ＞０．０５）;两组间的产时或术时出血量、产后２小时出血量及２４小时的出血总量、子宫内膜炎的发生率,差异亦无显著性（Ｐ＞０．０５）,两组间的血性恶露持续时间差异有显著性（Ｐ＜０．０５）。结论ＧｙｎｅＦｉｘＴＭＰＰ－ＩＵＤ对产后出血及产褥期感染无明显影响,具有较好的安全性,是产后立即避孕的一种较好方法,对血性恶露持续时间的影响及产生原因有待进一步研究。     

左旋18—甲基炔诺酮T型宫内节育器对子宫内膜血管内皮细胞因子Ⅷ活…

本研究检测了３４例正常育龄妇女放置左旋１８－甲基炔诺酮宫内节育器（ＬＮＧ－ＩＵＤ－２０）前，后子宫内膜血管内皮细胞因子Ⅷ（ＦⅧ）的活性。ＰＡＰ法染色，计算机数字化图像分析系统测定ＦⅧ活性的灰度值。结果：置器１２个月后，子宫内膜血管内皮细胞ＦⅧ活性大部分较放器前明显减弱（Ｐ＜０．００１），少数前后不变。提示ＬＮＧ－ＩＵＤ－２０可能干扰了子宫内膜血管内皮细胞ＦⅧ的合成，释放。     

Should endometrial hyperplasia be regarded as a reason for abnormal uterine bleeding in users of the intrauterine contraceptive device?

OBJECTIVE: Histopathological evaluation of the endometrium in cases having an intrauterine device (IUD) removed for abnormal uterine bleeding. METHODS: Fifty-eight consecutive patients with a complaint of uterine bleeding leading to IUD removal were recruited for this study. Endometrial sampling, via Novak curette, was performed during IUD removal for histopathological evaluation of the endometrium. RESULTS: A total of 58 current IUD users, presenting with uterine bleeding, were retrospectively analyzed. Mean age of the women was 37.1 +/- 2.1 years (range 25-43). Mean duration of IUD use was 4.2 +/- 1.3 years (range 1-10). Out of 58 cases, 21 (36.2%) did not harbor any endometrial pathology. In eight cases (13.8%), hyperplastic endometrial changes were apparent, six of which were simple hyperplasia (four of them were focal). Two cases of complex hyperplasia were detected (one was diffuse with atypia and one was focal without atypia). In this series, there was one case with an endometrial polyp. Mean age of cases with hyperplastic endometrium was found to be statistically high compared to those with normal endometrial histology (42.4 +/- 3.2 vs. 37.6 +/- 2.1, p = 0.04). In cases with IUD use of > 5 years, chronic endometritis was more prevalent, compared to those with < 5 years of use (chi(2) 5.08, p = 0.02). CONCLUSIONS: IUD use is a risk factor for chronic endometritis. Nevertheless, in 13.8% of cases in this series, as a reason for abnormal uterine bleeding, other than endometritis, endometrial hyperplasia constituted the second most common endometrial pathology among cases over the age of 40, on current IUD use and having complaints of abnormal uterine bleeding. Hence, this finding should prompt the physician to perform endometrial sampling in users of an IUD over the age of 40, presenting with abnormal uterine bleeding.     

从子宫内膜的病理变化探讨宫内节育器引起出血的原因

本文观察了带不锈钢宫内节育器后引起出血的104例(50.96%的病例带器5年以上)子宫内膜的病理变化,以探讨出血的原因。子宫内膜主要的病理变化为慢性子宫内膜炎(53.85%),子宫内膜增生过长(19.23%),间质充血水肿(13.46%)。104例中40岁以上、带环5年以上的43例与同等条件的非因症取环的36例相对照,结果两组的慢性子宫内膜炎的发生率有显著差异(p<0.01);子宫内膜增生过长和间质充血、水肿的发生率无显著差异,因此认为带器出血可能与慢性子宫内膜炎有关。     

Chronic Endometritis and Positive Mycoplasma Cultures: Is There a Correlation?

Objective: This study was undertaken to assess the impact of mycoplasma strains (Mycoplasma hominis or Ureaplasma urealyticum) on the development of chronic endometritis.Methods: Fifty-eight patients with acute pelvic infection were enrolled in this prospective cohort study. Endometrial cultures and biopsies were obtained on admission and 5-7 and 21-28 days after completion of treatment.Results: Of 148 samples, 40 were positive for mycoplasma strains (group A) and 58 were positive for mycoplasma with other pathogens (group B). Twenty-seven samples were positive for other pathogens only (group C). Chronic endometritis was seen in 7 (17.5%), 30 (51.7%), and 10 (37%) in group A, B, and C patients, respectively.Conclusions: The presence of mycoplasma strains in the endometrial cavity was not found to be associated with an increased incidence of chronic endometritis.     

Laparoscopic tubal sterilization combined with removal of an intrauterine contraceptive device. A report of 49 cases

A retrospective study was done on 49 patients who underwent removal of an intrauterine device (IUD) and laparoscopic sterilization as a combined procedure during a 13-year period at Booth Memorial Medical Center, Flushing, New York. Five patients were given prophylactic antibiotic therapy, one was treated with postoperative antibiotic therapy for an asymptomatic actinomycosis infection of the endometrium, diagnosed on the curettings, and two patients developed postoperative infections requiring antibiotic therapy. Twenty-one patients had endometritis of various degrees diagnosed on the endometrial curettings, but only two developed clinical infections postoperatively. Elimination of those patients receiving prophylactic antibiotics from the study group left 43, of whom 41 (95%) had an uncomplicated postoperative course and did not develop clinical pelvic inflammatory disease even though 15 of them had endometritis diagnosed on curettage. It appears that removal of an IUD at the time of laparoscopic sterilization does not significantly affect the safety or postoperative morbidity of the sterilization procedure.     

中药红藤方对大鼠的异位子宫内膜芳香化酶表达的影响

目的:探讨中药红藤方对异位子宫内膜的抑制作用。方法:用手术自体移植法成功建立的子宫内膜异位症大鼠模型,随机分成5组:红藤方高剂量组(80g生药/kg,A组)、低剂量组(20g生药/kg,B组)、达那唑组(60mg/kg,C组)、去势组(D组)和模型组(E组),连续给药21d后,检测各组的血清E2水平及异位内膜和卵巢的芳香化酶的变化;另测定异位内膜的体积。结果:A组、C组和D组的异位内膜生长均明显受到抑制,且3组间无统计学差异(P>0.05),与E组比有统计学差异(P<0.05);组织学观察可见,异位内膜呈退化趋势,A、C和D组间大鼠血清中的E2水平无统计学差异(P>0.05),与E组相比有统计学差异(P<0.05);A组、C组及D组异位内膜、卵巢组织的芳香化酶P450低表达,A组与E组间有统计学差异(P<0.05)。结论:红藤方可通过抑制异位内膜、卵巢的芳香化酶活性表达,降低局部雌激素含量,抑制异位内膜的生长,使异位内膜萎缩。     

应用宫内节育器的妇女沙眼衣原体感染与子宫内膜中铜含量的关系

目的:探讨女性生殖道沙眼衣原体(CT)感染与宫内节育器(IUD)种类及内膜中铜含量的关系。方法:用聚合酶链反应检测65例置含铜IUD及97例置不锈钢单环的妇女宫颈分泌物CT;对因症取出IUD的20例妇女,取器后刮取子宫内膜,用原子吸收分光光度法测子宫内膜铜含量。结果:放置含铜IUD者CT感染率(3.1%)明显低于置不锈钢单环者(12.3%),P<0.05;放置含铜IUD的妇女子宫内膜铜含量明显高于置不锈钢单环者(P<0.05)。结论:含铜IUD对生殖道CT感染有抑制作用。含铜IUD可能通过释放的铜离子来发挥抗CT作用。     

The long-term safety of use of the stainless steel IUD: over 20 years use. Clinical and pathological analysis]

635 women with stainless steel rings retained in utero for 20 years or more and 724 women of similar age without IUDs as controls were under investigation. Comparison of incidences of clinical symptoms of paired wearers and controls by age in premenopausal women and by postmenopausal duration in postmenopausal women showed that the tinged vaginal discharge in the study group was 4.87% higher than the controls (P0.05). There was no difference in menorrhagia, irregular bleeding, or other main effects. No cancerous changes were found in the uterine curettage specimens of 374 IUD users in the study group. Special attention was paid to the epithelium at the site in contact with the IUD and its adjacent areas showed no apparent dysplasia. There were 9 cases (2.41%) with mild hyperplasia of the endometrium. The incidence had no correlation with the prolongation of insertion duration. Among the 315 relatively intact endometrium specimens, there were 32 cases of inflammation (10.15%). The incidence had no correlation with duration. 3 endometritis cases were actinomyces infection. Among 374 removals, the removal difficulties did not apparently relate with their IUD insertion duration but did correlate to duration of menopause. Hysterograms of 23 cases showed that atrophy of uterine cavities progressed with the increase of menopausal years; the longer the duration, the deeper incarceration of the IUD. (author's)     

抗纤溶药物用于减少分娩出血量的临床研究

目的 评价抗纤溶药物用于减少分娩出血量的有效性和安全性。方法 对120例阴道分娩的初产妇随机分为氨甲环酸组(A组:氨甲环四+缩宫素)、氨甲苯酸组(B组:氨甲苯酸+缩宫素)和缩宫素组(C组:缩宫素),观察第三产程和第四产程出血量,并分别于产前(第一产程)、产后半小时和产后2h检测血纤维蛋白原(FBG)及D-二聚体(D-dimer)。结果 ①3组间第四产程出血量差异有显著性(P<0.01);总出血量差异有显著性(P<0.05);A组少于C组。②各组间血纤维蛋白原无统计学差异,各组间D-dimer差异非常显著(P<0.001),A组产后2h高于产前(P<0.05),但与产后半小时无差异;B组的产后半小时及产后2h无差异,但均高于产前;C组产后2h高于产后半小时(P<0.05),明显高于产前(p<0.01),且高于A组产后2h(P<0.05)。③3组均无血栓发生。结论 阴道分娩后,在使用宫缩剂的基础上,适当使用抗纤溶药物可以抑制D-dimer浓度的上升,减少产后出血量。     

Endometrial reaction to intrauterine device in pregnancy

It is generally assumed that the intrauterine device (IUD) exerts its action by altering endometrial receptivity for the implanting embryo. The most frequently encountered endometrial reaction reported in the presence of an IUD is a chronic inflammatory reaction which may be responsible for the alterations in the normal physiology of the human endometrium. In order to evaluate the endometrial response to the IUD when pregnancy occurs with the device in situ, we have examined the morphology of decidual tissue obtained during interruptions of pregnancy of 32 patients who had conceived in the presence of IUDs. Twenty-three decidual specimens, obtained during interruption of pregnancies without an IUD, served as controls. The incidence of chronic inflammatory reaction was 6.25% in the presence of an IUD and 4.34% in the control group. The incidence of chronic endometritis reported in nonpregnant IUD users is higher (14-100%) than the incidence of chronic endometritis observed in both groups. This observation may be the result of the generally observed alterations in the immune system during a normal pregnancy, but may also be interpreted as a primary reduced endometrial reaction to the IUD, consequently leading to the contraceptive failure in this group.