胎膜早破产妇胎膜细菌培养及药敏结果分析

目的:分析胎膜早破(PROM)产妇胎膜细菌培养及药敏结果,为围生期感染用药提供科学依据。方法:对2016年7月至12月在我院分娩的1041例PROM产妇胎膜标本进行细菌培养及药敏试验。结果:1041例PROM患者胎膜细菌培养中,369例(35.4%)培养阳性,革兰阴性菌占66.7%,革兰阳性菌占33.1%。足月PROM期待时间延长,培养阳性率无相应升高的趋势(P>0.05);未足月PROM(PPROM)期待时间延长,培养阳性率呈增高趋势(P<0.05)。产前未使用抗生素组培养菌株种类35种,多于产前使用抗生素组培养菌株种类17种。主要感染病菌为大肠埃希菌,占59.7%。大肠埃希菌对哌拉西林、氨苄西林、四环素耐药明显,耐药率均在45.0%以上,对其余抗菌药物的较敏感。大肠埃希菌产前使用抗生素组较未使用抗生素组药物耐药率升高(P<0.05)。革兰阳性球菌对呋喃妥因、替考拉宁、万古霉素、利奈唑胺耐药率为0。结论:胎膜早破产妇胎膜感染以革兰阴性杆菌为主,主要感染菌为大肠埃希菌。经验性预防使用抗生素可能会增加细菌耐药率,应根据病原学特征合理应用抗生素。     

沙眼衣原体、解脲支原体感染与男性不育

目的:了解沙眼衣原体、解脲支原体感染患者精子密度、活率和抗精子抗体的变化及其对生育影响。方法:选取沙眼衣原体、解脲支原体感染男性不育患者50例,测定其抗生素治疗前后的精液常规参数和抗精予抗体,进行动态分析和统计学比较。结果:治疗后精子密度。精子活率显著提高,畸形率和抗精子抗体滴度明显降低。结论:沙眼衣原体、解脲支原体感染从多方面影响男性生育能力。     

自身免疫不育症男性精液中免疫球蛋白浓度

人类精子表面抗原的抗体是引起男性不育的主要原因之一。20%的无法解释的男性不育检测出抗精子抗体(ASA),且在男性和女性血清、精液及宫颈分泌中均可检测出。它们与精子表面抗原结合而发生制动和凝集,影响精子顶体反应及干扰生殖细胞之间的相互作用。ASA能导致体外受精率下降,有报道如果30%的精子表面被覆ASA,则导致低妊娠     

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。     

亚甲基四氢叶酸还原酶基因C677T多态性与男性不育的相关性

目的:探讨亚甲基四氢叶酸还原酶(MTHFR)基因C677T多态性与中国东北人群男性不育的关系。方法:应用聚合酶链式反应-限制性片断长度多态性(PCR-RFLP)方法检测53例健康可育男性和182例不育男性的MTHFR基因C677T位点多态性。结果:弱精子症不育组(AS组)和不明原因不育组(UR组,精液常规正常)的3种基因型和T等位基因频率分别与对照组相比,差异均具有统计学意义(P<0.05)。结论:MTHFR基因C677T多态性可能与中国东北人群男性不育有相关性,且与弱精子症和不明原因不育的发生密切相关。     

整合素配体玻连蛋白在人精子的表达及其与受精的关系

目的 :进一步研究整合素配体玻连蛋白 (Vn)在人精子的表达及其与受精的关系。方法 :选用 1 4例生育力正常的成年男性及 8例精液常规分析正常的不明原因不育男性患者的精液标本 ,液化后提取上游精子。精子体外获能后用兔抗人 Vn多克隆抗体及羊抗兔 Ig G-FITC行免疫染色。然后用流式细胞仪计数 Vn表达阳性精子百分数。部分获能精子同时与去透明带金黄地鼠卵行异种体外受精 (SPA)以检测其受精力 ,比较两组获能精子表面Vn表达阳性精子百分率及受精率差异并分析受精率与 Vn表达阳性的获能精子百分数之间的相关性。结果 :生育组与不育组获能精子 Vn表达水平分别为 2 1 .2 4± 1 1 .70 %与3.6 4± 3.2 7% ,不育组明显低于生育组 (P<0 .0 5)。生育组受精率大于 1 0 % ,不育组受精率小于 1 0 % ,符合划分生育力正常与异常的标准。所有标本 Vn表达阳性的获能精子百分率与精子受精率间具有相关性 (r=0 .476 )。结论 :人获能精子表面存在一定水平的整合素配体玻连蛋白表达 ;Vn参与受精过程 ;Vn表达异常可能与一些不明原因的不育有关     

下呼吸道感染抗生素合理使用及病原菌耐药分析

目的:了解肿瘤住院患者下呼吸道感染病原菌分布及感染危险因素。方法:采用API鉴定系统鉴定,K—B纸片扩散法检测主要细菌药敏。结果:2010年7月—2010年12月,96例下呼吸道感染肿瘤住院患者痰标本细菌培养结果阳性,共分离出病原菌114株,其中革兰阴性杆菌55株(48.2%),革兰阳性球菌15株(13.2%),真菌33株(28.9%),革兰阴性球菌11株(9.65%)。检出居前四位的细菌依次为:肺炎克雷伯菌19.3%,大肠埃希菌13.2%,卡他布兰汉菌9.65%,铜绿假单胞菌7.02%;18例同时合并2种菌感染,占15.8%;MRSA阳性率为33.3%。结论:严格遵守抗生素的使用原则,合理使用抗生素,建立完善的控制医院感染的制度是预防医院感染发生、保证病人医疗安全的重要措施。     

1236对不孕夫妇病因探讨

目的 :探讨不孕症的病因 ,从而指导临床治疗。方法 :对 12 36对不孕夫妇进行病史询问、体检及相应的辅助检查 ,对其不孕的原因进行总结分析。结果 :①单纯女方异常者 5 34对 ,占 4 3 2 0 % ;单纯男方异常者 2 5 8对 ,占2 0 87% ;双方均异常者 4 4 4对 ,占 35 92 %。②女方继发性不孕因素高于原发性不孕 ,两组差异有非常显著性 (P <0 0 1) ;男方原发不育因素高于继发组 ,差异有非常显著性 (P <0 0 1)。③女性不孕 978例中 ,排卵障碍原发不孕组高于继发组 ,差异有非常显著性 (P <0 0 1)。输卵管阻塞 5 70例 ,占 5 8 2 8% ,继发不孕组明显高于原发组 ,差异有非常显著性(P <0 0 1)。④男性不育因素 6 96例中 ,发病因素高低依次为弱精子症、少精子症、免疫学病因、男性副性腺感染。其中原发组精液异常高于继发性不育组 ;而继发性不育组男性副性腺感染、免疫学病因高于原发组。结论 :①重视生殖系统感染对不育的影响 ,且应警惕泌尿生殖系统的特殊感染。②男性因素导致的不育不容忽视。不论原发或继发不孕症 ,均应强调男女双方的检查和治疗 ,并应同步进行。③内分泌和免疫学因素对不育的影响值得进一步认识。     

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。     

抗精子抗体引起免疫性不育症的类固醇疗法

<正> 抗精子抗体能引起男女不育症已在世界范围内得到肯定。在人类的整个生殖过程中,抗精子抗体影响精子在女性生殖道的存活、运动,干扰卵细胞的受精和受精卵的着床过程,从而引起早期流产,使受孕率降低.有资料表明在不明原因的男女不育者中,约有9%的男性及15%的女性不育者可检出抗精子抗体.各国学者对抗精子抗体与不育症的关系做了大量的研究工作,其中有关抗精子抗体的生物学特点及其引起不育的机     

正常和不育男性血清及精浆Ig、补体水平的观察比较

IgG是精浆中正常存在的成份,而IgA并不常见。正常男性中精浆1gM和补体C_3、补体C_4的检出率很低或不能被检出。关于不育男性血清和精浆中Ig和补体的水平,以往报道不一。本文对循环抗精子抗体(A8Ab)阴性和阳性的不育男性以及正常男性血清和精浆中Ig、补体水平进行了观察,就循环抗精子抗体(简称精抗)的出现与精浆Ig、补体水平间的关系作了简要讨论。     

Positive bacterial culture of semen from infertile men with asymptomatic leukocytospermia

OBJECTIVE: To examine results of semen culture in a population of infertile men with asymptomatic leukocytospermia, and to determine the correlation between culture results and sperm characteristics in these patients. METHODS: Semen samples were collected from a group of infertile men (n = 80) after 2-3 days of sexual abstinence. Standard semen analysis was performed according to World Health Organization (WHO) guidelines. Seminal leukocyte concentrations were determined by a myeloperoxidase staining technique. Culture of semen was performed on enriched and specific culture media. RESULTS: Based on the results of semen culture, the samples were classified into three groups: group 1 (enteric gram-negative bacilli [Enterobacteriaceae], n = 13), group 2 (bacteria other than Enterobacteriaceae, n = 15), and group 3 (negative cultures, n = 52). No correlation was found between positive semen culture and sperm characteristics (concentration, motility, and morphology). However, seminal leukocyte concentrations were negatively correlated with percentages of motile sperm and normal sperm morphology. CONCLUSION: Our data indicate that semen samples from infertile men with asymptomatic leukocytospermia may have bacterial contamination, evidenced by positive bacterial cultures. Lack of correlation between positive semen cultures and sperm characteristics may be indicative of early or mild (subclinical) infection.     

Varicocele is associated with abnormal retention of cytoplasmic droplets by human spermatozoa

OBJECTIVE: To determine whether varicocele is associated with retention of sperm cytoplasmic droplets in infertile men. DESIGN: Retrospective study.Setting: University infertility clinic. PATIENT(S): Nonazoospermic men with idiopathic (n = 69) and varicocele-associated infertility (n = 73), and 20 fertile controls presenting for vasectomy. INTERVENTION(S): None. MAIN OUTCOME MEASURES(S): Standard semen parameters and percentage of spermatozoa with cytoplasmic droplets on Papanicolaou smears. RESULT(S): No statistically significant differences were found between the fertile and infertile groups with respect to semen volume. Fertile controls had significantly greater mean percent sperm motility and normal morphology than infertile men. The mean percentage of sperm with residual cytoplasm was statistically significantly different in all three groups. Infertile men with varicocele had the highest percentage of sperm with cytoplasmic droplets, the next highest level being in men with idiopathic infertility and the lowest level in fertile controls (11.7 +/- 1.0, 8.1 +/- 0.9 and 3.2 +/- 0.4%, respectively, P<.0001). CONCLUSION(S): Our data show that idiopathic and even moreso, varicocele-related male infertility are conditions associated with impaired disposal of residual sperm cytoplasm by the testis and/or epididymis. These data provide a possible mechanism for the observed semen abnormalities and reduced fertility potential associated with varicocele and idiopathic male infertility.     

Correlations between two markers of sperm DNA integrity, DNA denaturation and DNA fragmentation, in fertile and infertile men

OBJECTIVE: To evaluate two different assays of human sperm DNA integrity, DNA denaturation (DD) and DNA fragmentation (DF), and to correlate these with standard semen parameters. DESIGN: Prospective, observational study. SETTING: University infertility clinic.Patient(s): Forty consecutive semen samples from 33 nonazoospermic men presenting for infertility evaluation and 7 fertile men presenting for vasectomy. Intervention(s): Assessment of sperm concentration, motility, morphology, DD and DF. MAIN OUTCOME MEASURE(S): Sperm DD and DF in fertile and infertile men. RESULT(S): The mean (+/-SE) rates of DD and DF were significantly higher in infertile subjects compared to fertile controls, respectively: 25.4 +/- 3.0 vs. 10.2 +/- 2.3 (P=.028) and 27.6 +/- 2.5 vs. 13.3 +/- 2.5% (P=.016). DF and DD correlated strongly (r = 0.71, P<.0001). Also, DD and DF correlated negatively with standard semen parameters (concentration, motility, and morphology), the strongest correlation being with sperm motility. CONCLUSION(S): The strong correlation between sperm DD and DF, and the higher levels of sperm DNA damage in infertile compared with fertile men, indicate that male infertility is associated with poor sperm DNA integrity. Although infertile men may father children with assisted conception, fertilization with DNA-damaged spermatozoa may increase the risk of genetic disease in the offspring.     

Detection of Chlamydia trachomatis in semen and urethral specimens from male members of infertile couples in Tunisia.

The sequelae to infection with Chlamydia trachomatis in women are an established cause of tubal infertility. However, little is known about chlamydial infection and male infertility. The main objective of this study was to evaluate the presence of asymptomatic C. trachomatis infections in urethral and semen specimens from the male members of infertile couples by means of four different methods: the direct fluorescence antibodies assay, cell culture, the Roche Cobas Amplicor polymerase chain reaction, and the presence of chlamydial local IgA antibodies by the recombinant antibody-enzyme-linked immunosorbent assay. One or more chlamydial infection markers were detected in 42 (45.7%) of the 92 examined urethral and semen specimens from the male partners of infertile couples. C. trachomatis was detected in 23.9% (22/92) of urethral specimens and in 35.9% (33/92) of semen specimens. Although there was a significant correlation between the detection of one or more chlamydial infection markers in urethral and semen specimens (p = 0.01), no significant correlation was found between the detection of C. trachomatis DNA in these samples. Furthermore, no significant association was found between the presence of chlamydial local IgA antibodies and the detection of C. trachomatis. The discrepancies in positive results found between some techniques for the detection of C. trachomatis in urethral and semen specimens might be explained by variations in the sensitivities and specificities of the tests carried out and the use of specimens from different anatomical locations. Our findings suggest that C. trachomatis seems to be widespread among the male partners of infertile couples in Tunisia. The detection of C. trachomatis in urethral or semen specimens can serve as a marker for the presence of this organism in the genital tract, which is not necessarily the cause of male infertility. The study of the correlation between the detection of chlamydial infection markers and the parameters of male fertility seems to be necessary in order to determine the direct link between chlamydial infection and male infertility and to choose the most efficient technique and most suitable specimen with which to diagnose C. trachomatis-associated male infertility.     

Analysis of aneuploidy in mini-percoll gradient centrifuged human sperm for intracytoplasmic sperm injection (ICSI) using fluorescence in situ hybridization

AIM: To study the aneuploidy rates of chromosomes 13, 18, 21, X and Y in Percoll gradient centrifuged sperm from infertile patients with male infertility factor treated by intracytoplasmic sperm injection (CSI) compared with healthy fertile donors and infertile patients with normal semen parameters. METHODS: This case-controlled study was conducted in a university hospital. Semen samples were obtained from three healthy fertile donors, eight infertile patients with normal semen parameters, and 18 infertile patients with male infertility factor. All samples were subjected to mini-Percoll gradient centrifugation before being processed through fluorescent in situ hybridization. The incidences of aneuploidy were compared using Chi-squared test. RESULTS AND CONCLUSIONS: A total of 64949 spermatozoa were analyzed. The disomy rates for chromosomes 13, 18, 21, and X or Y of sperm from patients with male infertility factor were 0.21%, 0.37%, 0.36% and 0.63%, respectively, whereas the diploidy rate was 0.17-0.23%. These incidences were higher than those from men with normal semen parameters. The result suggested that the embryos of patients with male infertility factor treated by ICSI are at increased risk of chromosome abnormalities.     

Relationship between oxidative stress, semen characteristics, and clinical diagnosis in men undergoing infertility investigation

OBJECTIVE: To determine whether particular semen characteristics in various clinical diagnoses of infertility are associated with high oxidative stress and whether any group of infertile men is more likely to have high seminal oxidative stress. Reactive oxygen species (ROS) play an important role in sperm physiological functions, but elevated levels of ROS or oxidative stress are related to male infertility. DESIGN: Measurement of sperm concentration, motility, morphology, seminal ROS, and total antioxidant capacity (TAC) in patients seeking infertility treatment and controls. SETTING: Male infertility clinic of a tertiary care center. PATIENT(s): One hundred sixty-seven infertile patients and 19 controls.Intervention(s): None. MAIN OUTCOME MEASURE(s): Semen characteristics, seminal ROS, and TAC in samples from patients with various clinical diagnoses and controls. RESULT(s): Fifteen patients (9.0%) were Endtz positive and 152 (91.0%) Endtz negative. Sperm concentration, motility, and morphology were significantly reduced in all groups compared with the controls (P =.02), except in varicocele associated with infection group. Mean (+/-SD) ROS levels in patient groups ranged from 2.2 +/- 0.13 to 3.2 +/- 0.35, significantly higher than controls (1.3 +/- 0.3; P<.005). Patient groups had a significantly lower mean (+/-SD) TAC from 1014.75 +/- 79.22 to 1173.05 +/- 58.07 than controls (1653 +/- 115.28, P<.001), except in the vasectomy reversal group (1532.02 +/- 74.24). Sperm concentration was negatively correlated with ROS both overall and within all groups (P相似文献   

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。