The heterogeneity of premature ovarian failure:A report with six cases

Objective:To investigate the heterogeneity of premature ovarian failure(POF).Methods:A retrospective study was carried out in Peking Union Medical College Hospital(PUMCH),two hundred and forty-five women with POF were retrospectively analyzed in the reproductive endocrinology clinic in PUMCH from 1988 to 2008.Results:During the hormone replacement therapy,ovarian function recovery was observed in 6 idiopathic POF cases,3 out of these 6 got pregnaney and regular menses with elevated estradiol and decreased follicular stimulating hormone(FSH).The spontaneous pregnancy in the group was 1.22%(3/245).It is indicated that even women di-agnosed as POF still have the possibility of spontaneous ovulation.Conclusions:POF is a kind of disease with heterogeneity.We must give the individualized therapy to POF pa-tients.     

Inhibin alpha gene G769A mutation in Chinese women with premature ovarian failure

Objective: To examine whether the inhibin alpha (INHα) gene G769A mutation is present in Chinese women with idiopathic premature ovarian failure (POF). Methods: The study was carried out in 77 Chinese women with idiopathic POF and 35 normal controls(including 25 normal females with a regular menstrual history and 10 normal post-menopause women)by a case-control analysis. Genomic DNA was extracted from the peripheral blood of the patients and control subjects. The inhibin alpha gene was amplified by PCR. The PCR products were subsequently digested with enzyme BbvI, and then were subjected to electrophoresis on agarose gels and stained with ethidium bromide to determine the INHα G769A mutation. Results:With BbvI digestion three fragments of 130, 88 and 25 base pairs were noted for all 77 POF patiens and 35 controls, thus demonstrating normal inhibin alpha allele. No patient or control was heterozygous or homozygous for the mutant allele. Conclusions: The inhibin alpha gene mutation may be rare in Chinese women with POF. The etiology of idiopathic POF for most patients deserves further investigation.     

抑制素α基因与卵巢早衰的相关性研究

目的检测在中国特发性卵巢早衰(POF)妇女中是否存在抑制素α基因的G769A突变。方法采用病例对照研究方法,对来自中国的特发性POF患者77例和对照组35例,采取静脉血提取DNA,用PCR方法扩增抑制素α基因,其PCR产物经BbvI酶切后琼脂糖凝胶电泳判断有无G769A突变。结果POF患者和对照组均显示130、88和25 bp三条带,均无抑制素α基因的G769A杂合或纯合突变。结论抑制素α基因的G769A突变在中国特发性POF妇女中可能很少见,大部分特发性POF的病因有待于进一步研究。     

卵巢早衰与自然绝经妇女骨密度的对比观察

目的　比较卵巢早衰 (POF)与自然绝经妇女的骨密度 (BMD)。方法　 6 3例经DEXA确诊为骨质疏松的病人分为两组 :2 9例POF为A组 ,年龄 4 8～ 76岁 (6 2 1± 7 0 ) ;34例自然绝经妇女为B组 ,年龄 5 2～ 77岁 (6 3 4± 6 0 )。应用美国Hologic公司QDR4 5 0 0 W型双能X线骨密度仪测定A组和B组腰椎及股骨颈BMD。结果　A、B两组腰椎 2 4、股骨颈BMD相比 ,有显著性差异 (P <0 0 5 )。结论　POF比自然绝经妇女骨量丢失的早并且丢失的多 ,应及早应用HRT。     

卵巢早衰的免疫学研究进展

自身抗体的存在及T细胞介导的炎症反应共同促进卵巢早衰的发生。卵巢早衰患者体内多有如抗卵巢抗体等器官特异性抗体和抗类固醇细胞及其酶抗体等自身抗体,淋巴细胞亚群比例失衡。雌激素及中医药治疗是常用的方法,但疗效均不理想。本文对近年有关卵巢早衰的免疫学方面的研究进行综述,旨在为进一步研究卵巢早衰的发病机制,制定高危人群及早期诊断标准提供参考。     

赠卵体外受精-胚胎移植在卵巢早衰和非早衰受者中的应用

目的　探讨赠卵体外受精 胚胎移植 (IVF ET)中子宫内膜同步化激素治疗及比较卵巢早衰 (POF)和非POF受者的赠卵IVF ET效果。　方法　回顾性分析 5 0例赠卵IVF ET患者的 6 0个IVF周期和 73个ET周期。按赠卵指征分为POF组19例、2 3个周期和非POF组 31例、37个周期 ,进行t和 χ2 检验统计学分析。　结果　赠卵IVF ET的妊娠率为 4 8% (2 4 / 5 0 )和刺激周期为 4 3% (2 6 / 6 0 ) ;POF组妊娠率高于非POF组 ,但无显著性差异 (P >0 .0 5 )。子宫内膜同步化方法促性腺激素释放激素激动剂 /外源雌三醇 /黄体酮 (GEEP)方案组妊娠率明显高于后两者的 (EEP)组 (P <0 .0 5 )。　结论　卵巢早衰患者赠卵IVF ET妊娠率较高。子宫内膜同步化方法因人而异 ,有卵巢功能者GEEP方案优于EEP方案     

卵巢早衰实验动物模型的建立

目的探讨以透明带抗原建立自身免疫性卵巢早衰实验模型的方法。方法分别用合成的透明带的多肽片段、完全弗氏佐剂及三蒸水免疫实验组、佐剂对照组和空白对照组小鼠,并观察小鼠的性周期,用免疫荧光法检测小鼠外周血及卵巢中抗透明带抗体,在光镜及电镜下观察小鼠卵巢的组织学改变,观察小鼠的发病情况。结果实验组有70%小鼠表现为性周期紊乱,80%外周血、70%卵巢中出现抗透明带抗体,90%小鼠出现自身免疫性卵巢炎,均与对照组差异显著(P<0.01)。结论以透明带诱导自身免疫性卵巢早衰模型的发生率高,并且方法简单,是一种很好的实验方法。     

Uterine preservation during surgery for uterovaginal prolapse: a review

The traditional surgical treatment for uterovaginal prolapse has been vaginal hysterectomy. For many reasons, women may request uterine preservation at the time of prolapse surgery. The purpose of this paper is to review the medical literature pertaining to the role of uterine preservation during reconstructive surgery for uterovaginal prolapse. A MEDLINE search of literature in the English language (1966 to current) was carried out using the keywords hysterectomy, hysteropexy, uterine preservation, uterine suspension and uterovaginal prolapse. Fourteen articles primarily addressing the surgical repair of uterovaginal prolapse with uterine preservation were included in this review. Papers primarily addressing other forms of pelvic organ prolapse, incontinence or obliterative procedures were excluded. Existing procedures and their clinical outcomes were reviewed. The current literature suggests that uterine preservation during surgery for uterovaginal prolapse may be an option in appropriately selected women who desire it; prospective, randomized trials are needed to corroborate this.Abbreviations EBL Estimated blood loss - OR Operating room - PCOS Polycystic ovary syndrome     

口服避孕药对卵巢早衰患者的内分泌影响

目的 通过口服避孕药对卵巢早衰患者血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）水平及围绝经期症状的观察分析,探讨卵巢早衰的有效治疗方法.方法 将114例卵巢早衰患者随机分为两组,每组57人,第一组单服妈富隆片（妈富隆组）,第二组予补佳乐片＋安宫黄体酮片（HRT组）,于治疗后3、6、9月分别观察两组病人的潮热、盗汗、失眠、烦躁、注意力、乳房萎缩、生殖器萎缩等围绝经期症状以及血清FSH、LH、E2 的水平变化.并对治疗显效的患者进行促排卵＋中药治疗,指导受孕.结果 治疗后两组患者的围绝经期症状都显著改善,但组间无显著性差异;妈富隆组血清FSH、LH水平下降速度和幅度明显优于HRT组;E2水平上升、卵巢排卵恢复在两组无显著性差异.结论 口服妈富隆片对降低高水平的FSH、LH疗效显著,是治疗卵巢早衰的一种有效方法.     

Analysis of anti-zona pellucida antibody and tumor necrosis factor-α,γ-interferon and interleukin-2 in sera from patients with premature ovarian failure

Objective:To investigate the role and the clinical significance of anti-zona pellucidaantibody (AzpAb) and tumor necrosis factor-α(TNF-α),γ-interferon(IFN-γ) and inter-leukin-2 (IL-2) in sera from patients with premature ovarian failure (POF).Methods: The AzpAb in the serum of POF patient was analyzed by means ofELISA. The levels of TNF-α, IL-2 and IFN-γ in the serum were determined by meansof radioimmunoassay (RIA).Results:The level of serum AzpAb in the POF patients was significantly higher thanthat of the normal controls(P＜0.001). The levels of TNF-α and IL-2 were significantlyreduced (P＜0. 001), and the level of IFN-γ was significantly elevated (P＜0.01). Thelevels of above three cytokines in AzpAb positive group were significantly higher thanthose of the negative group in POF patients.Conclusion: This study suggested that AzpAb, TNF-α, IFN-γ and IL-2 might playimportant roles in the pathogenesis of autoimmune POF.     

利维爱预防卵巢早衰患者骨量丢失作用的探讨

本文通过给１２例卵巢早衰患者利维爱（Ｌｉｖｉａｌ）用药２个月,并于给药前后分别测定空腹尿钙与肌酐（Ｃａ／Ｃｒ）、羟脯氨酸与肌酐（ＯＨＰｒ／Ｃｒ）比值以及血清碱性磷酸酶（ＡＫＰ）、雌二醇（Ｅ２）、骨钙素（ＢＧＰ）、降钙素（ＣＴ）和白细胞介素－６（ＩＬ－６）的水平,以探讨Ｌｉｖｉａｌ防止卵巢早衰患者骨量丢失的作用机制。结果显示：Ｌｉｖｉａｌ给药后空腹尿Ｃａ／Ｃｒ、ＯＨＰｒ／Ｃｒ比值明显下降（Ｐ＜０．０１,Ｐ＜０．０２）;血ＡＫＰ、ＢＧＰ的水平无明显变化;ＣＴ的水平显著升高（Ｐ＜０．０５）,ＩＬ－６的水平显著下降（Ｐ＜０．０２）。提示：Ｌｉｖｉａｌ能有效地改善年轻的卵巢早衰患者的骨代谢状况,防止其骨量的丢失,刺激ＣＴ的分泌和抑制ＩＬ－６的产生可能是Ｌｉｖｉａｌ改善卵巢早衰患者骨代谢状况的重要作用机制之一。     

卵巢早衰患者血清抗透明带抗体和肿瘤坏死因子-α、γ-干扰素及白细胞介素-2的分析

目的 :探讨抗透明带抗体 ( Azp Ab)和肿瘤坏死因子 -α( TNF-α) ,γ-干扰素( IFN-γ)及白细胞介素 -2 ( IL-2 )在卵巢早衰 ( POF)发病中的作用及其临床意义。方法 :以定量酶联免疫吸附试验 ( EL ISA)测定 POF患者血清中 Azp Ab水平 ,放射免疫测定 IFN-γ、IL-2和 TNF-α的水平。结果 :POF组 Azp Ab明显高于正常对照组 ( P<0 .0 0 1 ) ,TNF-α和 IL -2显著降低 ( P<0 .0 0 1 ) ,IFN-γ明显升高 ( P<0 .0 1 )。 POF患者中 ,Azp Ab阳性组 ,以上三种细胞因子水平均明显高于 Azp Ab阴性组。结论 :Azp Ab,TNF-α,IFN-γ和IL-2在自身免疫性 POF的发病中起着重要作用。     

Analysis of risk factors associated with surgical failure of sacrospinous suspension for uterine or vaginal vault prolapse

The goal of this study was to analyze the potential risk factors determining surgical failure after sacrospinous suspension for uterine or vaginal vault prolapse. Each woman underwent a detailed history taking and a vaginal examination before treatment. Follow-up evaluations were at immediate post-operation, 1 week, 1 to 3 months, 6 months, 9 months, and annually after the operation. The surgical failure rate (27/168) following sacrospinous suspension was 16.1%. Using multivariable logistic regression, women with the presence of C or D point stage I at immediate post-operation were a significant risk factor for surgical failure after sacrospinous suspension (odds ratio, 35.34; 95% confidence interval, 8.75–162.75; p < 0.001). The success rate during the 18-month follow-up decreased significantly in women with the presence of C or D point stage I at immediate post-operation than stage 0. Although the sample size of women with symptomatic uterine or vaginal vault prolapse is small, impaired correction of anatomic defects is a significant risk factor for surgical failure of sacrospinous suspension.     

Uterine prolapse after pelvic trauma: case report and literature review

Up to date, the connection of pelvic trauma with genital prolapse is not widely recognized. These cases could be classified in a group where disruption of normal anatomy of the pelvis is apparent (i.e., pelvic fracture), and in a second group, where pelvis remains unaffected by the pelvic trauma (i.e., seat belt-related injuries). The aim of the report is to describe the management of a 39-year-old nulliparous patient presenting with stage III uterine prolapse after pelvic trauma; the patient had a history of Mitrofanoff’s procedure for neurogenic bladder followed by closure of the bladder neck and permanent suprapubic urinary catheter for intractable incontinence. The prolapse was managed with a mesh anterior colporraphy combined with sacrospinous hysteropexy. At 3 months follow-up, she is well with no prolapse recurrence.     

雌孕激素替代治疗雷公藤所致卵巢早衰的疗效观察

目的通过雌、孕激素序贯性干预治疗,探讨雷公藤(TW)所致卵巢早衰(POF)的防治方法。方法选择雷公藤多甙片(TWP)治疗后继发性POF患者21例,给予雌、孕激素序贯性替代治疗(HPT),观察治疗前及停药后的临床症状、性激素变化和月经恢复情况。结果21例患者临床表现和性激素测定均符合POF的诊断。与替代治疗前相比,HPT治疗停止3个月后卵巢分泌雌激素(E2)明显增高[(329.90±77.53)pmol/L比(83.47±8.46)pmol/L,P<0.01],垂体分泌的卵泡刺激素(FSH)[(6.70±2.24)U/L比(110.87±20.34)U/L,P<0.01]和黄体生成素(LH)[(5.91+2.67)U/L比(52.62±15.65)U/L,P<0.01]则明显下降(P<0.01),围绝经期征候群改善,总有效率为90.47%。结论TW可造成育龄期妇女卵巢功能减退或衰竭,及时停药和规律地雌、孕激素干预治疗有较好疗效。     

免疫抑制剂在卵巢功能保护应用中的研究进展

近年来,在社会、环境及医源性因素影响下,女性不孕症的发病率显著上升且趋于年轻化,卵巢功能提前耗竭是主要的原因之一。针对肿瘤放化疗、自身免疫性疾病等原因所致的卵巢储备功能减退(DOR)、早发性卵巢功能不全(POI)或卵巢早衰(POF),保护卵巢功能、延缓卵巢功能的下降、保留患者的生育机会是急需解决的问题。目前,免疫抑制剂广泛应用于器官移植及自身免疫性疾病的治疗,也有部分研究将免疫抑制剂应用于POF动物模型或POF患者中进行卵巢功能保护,本文将首次就这一问题进行文献综述。     

毓麟珠通过改善小鼠卵巢微环境防治早发性卵巢功能不全的作用机制研究

目的研究毓麟珠通过改善卵巢微环境防治早发性卵巢功能不全(POI)的作用机制。方法选取BALB/c雌性小鼠随机分为空白组、模型对照组、中药组和阳性药组,每组10只。除空白组外其余三组均皮下注射小鼠透明带3(ZP3)多肽建立免疫性POI模型,模型建立后分别给予生理盐水、戊酸雌二醇、毓麟珠溶液灌胃,每天一次,连续6周。高频超声系统动态监测卵巢面积、卵泡数、卵巢血流;取血检测血清激素水平。用BCA试剂盒检测卵巢组织超氧化物歧化酶(SOD)、活性氧(ROS)、谷胱甘肽过氧化物酶(GSH-Px)和丙二醛(MDA)的水平。结果 (1)模型对照组小鼠卵巢面积、卵泡数显著低于空白组(P<0.05);与模型对照组比较,阳性药组、中药组卵巢面积均显著增加(P<0.05),中药组卵泡数显著增加(P<0.05),且显著高于阳性药物组(P<0.05)。(2)模型对照组小鼠较空白组小鼠卵巢动脉脉压差增大,搏动指数、阻力指数增高(P<0.05);与模型对照组比较,阳性药组、中药组脉压差、搏动指数、阻力指数均显著降低(P<0.05)。(3)与空白组比较,模型对照组血清FSH、LH显著...     

生地黄汤对卵巢早衰大鼠骨代谢的干预作用

目的研究生地黄汤对卵巢早衰大鼠骨代谢的影响。方法 48只成年雌性SD大鼠,随机分为空白组、模型组、阳性对照组、生地黄汤高、中、低剂量治疗组。除空白组外,其余各组每日灌胃雷公藤多甙片75 mg/kg,连续造模14 d。从第15 d起,模型组灌胃生理盐水2 mL/kg;阳性对照组灌胃补佳乐1 mg/kg;高、中、低剂量治疗组灌胃生地黄汤(12、6、3 g/kg),每日1次,连续给药21天。放射免疫法测定血清中雌激素(E2)、孕酮(P)的含量;比色法检测血清中钙、磷的含量;ELISA法检测血清中碱性磷酸酶(ALP)、骨碱性磷酸酶(BALP)、1,25二羟基维生素D_3(1,25(OH)_2D_3)含量。结果与模型组比较,生地黄汤高、中剂量治疗组血清中E2、P水平升高(P0.05);生地黄汤高剂量组血清钙、磷的含量高于模型组(P0.05);生地黄汤各剂量组血清ALP、BALP含量均较模型组降低(P0.05),1,25(OH)2D3含量高于模型组(P0.01)。结论生地黄汤可以通过类雌激素样作用升高血清雌二醇水平,改善早衰卵巢功能,同时增强成骨细胞活性,使骨形成大于骨吸收,调节骨代谢平衡,改善卵巢功能减退引起骨质疏松。     

湖北海棠总黄酮对卵巢早衰大鼠卵巢功能及骨代谢的影响

目的观察湖北海棠总黄酮对卵巢早衰大鼠卵巢功能及骨代谢的影响。方法将48只成年雌性大鼠随机分为空白组、模型组、戊酸雌二醇组及湖北海棠总黄酮高、中、低剂量组,每组8只。除空白组外,其余各组每天给予灌胃雷公藤多苷片(75 mg/kg),连续14 d,复制卵巢早衰模型。第15天起,戊酸雌二醇组给予灌胃戊酸雌二醇(1 mg/kg);湖北海棠总黄酮高、中、低剂量组分别给予灌胃湖北海棠总黄酮(160、80、40 mg/kg),每日1次,连续给药21 d。观察各组大鼠:动情周期;卵巢指数、子宫指数;血清中雌激素(E2)、孕激素(P)、卵泡刺激素(FSH)、黄体生成素(LH)水平变化;卵巢、子宫形态学变化;血清碱性磷酸酶(ALP)、骨碱性磷酸酶(BALP)活性、1,25(OH)_2D_3含量、超氧化物歧化酶(SOD)活力、丙二醛(MDA)含量,检测卵巢组织中ERα的表达。结果与空白组比较,模型组大鼠动情周期紊乱,卵巢指数、子宫指数降低,血清中E2、P水平降低,FSH水平升高(P0. 05,P0. 01)。与模型组比较,戊酸雌二醇组和湖北海棠总黄酮治疗组血清生殖激素水平得到明显改善(P0. 05),卵巢内生长卵泡数量增多,子宫内膜增厚,血清中ALP活力、BALP含量降低,1,25(OH)_2D_3含量升高(P0. 05,P0. 01);血清中SOD活力增强,MDA含量降低;卵巢组织中颗粒细胞、基质细胞ERα的表达增强。结论湖北海棠总黄酮对卵巢早衰大鼠卵巢及骨质疏松具有一定的治疗保护作用,其作用机制可能与体内抗氧化能力、增强颗粒细胞内雌激素受体的表达密切相关。     

Acute renal failure due to uterine prolapse: a case report

Abstract

Herein, we present a successfully treated case with acute renal failure due to ureteral obstruction caused by total uterine prolapsed. A 55-year-old female patient presented to our hospital with the complaints of protrusion of the uterus for the last 3 months, pollakiuria, nocturia, decreased urine volume, and swelling of her body for the last week, and as well as impaired general status with shortness of breath for the last several days. Her physical examination revealed a blood pressure of 140/90?mmHg, pulse rate of 80 beats/min, body temperature of 37.8?°C, as well as uterine prolapse with infection and erosion on the surface of the uterus, crepitating rales in the basal segments of both lungs, and pretibial edema. Results of laboratory analyses were as follows: BUN?=?70?mg/dL, Cr?=?6.5?mg/dL, CRP?=?8.7?mg/dL, and leukocyte?=?12,000/mm³. Blood gas analysis revealed a pH of 7.35 and bicarbonate level of 14?mmol/L. Data obtained from ultrasonography, DTPA scintigraphy, and abdominal CT, which were performed assuming that the patient had post-renal renal failure due to the compression by uterus, supported this assumption. Bilateral nephrostomy catheters were inserted and appropriate fluid-electrolyte therapy for volume status and antibiotherapy were commenced. Renal functions returned to normal levels on the 4th day of therapy and her complaints disappeared. The patient underwent total abdominal hysterectomy and was monitored in terms of renal functions and diuresis. The present case was presented due to its importance for being a quite rare case who dramatically responded to accurate intervention performed in time.