多囊卵巢综合征患者血清中一氧化氮水平及其相关因素的临床研究

目的探讨多囊卵巢综合征（PCOS）患者血清一氧化氮（NO）水平与其血管并发症的关系。方法采用硝酸还原酶法测定27例PCOS患者（PCOS组）,21例因男方因素或输卵管因素不孕患者（对照组）血清NO水平,测定并计算体重指数（BMI）、腰臀比（WHR）、收缩压（SBP）、舒张压（DBP）、体脂含量、胰岛素抵抗指数（HOMA-IR）、胰岛素敏感指数（IAI）、血清性激素、空腹血糖（FPG）和胰岛素（FINS）水平。结果非肥胖PCOS组的HOMA-IR高于非肥胖对照组,IAI、血清NO水平低于非肥胖对照组,差异均有显著性（P〈0.05）。非肥胖PCOS组IAI明显高于肥胖PCOS组,差异有显著性（P〈0.01）。血清NO水平在PCOS组和其对照组间差异无显著性（P〉0.05）。PCOS组中,血清NO水平与HOMA-IR（r=-0.317,P〈0.05）、体脂含量（r=-0.346,P〈0.05）呈负相关。结论PCOS患者血清NO水平降低,提示PCOS患者可能存在血管内皮功能受损。     

多囊卵巢综合征患者脂联素、C反应蛋白水平的变化及其意义

目的:探讨脂联素(APN)、C反应蛋白(CRP)的变化对多囊卵巢综合征(PCOS)发病的意义。方法:按体重指数(BMI≥25kg/m2或<25kg/m2)分别将PCOS患者52例、对照组47例分为PCOS肥胖组(25例)、非肥胖组(27例)和对照肥胖组(23例)、对照非肥胖组(24例)4组。用ELISA法测定4组的APN水平、散射比浊法测CRP水平,葡萄糖氧化酶法测定空腹血糖(FPG)、化学发光法测空腹胰岛素(FIN)水平,并计算胰岛素抵抗指数(HOMA-IR)。结果:①PCOS组APN水平低于对照组(P<0.05),且同组肥胖者低于非肥胖者。②PCOS组CRP水平高于对照组(P<0.05),且肥胖者高于非肥胖者。③APN水平与BMI、HOMA-IR水平呈明显负相关(P<0.05)。结论:PCOS组APN水平降低,CRP水平升高,且以肥胖者明显。APN水平降低、CRP水平升高与PCOS患者胰岛素抵抗密切相关。     

血清促生长激素释放激素受体配体与多囊卵巢综合征的相关性分析

目的:探讨血清促生长激素释放激素受体配体(Ghrelin)水平在多囊卵巢综合征(PCOS)中的意义.方法:选择我院PCOS患者48例作为研究对象(PCOS组),同期选择非PCOS患者40例作为对照(对照组),根据体重指数(IBM)将PCOS组、对照组患者分别分为肥胖与非肥胖,根据稳态模型胰岛素抵抗指数(HOMA-IR)将PCOS组及全部患者分为胰岛素抵抗(IR)与非IR.测定血清Ghrelin水平及内分泌代谢指标.结果:血清Ghrelin水平PCOS组低于对照组(P<0.05);肥胖组低于非肥胖组(P<0.05);非肥胖组低于非肥胖对照组(P<0.05);IR组低于非IR组(P<0.05).血清Ghrelin水平与BMI、空腹胰岛素(FINS)、HOMA-IR呈负相关(P<0.01,P<0.05,P<0.05),与胰岛素敏感指数(ISI)呈正相关(P<0.05).结论:PCOS患者存在血清低Ghrelin水平,Ghrelin水平与BMI、IR程度呈负相关.Ghrelin可能与PCOS的肥胖发生有相关性.血清Ghrelin检测可能作为预测PCOS患者IR的一个指标.     

血清抵抗素、C-反应蛋白及IL-6与PCOS的相关性研究

目的:探讨血清脂肪细胞因子抵抗素(resistin)、C-反应蛋白(CRP)、白细胞介素6(IL-6)水平与PCOS发生的相关性。方法:收集PCOS患者45例,再根据体质量指数(BMI)分为肥胖亚组(≥25kg/m2,22例)和非肥胖亚组(<25kg/m2,23例)。正常对照组45例,同样按BMI分为肥胖亚组(14例)和非肥胖亚组(31例)。空腹采集血清,采用酶联免疫分析法测定抵抗素、免疫比浊法测定CRP、放射免疫法测定IL-6,全自动生化分析仪测定血糖、血脂、化学发光法测定内分泌水平和血清胰岛素水平,同时测量身高、体质量、腰围、臀围,计算BMI和腰臀比值(WHR)。结果:与对照组非肥胖者相比,PCOS组肥胖、非肥胖者及对照组肥胖者抵抗素水平均显著增高(P<0.05);PCOS组和对照组肥胖者的CRP水平均高于对照组非肥胖者(P<0.05);PCOS组肥胖和非肥胖者的IL-6水平高于对照组非肥胖者(P<0.05)。抵抗素和CRP均与BMI、WHR、HOMA-IR呈显著正相关(P<0.05);IL-6与BMI、WHR有显著相关性,与HOMA-IR无相关性。结论:脂肪细胞因子抵抗素、CRP及IL-6参与PCOS患者肥胖和胰岛素抵抗的发生发展。     

血清脂联素水平测定在多囊卵巢综合征中的意义

目的:探讨脂联素水平在多囊卵巢综合征(PCOS)中的意义。方法:选择我院PCOS患者48例作为研究对象,同期选择非PCOS患者40例作为对照,分为肥胖组与非肥胖组,胰岛素抵抗组与非胰岛素抵抗组。测定血清脂联素水平及内分泌代谢指标。结果:①PCOS组血清脂联素水平低于对照组(P<0.05);非肥胖PCOS组低于非肥胖对照组(P<0.05);胰岛素抵抗组低于非胰岛素抵抗组(P<0.05)。②血清脂联素水平与体重指数(BMI)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、腰臀比(WHR)、甘油三酯(TG)呈负相关(P<0.01,P<0.05),与葡萄糖胰岛素比值(GIR)、胰岛素敏感指数(ISI)呈正相关(P<0.01)。控制BMI影响后血清脂联素水平仍与HOMA-IR、TG呈负相关(P<0.05),与GIR、ISI呈正相关(P<0.01)。结论:①PCOS患者存在低脂联素血症,脂联素水平与胰岛素抵抗程度呈负相关。②脂联素可以作为PCOS发生糖尿病远期并发症的预测指标。     

多囊卵巢综合征151例分析

目的：总结多囊卵巢综合征（PCOS）肥胖与非肥胖患者的临床特征及相关影响因素。方法：将151例PCOS患者分为二组，体重指数大于或等于25的PCOSI组；体重指数小于25的PCOSⅡ组。回顾分析两组的临床资料。用放射免疫法测定血清泌乳素、黄体生成素、卵泡刺激素、雌二醇、睾酮、雄烯二酮。结果：①PCOSI组的雄烯二酮、糖负荷后60、120min血糖、血糖曲线下面积、空腹胰岛素、糖负荷后60、120min胰岛素及胰岛素释放曲线下面积均显著高于PCOSⅡ组（P均＜0．05）；②PCOSI组中A、T与胰岛素曲线下面积呈正相关（P＜0．05）；PCOSⅡ组中LH与A呈正相关（P＜0．01）。结论：①肥胖的PCOS患者的临床内分泌紊乱更严重；②肥胖PCOS的高雄激素血症的形成可能是胰岛素抵抗所致，而非肥胖PCOS患者的高雄激素血症主要受LH的影响。     

生活方式调整及药物治疗多囊卵巢综合征的临床研究

目的探讨生活方式调整、二甲双胍及罗格列酮治疗多囊卵巢综合征（PCOS）的临床疗效。方法将106例PCOS患者随机分为单纯生活方式调整（锻炼及饮食控制）、生活方式调整＋二甲双胍与生活方式调整＋罗格列酮治疗3组,分别为43、36、27例,共有60例（分别为22、21、17例）患者完成治疗,观察3组患者治疗前、后排卵情况,比较体重指数（BMI）、腰围、腰围与臀围比值（WHR）、血清睾酮、空腹真胰岛素水平、血脂、稳态模型法测定的胰岛素抵抗指数（HOMA-IR）、空腹血糖与胰岛素比值（GIR）、定量胰岛素敏感检测指数（QUICKI）的变化。结果治疗前3组患者年龄、BMI、腰围、WHR、睾酮水平、空腹真胰岛素水平、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白．胆固醇（HDL-C）、低密度脂蛋白-胆固醇（LDL-C）比较,差异均无统计学意义（P〉0．05）。单纯生活方式调整组的43例患者中22例完成治疗,23％（5／22）恢复排卵;生活方式调整＋二甲双胍组的36例患者中21例完成治疗,43％（9／21）恢复排卵;生活方式调整＋罗格列酮组的27例患者中17例完成治疗,59％（10／17）恢复排卵。3组患者的恢复排卵率比较,差异无统计学意义（P〉0．05）;但生活方式调整＋罗格列酮组较单纯生活方式调整组恢复排卵率高,且差异有统计学意义（P〈0．05）。治疗后3组患者的BMI、腰围、WHR、睾酮、TC、TG、LDL-C、HDL-C比较,差异均无统计学意义（P〉0．05）。结论生活方式调整、二甲双胍、罗格列酮对PCOS患者均有恢复排卵作用。     

肥胖与非肥胖多囊卵巢综合征患者血清肿瘤坏死因子-α(TNF-α)水平的比较

目的:比较肥胖与非肥胖多囊卵巢综合征(PCOS)患者血清肿瘤坏死因子-α(TNF-α)水平的差异。方法:55例PCOS患者,根据体质量指数(BMI)分为肥胖组(BMI>25,n=31)和非肥胖组(BMI≤25,n=24);同期选择50例非PCOS育龄妇女,分为肥胖对照组(BMI>25,n=25)和非肥胖对照组(BMI≤25,n=25)。应用酶联免疫吸附法(ELISA)测定血清TNF-α的含量,分析TNF-α与胰岛素抵抗指数(HOMA-IR)的相关性。结果:PCOS肥胖组与PCOS非肥胖组的TNF-α水平分别显著高于其相应的对照组(P<0.01),PCOS非肥胖组的TNF-α水平也显著高于肥胖对照组(P<0.05)。PCOS肥胖组与PCOS非肥胖组之间的TNF-α水平无显著差异(P>0.05)。PCOS组TNF-α与HOMA-IR呈显著正相关(P<0.05)。结论:肥胖与非肥胖PCOS患者的血清TNF-α水平均升高,可能存在肥胖以外升高TNF-α的途径;TNF-α与PCOS的IR发生有密切联系。     

多囊卵巢综合征患者血栓调节蛋白水平变化的研究

目的通过检测多囊卵巢综合征（PCOS）患者血清血栓调节蛋白（TM）的水平变化,探讨TM与PCOS发生血管病变的关系。方法选择PCOS患者80例为研究组,其中胰岛素抵抗（IR）组43例和非IR组37例,正常妇女30例为对照组,采用酶联免疫吸附法检测血清TM水平;生化法检测血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、空腹血糖（FSG）、载脂蛋白A1（ApoAl）和载脂蛋白B（ApoB）;放射免疫法检测内分泌激素和空腹胰岛素（FINS）。结果非IR组、氓组TM水平与对照组比较,差异有显著性（P〈0．05）,非IR组和氓组TG、ApoB高于对照组（P〈0．01）,而HDL—C、ApoAl低于对照组（P〈0．01）。结论伴胰岛素抵抗的PCOS患者TM水平增高,可能与其发生血管病变有关。     

多囊卵巢综合征大鼠脂肪组织中TNF-α的表达及其意义

目的研究由脱氢表雄酮（DHEA）诱导的多囊卵巢综合征（PCOS）SD大鼠动物模型的脂肪组织中TNF—α mRNA及蛋白的表达与其性激素变化及胰岛素抵抗（IR）的关系。方法以DHEA皮下注射21日龄SD雌性大鼠为研究组，观察其卵巢重量、光镜（HE染色）及透视电镜下改变，测定糖耐量、血清胰岛素、E2、T、P、PRL、FSH和LH水平，采用逆转录聚合酶链反应（RT—PCR）法及Western Blot技术检测其脂肪组织中TNF—α mRNA和蛋白的表达。结果实验组卵巢重量显著高于对照组（P〈0．05），实验组卵巢呈多囊样改变而黄体形成比例减少；实验组血清T、E2、空腹血糖和胰岛素水平明显高于对照组（P分别〈0．001、〈0．05、〈0．001和〈0．05），空腹血胰岛素与空腹血糖乘积的倒数（1／FINS×FGC）显著高于对照组（P〈0．05）；PCOS大鼠白色脂肪组织中TNF—α mRNA及蛋白表达均显著高于对照组（P〈0．05）。结论DHEA诱导的P—COS大鼠动物模型与PCOS患者相似，且有IR现象；由白色脂肪组织分泌的TNF—α在PCOS的发生机制中起着部分调节作用，从而加重PCOS患者的胰岛素抵抗。     

Magnesium intoxication in women with preeclampsia with severe features treated with magnesium sulfate

ABSTRACT

Objective

To evaluate the maternal-neonatal outcome in magnesium (Mg)-intoxicated women with preeclampsia with severe features (PESF) treated with magnesium sulfate (MgSO₄).     

Symptoms associated with vaginal colonization with yeast

We correlated vulvovaginal symptoms with vaginal cultures for yeast in healthy female college students. Yeasts were isolated from 42 (29.2%) of 144 women. Only four (22%) of 18 women with positive fungal cultures had fungal elements visualized microscopically in vaginal material suspended in 10% potassium hydroxide (potassium hydroxide wet preparations). Symptoms, mainly vulvovaginal itching and irritation, were reported by 28 (67%) of 42 women whose cultures contained yeast and by 22 (22%) of 102 women who were not colonized by yeast (p less than 0.01). We conclude that vaginal colonization by yeasts is commonly associated with vulvovaginal symptoms, often in the absence of positive potassium hydroxide wet preparation results. These data suggest that vaginal specimens from women who have vulvovaginal symptoms and negative potassium hydroxide wet preparation results should be cultured for fungi before the diagnosis of fungal vulvovaginitis is excluded.     

重组人干扰素α-2b凝胶治疗慢性宫颈炎疗效观察

目的探讨重组人干扰素α-2b凝胶(商品名:尤靖安)治疗慢性宫颈炎的临床疗效。方法采用多中心、随机双盲、平行安慰剂对照的临床试验方法,选择2004-09-20-2005-09-10由6个试验中心共录入250例慢性宫颈炎患者,随机分为两组。治疗组:125例,采用尤靖安治疗;对照组:125例,采用凝胶基质治疗。隔日用药1次,10次为1疗程。于治疗后连续3次月经干净后的第3～7天进行疗效评价。结果纳入疗效分析240例(治疗组120例,对照组120例);通过统计分析,治疗组和对照组各时间点宫颈糜烂(现已改称宫颈柱状上皮异位)面积的减小值绝对值、相对于基线的变化百分率(%)间统计学差异有显著性意义(P=0·001);人乳头瘤病毒(HPV)阳性患者各时间点糜烂面积相对于基线的变化的绝对值和好转百分率差异有显著性意义(P<0·05),尤靖安组总有效率为84·87%,明显高于对照组的62·07%(P<0·05)。结论重组人干扰素α-2b凝胶治疗慢性宫颈炎疗效肯定,耐受性好,安全性高。     

Immature teratoma with gliomatosis peritonei associated with pregnancy

Immature teratoma is a malignant form of teratoma that contains immature structures resembling those of the embryo. It is rare and accounts for less than 1% of all ovarian cancers. It occurs most frequently in young women but it is very rarely reported in association with pregnancy.     

Immune function in patients with ovarian carcinoma treated with irradiation or with cytostatics

The immunocompetence of 25 patients with ovarian cancer was followed up during and after radiation or chemotherapy, by using the number of lymphocytes, E-rosette-forming cells, and mitogen responses as parameters. In comparison with chemotherapy, the irradiation caused a profound and permanent immunosuppression. In patients treated with chemotherapy, the number of E-rosette-forming cells and the mitogen responses were fewer in the patients who developed recurrence or dissemination.     

Improved survival of patients with cervical cancer treated with image-guided brachytherapy compared with conventional brachytherapy

Objective

Since the Group Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC–ESTRO) published recommendations for 3D MRI-based image-guided adaptive brachytherapy (IGBT) in the treatment of cervical cancer, many institutions have implemented this technique and favourable results were documented. We investigated if introduction of IGBT in our centre indeed improved treatment outcomes and reduced toxicity compared to conventional brachytherapy (CBT).

Methods

A retrospective analysis was done of outcomes of patients with stage IB-IVA cervical cancer treated with primary radiation therapy with curative intent between 2000 and 2012. Outcome measures were overall and disease-free survival, pelvic control, distant metastasis and treatment related adverse events (AE).

Results

126 patients were analysed; 43 had been treated with CBT between 2000–2007, and 83 with IGBT between 2007–2012. External beam radiation (mean; 46.6 Gy) was combined with concurrent weekly cisplatin (51.6%), or hyperthermia (24.6%); radiation alone was used in 23.8%. Median follow-up was 121.8 months for CBT patients, vs. 42.3 months for IGBT. Complete remission was achieved in 83.7% of patients in the CBT group and in 98.8% of IGBT patients (p < 0.01). Overall survival at 3 years was 51% and 86%, respectively (p = 0.001). Pelvic recurrence was found in 32% vs. 7% (p < 0.001). Most patients had low grade adverse events. High grade (3–4) AE occurred in 15.4% vs. 8.4% at 3 years (p = 0.06).

Conclusion

Introduction of IGBT for cervical cancer has led to significantly increased 3-year locoregional control and survival rates, whilst reducing late morbidity.     

Factors associated with postpartum hemorrhage with vaginal birth

A case-control study was performed to study risk factors for postpartum hemorrhage. Cases of hemorrhage were defined by a hematocrit decrease of 10 points or more between admission and post-delivery or by the need for red-cell transfusion. Patients with antenatal bleeding were excluded. Among 9598 vaginal deliveries, postpartum hemorrhage occurred in 374 cases (3.9%). Three controls were matched to each case and multiple logistic regression was used to control for covariance among predictor variables. Factors having a significant association with hemorrhage were prolonged third stage of labor (adjusted odds ratio 7.56), preeclampsia (odds ratio 5.02), mediolateral episiotomy (4.67), previous postpartum hemorrhage (3.55), twins (3.31), arrest of descent (2.91), soft-tissue lacerations (2.05), augmented labor (1.66), forceps or vacuum delivery (1.66), Asian (1.73) or Hispanic (1.66) ethnicity, midline episiotomy (1.58), and nulliparity (1.45). These data may help predict postpartum hemorrhage and may be useful in counseling patients about the advisability of home delivery, intravenous access in labor, or autologous blood donation.