子宫肌瘤与肌肉组织雌孕激素受体含量与月经周期及子宫内膜组织相关系的探讨

应用放射受体分析法测定４０例子宫肌瘤患者子宫肌瘤、肌肉组织雌激素受体（ＥＲ）、孕激素受体（ＰＲ）的含量，月经周期根据月经史及子宫内膜组织相来判断，比较两种组织ＥＲ、ＰＲ含量与月经周期及子宫内膜组织相的关系。结果：子宫肌瘤组织的ＥＲ、ＰＲ含量高于同一子宫正常肌层的含量（Ｐ＜０．０５）；子宫肌瘤与肌肉两种组织中ＥＲ含量在子宫内膜增殖期高于分泌期（Ｐ＜０．０２５，Ｐ＜０．０５），ＰＲ含量分泌期高于增殖期（Ｐ＜０．０２５）。２３例有正常月经周期者，１５例与子宫内膜组织相符合，８例与子宫内膜组织相不符合。１５例无正常月经周期者，子宫内膜组织相多为增殖期改变，占８０％。提示：子宫肌瘤的发生、发展与雌、孕激素及其受体含量有关，孕激素在肿瘤发生、发展中可能起协同作用，提示抗孕激素治疗子宫肌瘤的可能性。     

子宫肌瘤与肌肉组织雌孕激素受体含量与月经周期及子 …

应用放射受体分析法测定４０例子宫肌瘤患者子宫肌瘤、肌肉组织雌激素受体（ＥＲ）、孕激素受体（ＰＲ）的含量，月经周期根据月经史经子宫内膜组织相来判断，比较两种组织ＥＲ、ＰＲ含量与月经周期及子宫内膜组织相的关系。结果：子宫肌瘤组织的ＥＲ、ＰＲ含量高于同一子宫正常肌层的含量（Ｐ〈０．０５）；子宫肌瘤与肌肉两种组织中ＥＲ含量在子宫内膜增殖期高于分泌期（Ｐ〈０．０２５，Ｐ〈０．０５），ＰＲ含量分泌期高于增殖期     

黄体功能缺陷与子宫内膜效应不良患者的内分泌特征

目的：分析比较黄体功能缺陷（ＬＰＤ）和子宫内膜效应不良（ＩＥＲ）患者的内分泌特征。方法：采用放射免疫法和放射性配体饱和竞争、葡聚糖活性碳吸附分析法，测定ＬＰＤ、ＩＥＲ患者和月经周期正常者（对照组）的血清激素水平及同一月经周期子宫内膜组织中的雌、孕激素受体含量。结果：ＬＰＤ患者黄体期的雌、孕激素水平显著低于对照组（Ｐ＜０．００１），其子宫内膜雌、孕激素受体含量在整个月经周期中与对照组无差异（Ｐ＞０．１）；而ＩＥＲ患者整个月经周期的血清雌激素水平均低于对照组（Ｐ＜０．００１），但黄体期的血清孕激素水平与对照组无差异（Ｐ＞０．１），子宫内膜增生期的胞浆雌激素受体、胞核孕激素受体和整个月经周期的胞浆孕激素受体含量亦显著低于对照组（Ｐ＜０．００１，Ｐ＜０．００１，Ｐ＜０．０５）。结论：ＬＰＤ和ＩＥＲ是内分泌特征根本不同的两种情况，ＬＰＤ主要表现为黄体细胞分泌雌、孕激素功能下降，子宫内膜相应受体含量正常；ＩＥＲ则为整个周期的雌激素水平降低及相应受体合成障碍，而黄体分泌孕激素的功能正常。     

子宫肌瘤组织雌、孕激素受体及细胞增殖相关抗原与激素及细胞核体关系的探讨

应用ＡＢＣ法和计算机图象分析系统（ＩＡＳ），定量分析３９例子宫肌瘤患者子宫组织雌激素受体（ＥＲ）、孕激素受体（ＰＲ）、细胞增殖相关抗原（Ｋ１ｉ－６７）的含量；对其中２２例应用放射免疫法测定血浆雌二醇（Ｅ＿２）、孕酮（Ｐ）、促黄体素（ＬＨ）、促卵泡素（ＦＳＨ）含量；以及对其中８例应用立体学方法进行细胞核体定量分析。结果：子宫肌瘤组的ＥＲ、ＰＲ、Ｋｉ－６７显著高于同一子宫正常肌层的含量（Ｐ＜０．０１）；子宫肌瘤的细胞核体数密度和体密度也显著高于同一子宫正常肌层的对应值（Ｐ＜０．０５，Ｐ＜０．０１）；子宫肌瘤的ＥＲ、ＰＲ与血浆的Ｅ＿２、Ｐ含量无明显相关性，而与ＬＨ、ＦＳＨ含量呈负相关（Ｐ＜０．０５）；Ｋｉ－６７与Ｐ呈正相关（Ｐ＜０．０５）；子宫肌瘤的ＥＲ与其细胞核体数密度呈正相关（Ｐ＜０．０５）。提示：子宫肌瘤的发生、发展与雌、孕激素、ＬＨ、ＦＳＨ及其受体含量有关，孕激素在肿瘤发生、发展中可能起协同作用。     

重复性早期自然流产病人非孕期血清激素水平和子宫内膜组织ER、PR含量变化的研究

用放免法测定了４０例拟诊为由内分泌病因所致的重复性早期自然流产病人卵泡期和黄体期的血清雌二醇（Ｅ２）、孕酮（Ｐ）、卵泡刺激素（ＦＳＨ）、促黄体生成素（ＬＨ）和血清催乳素（ＰＲＬ）水平，同时用生化法测定了相应增生期和分泌期子宫内膜组织中胞浆及胞核的雌、孕激素受体含量。通过和对照组比较，发现重复性早期自然流产病人黄体期和卵泡期的Ｅ２水平均显著低于对照组（Ｐ＜０．００５和Ｐ＜０．０５），其余各项激素水平与对照组无差异（Ｐ＞０．０５）；其子宫内膜增生期的胞浆雌激素受体（ＥＲｃ）含量显著低于对照组（Ｐ＜０．００５），分泌期子宫内膜的胞浆孕激素受体（ＰＲｃ）含量亦明显低于对照组（Ｐ＜０．０５）；各期子宫内膜组织的胞核雌、孕激素受体含量在两组间无差异。表明卵巢雌激素分泌不足和子宫内膜组织的受体含量减低是导致该组病人反复自然流产的原因。     

米非司酮对人蜕膜雌,孕激素受体及血清生殖激素的影响

目的：了解米非司酮对人蜕膜雌激素受体（ＥＲ）、孕激素受体（ＰＲ）和生殖激素的影响。探讨米非司酮的抗早孕机理。方法：应用葡聚糖活性碳吸附（ＤＣＣ）法和酶联组化法测定正常和服米非司酮１００ｍｇ后的人蜕膜组织ＥＲ、ＰＲ；采用放射免疫法检测血清β－ｈＣＧ、雌二醇（Ｅ２）、睾酮（Ｔ）和孕酮（Ｐ）的水平。结果：口服米非司酮１００ｍｇ后，人蜕膜组织胞浆ＰＲ明显减少（Ｐ〈０．０５），而胞浆ＥＲ明显增多（Ｐ〈０．０     

氨基导眠能与己酸孕酮治疗子宫内膜癌的作用比较

将子宫内膜癌３９例以双盲法随机分为３组，分别用己酸孕酮、氨基导眠能或两药联合治疗。结果：（１）氨基导眠能使雌二醇（Ｅ２）、孕酮（Ｐ）含量下降，己酸孕酮使血中Ｐ含量增加，联合治疗后Ｐ增加、Ｅ２下降（Ｐ〈０．０５￣０．０１）。（２）己酸孕酮使雌激素受体（ＥＲ）、孕激素受体（ＰＲ）阳性率略下降（Ｐ〉０．０５），氨基导眠能及联合用药后ＥＲ阳性率显著下降（Ｐ〈０．０５）。（３）三种不同方法治疗后均出现癌细胞     

多囊卵巢综合征患者子宫内膜病理改变及雌,孕激素受体测定

目的观察多囊卵巢卵巢综合征（ＰＣＯＳ）患者子宫内膜病理改变及雌激素受体（ＥＲ）、孕激素受体（ＰＲ）改变。方法对３９例ＰＣＯＳ患者进行子宫内膜病理检查,采用免疫组化方法测定子宫内膜ＥＲ及ＰＲ,并以正常妇女作为对照。结果３４例（８７．２％）ＰＣＯＳ患者子宫内膜呈无排卵型,内膜增殖症发生率为５１．３％（２０／３９）,内膜腺体发育不同步为３５．９％（１４／３９）,内膜间质反应不良为４６．２％（１８／３９）。ＰＣＯＳ患者子宫内膜增殖期ＥＲ、ＰＲ较正常妇女增多（Ｐ＜０．０５）,内膜增殖症者间质ＰＲ减少（Ｐ＜０．０５）且分布不均匀。结论ＰＣＯＳ患者子宫内膜的病理改变和局部ＥＲ、ＰＲ减少或缺乏,可能是不孕的原因之一。     

子宫内膜异位症异位与在位内膜发育日期及雌,孕激素受体水平

目的：探讨子宫内膜异位症的发病机理，方法：对２８例子宫内膜异位症的在位内膜和异位内膜进行病理组织学发育日期评定，对其中１５例采用免疫组化ＡＢＣ法测定雌激素受体（ＥＲ）、孕激素受体（ＰＲ）水平，并进行比较。结果：异位内膜较在位内膜发育落后的有１９例（６７．９％），提前的４例（１４．３％）仅５例（１７．９％）相符合；ＥＲ、ＰＲ水平异位内膜罗在位内膜低，在腺体中的差别有显著性（Ｐ〈０．０１，Ｐ〈０．０５     

子宫内膜异位症患者内膜雌,孕激素受体测定及口服棉酚后的变化

采用葡聚糖活性碳吸附法，对２７例正常生育妇女（对照组）及２４例子宫内膜异位症患者（Ｅｍ组），测定了宫腔内膜雌激素胞浆受体（ＥＲｃ）、孕激素胞浆受体（ＰＲｃ）浓度。并测定Ｅｍ组中１５例口服醋酸棉酚２个月后，月经周期同日测定ＥＲｃ及ＰＲｃ浓度；同时对１６例手术切除的子宫、附件标本的原位内膜与异位内膜的ＥＲｃ、ＰＲｃ浓度进行比较。结果：对照组子宫内膜ＥＲｃ、ＰＲｃ浓度呈周期性变化，以卵泡晚期最高，黄体中期显著下降（Ｐ＜０．０５），黄体晚期进一步降低。Ｅｍ组原位内膜ＥＲｃ、ＰＲｃ浓度及周期性波动与对照组无差异，但异位内膜ＥＲｃ、ＰＲｃ浓度显著低于原位内膜（Ｐ各＝０．００３６及＜０．０００１），且失去周期性变化。口服棉酚２个月后血清雌二醇、孕酮浓度无显著下降，４例（２６．７％）患者子宫内膜组织相显示腺体分泌减少，但原位内膜ＥＲｃ、ＰＲｃ浓度却已显著降低（Ｐ＝０．０２１７及０．０１）。本研究提示：异位内膜与原位内膜对内源性性激素反应的不同步现象与异位内膜雌、孕激素受体浓度低下有关；棉酚对原位内膜ＥＲｃ、ＰＲｃ浓度的早期抑制现象，并不依赖于对卵巢功能的抑制作用，这一作用途径应对异位内膜同样有效。     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症（EMs）发病机制尚未完全阐明。大量研究表明,免疫因素在EMs的发病机制中起重要作用。EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变。Toll样受体（TLRs）识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应。TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深入认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段。     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.     

Psychological and pharmacological treatments of mood and anxiety disorders during pregnancy and postpartum. Review and synthesis

The aim of this article is to review the main methods of treatment of anxious and depressive disorders during pregnancy and the postpartum. To this end, we analyse recent publications about the use and efficacy of psychotherapy and psychosocial interventions (cognitive behavioural therapy, interpersonal psychotherapy, psychoanalytical therapy) in the perinatal period. We also review recent papers about the use of psychotropic medication during pregnancy and breast-feeding, with special emphasis on clinical trials. We particularly focus on the risk/benefit assessment of antidepressants, mood stabilisers, antipsychotics and benzodiazepines, in terms of teratogenicity, and impact on neonatal adaptation and neuropsychological development. Various treatment modalities are presented and discussed. It appears that psychotherapies have proved their efficiency on most pre- and postpartum anxious and depressive disorders and represent a first line treatment in most cases. Psychopharmacological treatment is indicated for severe anxious and depressive disorders. The risks of such medication, especially antidepressants, may have been overestimated in the past. Provided reasonable precautions are taken and mothers and future mothers receive clear information on the potential risks and benefits, psychotropic medication could be more broadly prescribed during pregnancy and the breast-feeding period.     

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p?<?0.001 and p?=?0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p?<?0.001 and p?<?0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.     

绒毛膜羊膜炎与胎儿及新生儿疾病

绒毛膜羊膜炎是产科炎症反应,但与新生儿预后关系密切。母体的宫内炎症反应可以直接导致胎儿和婴儿患病率和死亡率增加,胎儿炎症反应综合征（FIRS）也不可忽视。早期识别和快速诊断有助于减少母儿的近期合并症,改善新生儿的远期预后。产科和儿科共同关注,整合信息,是早期发现、实施有效干预的临床重点之一。