体外受精与胚胎移植术后异位妊娠的单中心回顾性研究

目的探讨体外受精与胚胎移植术(IVF-ET)后异位妊娠(EP)的发生率、临床特点及应对措施。方法选择2010年1月至2015年12月于北京协和医院生殖中心经IVF-ET后确诊为EP的42例患者共计45个周期进行回顾性研究。结果 6年内共有3 656个周期为临床妊娠,42名患者共计45个周期为EP,比例为1.23%(45/3 656)。2名患者重复EP,5名患者宫内宫外同时妊娠(HP)。EP主要发生在输卵管壶腹部,共19周期,占EP的42.22%。因输卵管因素行IVF-ET后EP的患者有24周期(53.33%),非输卵管因素21周期(46.67%)。45周期EP中,3周期保守治疗,42周期采用腹腔镜或开腹手术治疗。5例HP患者中3例行手术+宫内孕保胎治疗,其中2例保胎成功最终娩出健康活婴。22名患者(52.38%)通过后续IVF-ET妊娠成功并产下健康活婴,3名患者(7.14%)暂时放弃生育计划,17名患者(40.48%)继续尝试IVF-ET。结论随着辅助生殖技术的改进与发展,其造成EP高风险或许会呈现逐渐降低趋势,但现今而言仍应引起我们高度重视。输卵管因素是EP发生的重要影响因素。在处理IVF-ET后患者时要考虑到IVF技术的特殊性,避免漏诊、误诊的发生。     

雌二醇屈螺酮片治疗绝经后妇女绝经相关症状的多中心临床研究

Objective To study the efficacy and safety of estradiol and drospirenone tablets (Angeliq)in treatment of menopausal symptoms among postmenopausal Chinese healthy women.Methods Total 244 postmenopausal Chinese healthy women who had moderate to severe hot flushes were randomly assigned for 16 weeks in this randomized multi-center double-blind placebo-controlled study.During the trial.the follow-up visits were conducted at week 4,8,12,16 of treatment and 2 weeks after treatment respectively.Height,weight,vital signs,hot flushes,other relevant menopausal symptoms and vaginal bleeding were observed in each follow-up visit,while the clinical global impression scale Was assessed at 16 weeks as well.Results It showed that hot flushes were reduced significantly more in observation group than that in placebo group ( P＜0.01 ), although both treatments were effective. The absolute values of mean severity index of total hot flushes decreased by - 0. 6± 0. 5 in observation group and - 0. 4 ± 0. 4 in placebo group from baseline respectively, which reached significant difference ( P ＜ 0. 05 ). However, the absolute values of mean severity index of moderate to severe hot flushes decreased by - 0. 6± 0. 8 in observation group and -0. 3± 0.6 in placebo group from baseline respectively, which had no significant difference (P ＞ 0. 05 ).After 16 weeks treatment, it also showed that estradiol and drospirenone had significant better efficacy than placebo on moderate to severe sweating, vaginal dryness and clinical global impression scale (P ＜0. 01 ).During the trial, blood pressure in observation group was stable. The rate of vaginal bleeding in observation group was higher than that in the placebo group, especially during the week 4 to week 8 when 48. 9% (87/178) in observation group and 10. 7% (6/56) in placebo group of patients bled. Although the cumulative amenorrhea rate of observation group was lower than that of placebo group in each cycle (28 days), it increased gradually along with duration of the treatment. The commonest adverse event in observation group was breast tenderness which accounted for 12.0% (22/183 ). The level of serum potassium was in the normal range in observation group mostly. Meanwhile, the other adverse events rate was low. Serious adverse events reported in this trial were assessed as not study drug related or as unlikely study drug related. Conclusion Estradiol and drospirenone tablets which could effectively alleviate menopausal symptoms in postmeuopausal Chinese healthy women is a novel hormone replacement therapy regimen with high safety and efficacy.     

睾丸退化的临床特征与鉴别诊断——附5例临床报告

目的总结睾丸退化患者的临床特征和鉴别诊断方法。方法回顾性总结了5例睾丸退化患者的临床表现、激素测定和性腺病理结果。结果睾丸退化患者社会性别均为女性,多数因外生殖器性别模糊或青春期后原发闭经而就诊,患者染色体核型为46,XY、盆腔检查无子宫和宫颈,青春期后缺乏女性第二性征发育、促性腺激素水平升高、性腺水平低下、人绒毛膜促性腺激素(hCG)刺激试验睾酮无增加,性腺均为发育不良的睾丸或条索状组织。结论睾丸退化患者临床较为罕见,其病因尚不清楚,临床上需注意与其他性发育异常患者鉴别。     

雌二醇屈螺酮片治疗绝经后妇女绝经相关症状的多中心临床研究

Objective To study the efficacy and safety of estradiol and drospirenone tablets (Angeliq)in treatment of menopausal symptoms among postmenopausal Chinese healthy women.Methods Total 244 postmenopausal Chinese healthy women who had moderate to severe hot flushes were randomly assigned for 16 weeks in this randomized multi-center double-blind placebo-controlled study.During the trial.the follow-up visits were conducted at week 4,8,12,16 of treatment and 2 weeks after treatment respectively.Height,weight,vital signs,hot flushes,other relevant menopausal symptoms and vaginal bleeding were observed in each follow-up visit,while the clinical global impression scale Was assessed at 16 weeks as well.Results It showed that hot flushes were reduced significantly more in observation group than that in placebo group ( P＜0.01 ), although both treatments were effective. The absolute values of mean severity index of total hot flushes decreased by - 0. 6± 0. 5 in observation group and - 0. 4 ± 0. 4 in placebo group from baseline respectively, which reached significant difference ( P ＜ 0. 05 ). However, the absolute values of mean severity index of moderate to severe hot flushes decreased by - 0. 6± 0. 8 in observation group and -0. 3± 0.6 in placebo group from baseline respectively, which had no significant difference (P ＞ 0. 05 ).After 16 weeks treatment, it also showed that estradiol and drospirenone had significant better efficacy than placebo on moderate to severe sweating, vaginal dryness and clinical global impression scale (P ＜0. 01 ).During the trial, blood pressure in observation group was stable. The rate of vaginal bleeding in observation group was higher than that in the placebo group, especially during the week 4 to week 8 when 48. 9% (87/178) in observation group and 10. 7% (6/56) in placebo group of patients bled. Although the cumulative amenorrhea rate of observation group was lower than that of placebo group in each cycle (28 days), it increased gradually along with duration of the treatment. The commonest adverse event in observation group was breast tenderness which accounted for 12.0% (22/183 ). The level of serum potassium was in the normal range in observation group mostly. Meanwhile, the other adverse events rate was low. Serious adverse events reported in this trial were assessed as not study drug related or as unlikely study drug related. Conclusion Estradiol and drospirenone tablets which could effectively alleviate menopausal symptoms in postmeuopausal Chinese healthy women is a novel hormone replacement therapy regimen with high safety and efficacy.     

正交试验优选酒制狗脊的炮制工艺

目的:优选酒制狗脊的炮制工艺。方法:以原儿茶酸、原儿茶醛含量为综合评价指标,选择黄酒比例、浸润时间、蒸制时间、闷润时间为考察因素,采用L9(34)正交试验优选酒制狗脊的炮制工艺。结果:酒制狗脊最佳炮制工艺为每100 kg狗脊加15 kg黄酒,室温闷润2 h,武火蒸制4 h后停火闷4 h。结论:优化的酒制狗脊工艺节时、节能、合理可行。     

黄连软化与切制工艺优选

目的:优化黄连的软化与切制工艺.方法:以盐酸表小檗碱、盐酸黄连碱、盐酸巴马汀和盐酸小檗碱含量为指标,采用单因素试验和正交试验优选黄连的软化和切制工艺,HPLC测定指标成分含量.结果:黄连的最佳软化方法为淋法,一般在室温下,每100 kg药材用60 L水软化48 h.黄连的最佳切制工艺为切成1～2 mm的顶头片.结论:优选的软化和切制工艺切实可行,可推广使用.     

囊胚冷冻保存时间对复苏移植临床结局的影响

目的分析冷冻保存时间对复苏后胚胎质量的影响,进一步探讨长期胚胎冷冻保存是否对临床结局产生影响。方法回顾性分析2005年12月至2015年1月在我院辅助生殖中心进行复苏囊胚移植患者的临床资料。按照复苏前囊胚的冷冻保存时间将1 808个移植周期分为7组,第1组为≤90d、第2组为91~180d、第3组为181~360d、第4组为361~720d、第5组为721~1 080d、第6组为1 081~1 440d、第7组为≥1 441d。比较7组的复苏后存活率、种植率、临床妊娠率、流产率和活产率以及各组间单胎的新生儿出生结局。结果 7组间胚胎存活率、胚胎种植率、生化妊娠率、临床妊娠率、流产率和活产率比较均无统计学差异(P均0.05);7组间的单胎新生儿出生结局比较亦无统计学差异(P0.05)。结论本研究提示胚胎长期冷冻保存对冻融胚胎的质量及发育潜力影响不大,但囊胚长期冷冻保存的远期安全性还有待于进一步研究。     

绝经后激素治疗与乳腺相关问题

探讨绝经后妇女乳腺生理特点、性激素对乳腺的作用以及激素治疗(HT)对乳腺的影响和与乳腺癌的关系,同时指出应在HT前及治疗中进行乳腺的定期检查,以期能安全长期进行HT,以获得HT带来的最大益处。     

住院治疗的不孕患者心理健康调查

目的了解住院治疗不孕的患者心理健康情况。方法根据相关文献采用自行设计调查表,对因不孕入院手术的患者100例进行有关心理健康调查。结果多数患者存在不同程度的心理问题。100%认为不孕很痛苦,98%内心承受不同程度的心理压力,93%被生育困扰,70%认为不孕检查和治疗带来心理压力和精神紧张,另外自感烦躁、自卑、绝望,认为不孕影响夫妻感情、性生活,影响与家人关系及婚姻,影响工作及生活态度。结论心理因素是不孕诊治过程中不容忽视的重要因素,可能直接或间接影响不孕症治疗的疗效,所以在进行躯体疾患诊治的同时,应重视心理治疗以提高不孕治疗成功率。     

早期子宫内膜癌和子宫内膜非典型增生患者保守治疗后的IVF-ET治疗结局

目的分析早期子宫内膜癌和子宫内膜非典型增生患者应用保留生育功能治疗并放置左炔诺孕酮宫内节育系统(曼月乐)后进行IVF-ET助孕的临床情况和胚胎体外培养结局。方法收集经保守治疗后完全缓解,于2017年10月至2020年4月期间转诊至我院生殖中心进行辅助生殖治疗的34例早期子宫内膜癌和子宫内膜非典型增生患者资料共57个IVF周期作为研究组,根据年龄、BMI、不孕原因、促排卵方案等在同时期匹配114个子宫内膜正常的IVF周期作为对照组。比较两组患者的基本资料、促排卵情况和胚胎体外培养情况。结果两组患者基本资料中年龄、BMI、不孕年限、基础激素水平(FSH、E2、PRL、LH)均无显著差异(P>0.05),仅研究组基础睾酮(T)水平显著低于对照组[(1.16±0.72)nmol/L vs.(1.71±0.68)nmol/L,P<0.001]。研究组较对照组Gn起始剂量[(271.2±56.3)U vs.(247.0±63.7)U]和总量[(3534.4±1263.3)U vs.(3104.9±1282.2)U]显著增高(P<0.05),研究组HCG日内膜厚度较对照组薄[(7.07±2.08)mm vs.(11.57±2.38)mm,P<0.05];两组间Gn天数无显著差异(P>0.05);HCG日激素水平除FSH无显著差异(P>0.05)外,其他所检测的激素水平(E 2、P、T、LH)在研究组均显著低于对照组(P<0.05)。两组间获卵数[(9.0±5.8)vs.(10.4±6.4)]、MII卵数[(7.9±5.4)vs.(9.1±6.1)]、受精率(90.42%vs.90.50%)、卵裂率(99.75%vs.99.26%)和优质胚胎率(10.37%vs.10.58%)均无显著差异(P>0.05);研究组囊胚形成率显著高于对照组(47.41%vs.40.75%,P<0.05)。34位患者中有19位进行了共27个周期的冻融胚胎移植,每移植周期的妊娠率为44.4%(12/27),累积妊娠率为63.2%(12/19)。结论子宫内膜病变保守治疗后体外受精过程与其他患者类似,对于存在不孕病史的早期子宫内膜癌和子宫内膜非典型增生患者,保守治疗后体外受精-胚胎移植可以提供可靠的生育结局。