隔姜温针灸联合西药治疗排卵障碍性不孕症的临床研究

目的:观察隔姜温针灸联合西药治疗排卵障碍性不孕症的疗效。方法:将符合研究条件的74例不孕症患者随机分为2组,每组各37例,对照组采用口服克罗米芬(枸橼酸氯米芬,CC)加普通针刺的方法,观察组在对照组基础上取气海、关元、中极三穴施以隔姜温针灸,两组患者分别治疗3个月经周期,治疗过程中用阴道B超监测两组患者子宫内膜最大厚度、子宫内膜形态A型率、卵泡最大直径以及是否排卵。结果:经过3个月经周期的治疗,观察组最大子宫内膜厚度及内膜A型率明显高于对照组(P0.05);两组治疗后卵泡最大直径以及排卵率差异无统计学意义(P 0.05)。结论:在CC促排卵周期中,隔姜温针灸较单纯针刺更有利于增长子宫内膜厚度,提高子宫内膜A型率,但对于卵泡最大直径以及排卵率无明显优势。     

经阴道超声监测卵泡及子宫内膜发育状况可提高受孕率

目的分析不孕症患者卵泡及子宫内膜的发育特点,为临床治疗提供准确依据。方法选取128例不孕症患者设为观察组,128例成功妊娠女性设为对照组。比较两组月经周期第8、10、12、14天卵泡大小,同时测量并比较观察组与对照组卵泡个数、扁卵泡个数、最大卵泡长与宽度,宫体、宫颈大小及子宫内膜厚度,监测结局。结果观察组排卵期卵泡个数、卵泡最大直径、卵泡每日增长直径及内膜厚度均低于对照组,差异有统计学意义(P < 0.05);观察组排卵正常型4例,明显低于对照组126例,差异有统计学意义(P < 0.05);观察组卵泡黄体化不破裂型、扁卵泡及无优势卵泡型分别为42例、64例及有84例均明显高于对照组2例、6例及1例,差异有统计学意义(P < 0.05)。观察组B型内膜的患者中,排卵正常型和排卵异常型分别有1例和18例,明显差于对照组125例和3例,差异有统计学意义(P < 0.05);观察组无优势卵泡的患者中,A型内膜和C型内膜分别有76例和7例,明显高于对照组0例和0例,差异有统计学意义(P < 0.05);观察组卵泡黄体化不破裂型的患者中,A型内膜和C型内膜分别有11例和15例,明显高于对照组0例和0例,差异有统计学意义(P < 0.05)。结论不孕症患者卵泡及子宫内膜发育状况异常,经阴道超声动态监测使不孕症患者实现“早发现,早诊断,早治疗”,有效提高受孕率。     

胃粘膜淋巴滤泡与幽门螺杆菌关系探讨

目的 探讨含有细胞毒素相关基因A（cagA)菌株感染与胃粘膜淋巴滤泡形成之间的关系，并对胃粘膜淋巴滤泡的发生与幽门螺杆菌（Hp）感染状况的关系等进行观察。方法 对655例慢性胃炎，消化性溃疡的患者进行胃镜检查，取胃窦 粘膜组织作Hp检测和组织病理检查，并选择70份Hp培养阳性的临床分离菌，用PCR扩增法进行cagA基因的检测。结果 Hp感染患者中胃粘膜淋巴滤泡的发生率（60.14%)显著高于非Hp感染者（17.06%)；胃粘膜淋巴滤泡在活动性胃炎比非活动性胃炎中更易检测到；在Hp相关性胃肠病中，慢性胃炎、胃溃疡、地下二指肠球溃这三者之间胃粘膜淋巴滤泡的发生率无显著性差异。结论 胃粘膜淋巴滤泡的发生直接与Hp感染相关， 并可作为一种Hp感染相关性胃肠病中一个较为恒定的形态特征；Hp作为一种抗原刺激胃粘膜产生淋巴滤泡的作用与Hp菌株的毒力（cagA基因）无关。     

Ovarian hyperstimulation syndrome: a review of recent practices

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic adverse event that occurs as a result of ovarian stimulation, particularly in susceptible women. It is caused by an unusually high ovarian response to stimulation and results in enlarged ovaries and fluid shift from intravascular compartment to the third space. Clinical features include abdominal distension, discomfort, ascites, and pleural effusion. There is a risk of thromboembolism and hepatic and renal dysfunction. Ovarian reserve tests can identify patients at high risk of OHSS, allowing targeted preventative measures. High-quality evidence supports the use of GnRH antagonist regimes in women with a high ovarian reserve. GnRH agonist trigger and elective cryopreservation of all embryos further reduce the risk of OHSS. All women at risk of OHSS should have adequate information and access to 24-hour care. Women presenting with possible OHSS should be assessed and investigated to confirm the diagnosis and classify severity. Mild and moderate OHSS can be managed on an out-patient basis, while severe OHSS often needs in-patient care. Principles of management are maintaining intravascular hydration by encouraging fluid intake guided by thirst, close monitoring of fluid balance, prevention of thromboembolic complications, drainage of ascites in selected cases and symptom relief. If conception occurs in the treatment, the course of OHSS is likely to be more severe and protracted.     

Chemotherapy and female fertility

Chemotherapy to treat cancer is usually responsible for early ovarian follicle depletion. Ovarian damage induced by cancer treatments frequently results in infertility in surviving patients of childbearing age. Several fertility preservation techniques have been developed. Nowadays, oocyte or embryo cryopreservation with or without ovarian stimulation and cryopreservation of the ovarian cortex are the most commonly used. However, these methods may be difficult to implement in some situations, and subsequent use of the cryopreserved germ cells remains uncertain, with no guarantee of pregnancy. Improved knowledge of the molecular mechanisms and signaling pathways involved in chemotherapy-induced ovarian damage is therefore necessary, to develop new strategies for fertility preservation. The effects of various chemotherapies have been studied in animal models or in vitro on ovarian cultures, suggesting various mechanisms of gonadotoxicity. Today the challenge is to develop molecules and techniques to limit the negative impact of chemotherapy on the ovaries, using experimental models, especially in animals. In this review, the various theories concerning ovarian damage induced by chemotherapy will be reviewed and emerging approaches for ovarian protection will be explained.