大豆异黄酮对围绝经期大鼠卵巢VEGF和NOS亚型mRNA表达的影响

目的 观察大豆异黄酮(SI)对围绝经期大鼠卵巢血管内皮生长因子(VEGF)及一氧化氮合酶亚型eNOS、iNOS mRNA表达的影响.方法 12月龄雌性Wistar大鼠42只,随机分为模型组,低(50mg/kg)、中(158 mg/kg)、高(500mg/kg)剂量SI组及尼尔雌醇(NI)组,另取3月龄大鼠10只作为青年组,灌胃给药8周.RT-PCR检测卵巢VEGF和NOS mRNA的表达;比色法检测血清和卵巢总NOS的活性.结果 围绝经期大鼠卵巢VEGF表达明显高于青年组(P＜0.01),eNOS、iNOS表达及血清、卵巢总NOS活性均较低(P＜0.01).经SI处理后,VEGF表达均明显下降,NOS表达及活性明显升高(P＜0.05或P＜0.01).结论 大豆异黄酮下调衰老卵巢VEGF mRNA表达,提高eNOS、iNOS表达及活性,可能是其改善围绝经期卵巢功能的机制之一.     

FSH／LH比值在评价围绝经期卵巢功能中的价值探讨

目的：探讨血清卵泡刺激素（FSH）与黄体生成素（LH）浓度比值在评价围绝经期卵巢功能的价值,以期更好地防治围绝经期妇女疾病,做好预防措施。方法选取2013年1月至2014年1月的42例围绝经期妇女为研究对象,其中45～＜56岁23例妇女为研究1组,56～65岁19例妇女为研究2组,另外选择30～44岁22例育龄期妇女为对照组。有月经者根据月经情况,无月经者随机抽取空腹静脉血采用化学发光法测定血清 FSH、LH、雌二醇（E2）、孕酮水平。结果在 FSH、LH、孕酮水平以研究2组最高,分别为（45.78±15.23）U／L、（35.48±18.46）UI／L、（12.58±0.86）nmol／L;在雌二醇水平以对照组最高,为（78.95±28.94）pmol／L。研究1、2组间、研究1组和对照组、研究2组和对照组间 FSH、LH、雌二醇、孕酮值比较差异均有统计学意义（P ＜0.05）;FSH／LH 比值大于1患者的比例,研究2组占68.42％,研究1组占39.13％,对照组占9.09％。3组比较差异均有统计学意义（P ＜0.05）。结论 FSH／LH 血清比值可作为一项评价围绝经期卵巢功能可靠指标。     

Unwanted pregnancies: Understanding contraceptive use and benefits in adolescents and older women

The highest percentages of unintended pregnancies and the largest increases in births reported in the United States in recent years were in adolescents and in women more than 35 years of age. Increasing numbers of these women will require contraception to avoid unintended pregnancy. In adolescents the combined oral contraceptive agents protect fertility indirectly and exert favorable actions on menstrual dysfunction and certain hormone-related disorders such as acne and hirsutism. To avoid sexually transmitted disease, barrier protection should be used along with oral contraceptives until mutually monogamous, stable relationships are established. Healthy older women who are nonsmokers may also safely use currently available contraceptives. These agents have little impact on metabolic parameters linked to the development of cardiovascular disease. In addition to providing reliable contraception, oral contraceptives offer noncontraceptive benefits to older reproductive-age women, including control of abnormal bleeding and a reduction in the incidence of ovarian and endometrial cancers and other gynecologic pathology. Intrauterine devices and progestin implants are safe, effective, and underused in the United States. Progestin implants may have an additional role in patients for whom estrogen preparations are contraindicated. Counseling is very important before insertion because of the high rate of nuisance side effects. The contraception selection process must consider the efficacy and acceptability of the specific,method to avoid the probability of unintended pregnancy and the risk of sexually transmitted diseases. (Ann J OBSTEr GYNECOL 1993;168:2042-8.)     

刮痧疗法用于围绝经期失眠患者的效果观察

目的观察刮痧对围绝经期失眠患者睡眠质量及激素水平的影响。方法将60例患者随机分为两组,对照组给予常规中药治疗,观察组在此基础上给予刮痧干预,主要刮拭头部经络、足太阳膀胱经、手少阴心经和足少阴肾经巡行部位,重点刮拭神庭、百会、四神聪、五脏俞、神门、涌泉等穴,每周1次,干预8周。观察两组干预前后匹兹堡睡眠质量指数(PSQI)和血清激素水平,如雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)的变化。结果干预后两组PSQI各因子评分及总分均显著降低(均P0.01),同时观察组在改善睡眠质量、入睡时间、睡眠效率、睡眠障碍和日间功能障碍方面显著优于对照组(P0.05,P0.01)。两组干预后组内和组间血清激素水平比较差异无统计学意义(均P0.05),但观察组干预后E2有上升趋势,FSH、LH有下降趋势。结论刮痧可有效改善围绝经期失眠患者的睡眠质量,对其内分泌水平的影响有待进一步探讨。     

Phytoestrogen‐Rich Natural Preparation for Treatment of Climacteric Syndrome and Atherosclerosis Prevention in Perimenopausal Women

The present study evaluated the risks and benefits of phytoestrogen treatment in healthy perimenopausal women in relation to the dynamics of climacteric syndrome and progression of atherosclerosis. Study participants were treated with placebo or phytoestrogen‐rich natural preparation Karinat based on grape (Vitis vinifera) seeds, green tea (Camellia sinensis) leaves, hop (Hunulus lupulus) cone powder and garlic (Allium sativum) powder. The dynamics of climacteric syndrome was evaluated by Kupperman Index and Utian Quality of Life Scale. Atherosclerosis progression was evaluated by measuring carotid intima‐media thickness. Significant changes of climacteric syndrome's severity in both Karinat and placebo groups (p = 0.005 and p = 0.001) were obtained after 24 months of follow‐up. Detailed analysis of Kupperman Index suggested that Karinat possessed a significant effect on nervousness (p = 0.010), weakness (p = 0.020) and formication (p = 0.010). A significant improvement of medical (p = 0.070) and emotional (p = 0.060) components of Kupperman Index and Utian Quality of Life Scale was also observed in Karinat group. However, difference in carotid intima‐media thickness between the two groups was not statistically significant at follow‐up. A slight positive effect of phytoestrogens on climacteric syndrome manifestations was demonstrated in this study. Karinat can be used for alleviation of climacteric syndrome and cardiovascular disease prevention in perimenopausal women. Copyright © 2017 John Wiley & Sons, Ltd.     

子宫内膜癌合并子宫肌瘤或（和）子宫肌腺瘤16例临床分析

目的探讨子宫内膜癌合并子宫肌瘤或（和）子宫肌腺瘤的临床表现及诊断方法。方法回顾性分析2003～2007年收治的16例子宫内膜癌合并子宫肌瘤或（和）子宫肌腺瘤患者的病史、临床表现及诊治经过。结果16例患者平均年龄53．93岁（45～80岁），其中围绝经期妇女8例（50．00%），绝经期妇女8例（50．00%）。13例（81．25％）有异常阴道流血并术前确诊；3例合并子宫肌腺瘤患者无异常阴道流血，仅表现下腹部疼痛性质改变，术前漏诊子宫内膜癌。结论围绝经期及绝经期子宫肌瘤或（和）子宫肌腺瘤患者有异常阴道流血者首先要除外子宫内膜癌，对合并子宫肌腺瘤患者即使没有异常阴道流血，但若下腹部疼痛性质改变，要高度警觉发生子宫内膜癌可能。     

风引汤治疗肝阳上亢型绝经综合征47例

目的：观察风引汤加减治疗肝阳上亢型绝经综合征的临床疗效。方法：选择94例肝阳上亢型绝经综合征门诊患者,随机分为观察组与对照组。观察组47例给予风引汤加减治疗,对照组47例给予心神安胶囊。观察2组临床疗效、中医证候的改善情况及血清中卵泡刺激素（FSH）、促黄体生成激素（LH）及雌二醇（E2）的水平变化。结果：总有效率观察组为93.62%,对照组为80.85%,2组比较差异有统计学意义（P〈0.05）;观察组改善烘热汗出、烦躁易怒、眩晕耳鸣、胁肋胀满、皮肤干燥、阴道干涩、悲伤欲哭、口苦咽干等症状的疗效优于对照组（P〈0.05）;对照组改善腰膝酸软的症状疗效优于观察组（P〈0.05）;其余症状2组比较,差异无统计学意义（P〉0.05）。治疗后E2、FSH、LH水平2组均明显改善（P〈0.05）;LH治疗后组间比较,差异无统计学意义（P〉0.05）,FSH、E2治疗后组间比较,差异有统计学意义（P〈0.05）。结论：风引汤在改善肝阳上亢型绝经综合征临床症状、内分泌方面具有优势,且无明显不良反应。     

趋化因子受体CXCR3在围绝经期干眼患者中的表达

目的:探讨分析以CXCR3为代表的趋化因子受体家族在围绝经期干眼患者中干眼发生、发展过程中的特征及临床意义。方法:选择围绝经期干眼患者30例,非围绝经期干眼患者30例,用印迹细胞学的方法分别取围绝经期、非围绝经期干眼患者结膜上皮细胞,经流式细胞学分析,比较两组CXCR3阳性细胞表达率的差异。结果:围绝经期干眼组泪膜破裂时间(BUT)、基础泪液分泌(Schirmer I test)值均显著低于非围绝经期干眼组(F=4.076,5.023,P<0.05);围绝经期干眼组CXCR3阳性细胞表达率显著高于非围绝经期的表达率(P<0.01)。CXCR3阳性细胞表达率与泪膜破裂时间、基础泪液分泌值均呈显著的负相关(r=-0.753,-0.684,P<0.05)。结论:可能由于性激素失衡,CXCR3及其配体介导的干眼眼表炎症在围绝经期是高发时期,其表达变化与干眼症临床检查指标密切相关。     

ESR1基因与5-HTT基因多态性的交互作用对女性围绝经期抑郁障碍的影响

目的 通过多因子降维法(MDR)模型探讨雌激素α受体(ESRl)基因与5-羟色胺转运体(5-HTT)基因多态位点的交互作用对围绝经期首发抑郁障碍的影响.方法 采用病例-对照研究,通过对在妇科门诊就诊的围绝经期汉族女性人群进行抑郁障碍筛查及诊断,最终共纳入围绝经期抑郁障碍患者63例(病例组),围绝经期健康女性131例(对照组).采用聚合酶链反应-限制性片段长度多态性( PCR-RFLP)法对5-HTT基因启动子区域多态(5-HTTLPR)位点、第2内含子上可变数目串联重复序列多态位点(Stin2)及ESR1基因第1内含子上限制性内切酶PvuⅡ(rs11155815)和Xba Ⅰ (rs11155816)多态位点进行基因分型.应用MDR软件对两基因交互作用与围绝经期首发抑郁障碍的关联进行分析.结果 病例组与对照组5-HTTLPR位点各基因型分布频率差异具有统计学意义(P=0.032),患病与L/L基因型呈正相关(OR=3.52,95％CI为1.36～9.09);而两组间Stin2位点、PvuⅡ位点及XbaⅠ位点各基因型分布频率比较,差异无统计学意义(P＞0.05).基因交互作用分析结果显示,5.HTT基因及ESR1基因上的4个多态位点的交互作用与抑郁障碍存在关联(P＜0.05),其中最优模型为5-HTTLPR与Xba Ⅰ多态位点交互作用与疾病的关联模型(x2 =9.24,p =0.010).结论 5-HTT基因与ESR1基因多态交互作用可能增加女性围绝经期抑郁障碍患病的风险.