卵巢成熟性畸胎瘤误诊为卵巢恶性肿瘤

1病例资料女,48岁。主因腹胀、消瘦伴尿量减少20 d入院。患者平素月经规律,20 d前无明显诱因开始出现腹胀、食欲欠佳。腹胀呈进行性加重,同时伴腰围增加,体重改变不明显,但面部及四肢明显消瘦。无恶心、呕吐,无腹痛、腹泻,无呼吸困难。门诊查体:腹部胀大如孕     

巨大盆腔包裹性积液误切除部分输卵管致医疗纠纷的反思

目的探讨盆腔包裹性积液的误诊及手术失误原因,并总结经验教训。方法回顾性分析我院近期收治1例巨大盆腔包裹性积液的临床资料。结果术前彩超示右附件区可见26.5 cm×24.0 cm×9.1 cm大小囊肿,拟行剖腹探查术,术中见腹腔内巨大薄壁囊肿样结构,与周围组织严重粘连,右侧卵巢覆于囊壁上,左侧附件未触及,囊壁下方管腔样结构疑似输卵管,行部分囊肿壁切除术,术后恢复良好。患者因术后1年未孕,起诉至法院。法院审理最终认定:医院未征得患者或其家属同意即直接采取部分切除右侧输卵管,存在过错,判定我院赔偿患者误工费、医疗费等共计9万余元。结论盆腔包裹性积液临床表现及超声检查不典型时极易误诊,提示术中应谨慎选择手术方式,并与患者及家属充分沟通,以避免医疗纠纷的发生。     

不典型宫角妊娠1例诊疗分析

1 病历简介 患者女,26岁.因"刮宫术后2个月,B超提示宫腔内异常占位"于2006年11月13日入院.患者既往月经规律,5/30天,末次月经在2006年5月5日,患者停经30天,查尿HCG(+),停经约80天出现腹痛和少量阴道出血,就诊于当地医院,彩超提示"胎停育",于2006年8月31日(停经88天)行刮宫术(手术具体情况不详),术后3天血止,无腹痛、腹坠等不适.     

CYP7B1与ER在胆汁淤积孕鼠胎鼠肝脏中的表达

目的 探讨雌激素受体(ERα、ERβ)与胆固醇7α羟化酶(CYP7B1)mRNA在妊娠期肝内胆汁淤积(ICP)孕鼠、胎鼠肝脏中的表达及其意义.方法 对照组孕鼠30只注射精制植物油;研究组孕鼠30只注射17-α-乙炔雌二醇.两组孕鼠分别于妊娠第13天、17天、21天断尾采母鼠血检测,于妊娠第21天抽取母鼠、胎鼠血并提取肝脏组织.应用酶联免疫吸附试验检测两组孕鼠及胎鼠血清中胆酸水平;应用实时定量PCR技术检测两组胎鼠肝脏ERα、ERβ、CYP7B1 mRNA的表达.结果 ①在妊娠第17天、21天研究组母鼠胆汁酸水平明显高于对照组(55.7±3.2μmol/L vs 23.4±1.2μmol/L,t=2.541,P<0.05;61.4±2.4μmol/L vs 25.5±2.1μmol/L,t=2.621,P<0.05);研究组胎鼠胆汁酸水平明显高于对照组(27.4±2.3μmol/L vs 11.5±2.6μmol/L,t=2.631,P<0.05);②研究组胎鼠肝脏CYP7B1 mRNA水平明显高于对照组(2.15±0.01vs 0.25±0.02,t=2.563,P<0.05);③研究组ERα mRNA水平明显高于对照组(0.81±0.02 vs 0.35±0.01,t=2.534,P<0.01).结论 ICP孕鼠胎鼠肝细胞ERα、CYP7B1的表达升高,胆汁酸的合成与代谢调节机制存在障碍,可能是导致ICP胎儿围生儿死亡发生的原因之一.     

Interaction among peroxisome proliferators-activated receptor alpha, cytochrome P450 oxysterol 7α-hydroxylase and estrogen receptor and its association with intrahepatic cholestasis in pregnant rats

Objective To investigate the relationship between interaction of peroxisome proliferators-activated receptor alpha (PPARα), cytochrome P450 oxysterol 7α-hydroxylase (CYP7B1) and estrogen receptor (ER) and intrahepatic cholestasis in pregnant rats. Methods Eighty clean SD pregnant rats were selected and divided into four groups randomly with 20 in each. Since the 13th day of pregnancy,rats in the control group was injected subcutaneously with refined vegetable oil 2.0 ml · kg-1 · d -1 , those in the low-dose, moderate-dose and high-dose groups received 17-α-ethynylestradiol (EE) 1.0 mg · kg-1 · d-1,1.25 mg · kg-1 · d-1 and 1.5 mg · kg-1 · d-1, respectively. All rats were sacrificed at the 21at day of pregnancy and maternal hepatic tissues were collected. The serum levels of alanine aminotransferase(ALT), aspartate transaminase (AST), total bile acid (TBA) and bilirubin (BIL) were determined by enzyme linked immunosorbent assay (ELISA). The mRNA expressions of PPARα, CYP7B1, Erα and Erβ in maternal rat livers were examined by real-time PCR. Results (1) Biochemical indicators: the serum levels of ALT,AST, TBA and BIL were significantly lower in the control group than in the rest 3 groups,respectively [ control group: (41.1 ± 2.8 ) U/L, (44.4 ± 3.6) U/L, (26.4 ± 5.6 ) μmol/L and( 2.8 ± 0.2)U/L;low-dose group: (48.2 ±3.4) U/L,(47.9 ±3.7) U/L,(36.4 ±4.2) μmol/L and (4.2 ±0.2) U/L;moderate-dose group: (70.4 ± 5.3 ) U/L, (68.4 ± 5.6) U/L, (64.3 ± 3.8 ) μmol/L and ( 6.2 ± 1.2)U/L; high-dose group: (72.4 ±7.6) U/L, (70.2 ±3.8) U/L, (72.4 ±7.8) μmol/L and (8.2 ±2.2)U/L, P<0.05], and those in the moderate or high-dose groups were higher than in the low-dose group (P<0.05). (2) mRNA expression of Erα and Erβ: the mRNA expression of Erα in pregnant rat livers increased in a dose-dependent manner, which were all significantly higher than that in the control group,respectively ( low-dose group: 0.76 ± 0.02 ); moderate -dose group: ( 0.99 ± 0.04; high-dose group:1.21 ±0.01 ;control group:0.65 ±0.01, P <0.05), but no difference was found among the 4 groups in the mRNA expression of Erβ ( P > 0.05 ). (3) mRNA expression of CYP7B1 and PPARα: the mRNA expression of CYP7B1 in pregnant rat livers increased from the low-dose group to the high-dose group, and were all higher than that of the control group ( low-dose group: 0.93 ± 0.01; moderate-dose group: 0.99 ±0.06; high-dose group: 1.22 ± 0.04; control group: 0.75 ± 0.02, P < 0.05 ). However, the mRNA expression of PPARα decreased from the low-dose group to the high-dose group, and were all lower than that of the control group (low-dose group: 0.83 ± 0.05; moderate-dose group: 0.71 ± 0.02; high-dose group:0.64 ± 0.03; control group: 1.35 ± 0. 05; P < 0.05 ) . Conclusions The down regulated mRNA expression of PPARα, caused by higher dose of estrogen, may increase the expression of CYP7B1 due to the ineffectiveness of the inhibition of PPARα on CYP7B1, which may further stimulate the Erα activity and then induce intrahepatic cholestasis. Abnormal expression of PPARα, CYP7B1 and ER may play a role in the pathogenesis of estrogen-induced intrahepatic cholestasis.     

Interaction among peroxisome proliferators-activated receptor alpha, cytochrome P450 oxysterol 7α-hydroxylase and estrogen receptor and its association with intrahepatic cholestasis in pregnant rats

Objective To investigate the relationship between interaction of peroxisome proliferators-activated receptor alpha (PPARα), cytochrome P450 oxysterol 7α-hydroxylase (CYP7B1) and estrogen receptor (ER) and intrahepatic cholestasis in pregnant rats. Methods Eighty clean SD pregnant rats were selected and divided into four groups randomly with 20 in each. Since the 13th day of pregnancy,rats in the control group was injected subcutaneously with refined vegetable oil 2.0 ml · kg-1 · d -1 , those in the low-dose, moderate-dose and high-dose groups received 17-α-ethynylestradiol (EE) 1.0 mg · kg-1 · d-1,1.25 mg · kg-1 · d-1 and 1.5 mg · kg-1 · d-1, respectively. All rats were sacrificed at the 21at day of pregnancy and maternal hepatic tissues were collected. The serum levels of alanine aminotransferase(ALT), aspartate transaminase (AST), total bile acid (TBA) and bilirubin (BIL) were determined by enzyme linked immunosorbent assay (ELISA). The mRNA expressions of PPARα, CYP7B1, Erα and Erβ in maternal rat livers were examined by real-time PCR. Results (1) Biochemical indicators: the serum levels of ALT,AST, TBA and BIL were significantly lower in the control group than in the rest 3 groups,respectively [ control group: (41.1 ± 2.8 ) U/L, (44.4 ± 3.6) U/L, (26.4 ± 5.6 ) μmol/L and( 2.8 ± 0.2)U/L;low-dose group: (48.2 ±3.4) U/L,(47.9 ±3.7) U/L,(36.4 ±4.2) μmol/L and (4.2 ±0.2) U/L;moderate-dose group: (70.4 ± 5.3 ) U/L, (68.4 ± 5.6) U/L, (64.3 ± 3.8 ) μmol/L and ( 6.2 ± 1.2)U/L; high-dose group: (72.4 ±7.6) U/L, (70.2 ±3.8) U/L, (72.4 ±7.8) μmol/L and (8.2 ±2.2)U/L, P<0.05], and those in the moderate or high-dose groups were higher than in the low-dose group (P<0.05). (2) mRNA expression of Erα and Erβ: the mRNA expression of Erα in pregnant rat livers increased in a dose-dependent manner, which were all significantly higher than that in the control group,respectively ( low-dose group: 0.76 ± 0.02 ); moderate -dose group: ( 0.99 ± 0.04; high-dose group:1.21 ±0.01 ;control group:0.65 ±0.01, P <0.05), but no difference was found among the 4 groups in the mRNA expression of Erβ ( P > 0.05 ). (3) mRNA expression of CYP7B1 and PPARα: the mRNA expression of CYP7B1 in pregnant rat livers increased from the low-dose group to the high-dose group, and were all higher than that of the control group ( low-dose group: 0.93 ± 0.01; moderate-dose group: 0.99 ±0.06; high-dose group: 1.22 ± 0.04; control group: 0.75 ± 0.02, P < 0.05 ). However, the mRNA expression of PPARα decreased from the low-dose group to the high-dose group, and were all lower than that of the control group (low-dose group: 0.83 ± 0.05; moderate-dose group: 0.71 ± 0.02; high-dose group:0.64 ± 0.03; control group: 1.35 ± 0. 05; P < 0.05 ) . Conclusions The down regulated mRNA expression of PPARα, caused by higher dose of estrogen, may increase the expression of CYP7B1 due to the ineffectiveness of the inhibition of PPARα on CYP7B1, which may further stimulate the Erα activity and then induce intrahepatic cholestasis. Abnormal expression of PPARα, CYP7B1 and ER may play a role in the pathogenesis of estrogen-induced intrahepatic cholestasis.     

卵巢癌的基因治疗

卵巢癌是女性生殖系统常见的恶性肿瘤之一,发病率虽然低于子宫内膜癌和子宫颈癌,但由于卵巢癌早期多无明显症状,又缺乏有效的早期诊断方法,约2/3患者诊断时已为晚期.目前卵巢癌的治疗,仍采用以手术为主,辅以多疗程化疗的治疗方法,但是对于FIGOⅢ～Ⅳ期即晚期癌的患者,虽经广泛的手术和高强度的化疗,多数仍于2年内复发,患者5年生存率在近20年来一直徘徊在约15%～30%,明显低于子宫内膜癌和宫颈癌,美国每年因卵巢癌死亡的人数甚至超过了其他所有妇科肿瘤所引起的死亡人数的总和[1].卵巢暴露于腹腔,癌细胞穿破卵巢包膜后,在较短时间内即可于横膈、肝脏、肠道、肠系膜、大网膜等腹腔脏器表面广泛播散、种植,手术难以将病灶完全切除,残留病灶和大量亚临床病灶主要依靠术后化疗,但卵巢癌属于对化疗中度敏感性肿瘤,化疗药物无法将其完全消灭,残存的肿瘤细胞在与化疗药物的长期接触中获得多重耐药性,使进一步的治疗更加困难.因此,寻找一种更有效,不良反应更小的治疗方法成为摆在妇科肿瘤工作者面前的一项重要任务.     

卵巢癌的基因治疗

卵巢癌是女性生殖系统常见的恶性肿瘤之一,发病率虽然低于子宫内膜癌和子宫颈癌,但由于卵巢癌早期多无明显症状,又缺乏有效的早期诊断方法,约2／3患者诊断时已为晚期。目前卵巢癌的治疗,仍采用以手术为主,辅以多疗程化疗的治疗方法,但是对于FIGOⅢ-Ⅳ期即晚期癌的患者,虽经广泛的手术和高强度的化疗,多数仍于2年内复发,患者5年生存率在近20年来一直徘徊在约15％～30％,明显低于子宫内膜癌和宫颈癌,美国每年因卵巢癌死亡的人数甚至超过了其他所有妇科肿瘤所引起的死亡人数的总和。     

野生型p53,GM-CSF和B7-1基因转移对卵巢癌细胞系SKOV-3增生的影响

目的研究人野生型p53、GM-CSF和协同刺激因子B7-1基因共转染对卵巢癌细胞增生的影响。方法以携带绿色荧光蛋白基因的重组腺病毒载体转染卵巢癌细胞系SKOV-3,荧光显微镜观察,流式细胞计数计算转染效率;以携带野生型p53、GM-CSF和B7-1基因的腺病毒转染SKOV-3细胞,RT-PCR检测目的基因表达,观察转染前后细胞形态的变化,绘制细胞生长曲线。结果当腺病毒的感染强度达到400 pfu/细胞时,转染率可达到81%;以携带目的基因的腺病毒转染SKOV-3细胞,能检测到相应基因表达;转染后SKOV-3细胞形态发生改变,增生减缓。结论腺病毒载体能介导目的基因转入卵巢癌细胞,并有效表达;人野生型p53、GM-CSF和B7-1基因共转染能减缓卵巢癌细胞的增生。     

高级别鳞状上皮内病变的危险因素及不同级别宫颈病变中的HPV感染亚型分布

目的探讨高级别鳞状上皮内病变(HSIL)的危险因素,以及不同级别宫颈病变中的HPV亚型分布情况。方法前瞻性选取首都医科大学附属北京友谊医院阴道镜室于2018年12月至2019年8月进行宫颈活检后病理组织确诊为宫颈上皮内瘤变(CIN)的患者,共计300例,收集患者的年龄、吸烟史、有无宫颈糜烂及阴道炎、初次性生活的年龄及孕产史的情况,采用单因素χ^2检验和多因素Logistic回归分析HSIL的危险因素。结果 HPV16亚型感染以及宫颈糜烂是HSIL的显著高危因素(P<0.05),OR值分别为3.143、2.138。在300例患者中,HPV总感染率前5位的亚型依次为HPV16(24.7%)、52(9.3%)、58(5.7%)、18(4.0%)、51(2.7%)。具体到不同CIN级别中,HPV的感染率又有所差别,在CIN I中,HPV感染率排名前5位的亚型依次为HPV16、52、58、18、56。在CIN II中,HPV感染率排名前5位的亚型依次为HPV16、58、52、51、18;在CIN III中HPV感染率排名前5位的亚型依次为HPV 16、52、58、18、51。HSIL与HPV感染种类无关(P>0.05)。结论宫颈上皮内瘤变的患者中,感染HPV亚型前5位分别为HPV 16、52、58、18、51。HPV16亚型感染以及宫颈糜烂是HSIL的独立危险因素。HSIL与HPV感染种类无关。