残角子宫急腹症1例

一、病例摘要 患者，女，11岁，主因“痛经1年余，加重2d”急诊入院。患者平素月经欠规律，10岁初潮，量中等，并出现渐进性痛经，每次均需口服止痛药缓解。末次月经18d前，持续至今未净。2d前腹痛较剧烈，肌注安痛定后缓解，今晨腹痛加重，伴肛门坠胀感，无头晕、心悸，无恶心、呕吐，无发热，收入院。查体：T：37．9℃，P90次/分，Bp：120／80mmHg（1mmHg=0．133kPa），R19次/分。     

高剂量来曲唑在卵巢低反应患者微刺激方案中的临床观察#br#

Objective?To explore the clinical application value of high-dose letrozole in poor ovarian response(POR) patients during mild ovarian stimulation protocols receiving IVF/ICSI. Methods?A retrospective analysis was performed on 102 patients with POR treated with letrozole mild ovarian stimulation in IVF/ICSI at our reproductive Center from January 2016 to December 2018. The high-dose letrozole group (7.5 mg/d×5 d) was the high-dose group (n=50), and the conventional letrozole group (5 mg/d×5 d) was the conventional dose group (n=52). Results?The age and basal FSH of the high-dose group were higher than those of the conventional dose group (P<0.05), and the number of sinus follicles (AFC) in the high-dose group was significantly lower than that in the conventional dose group (P<0.05). The time of use of gonadotropin (Gn) in high dose group was shorter than that in conventional dose group (P<0.05), the daily serum E2 level of human chorionic gonadotropin (hCG) was significantly decreased (P<0.05), the egg number was lower than that in conventional dose group, but the egg MⅡrate was significantly higher than that in conventional dose group (P<0.05). The clinical pregnancy rate and live birth rate per fresh transplant cycle increased in the high-dose group [55.56% vs 50%; 55.56% vs 37.5%], but the difference was not statistically significant compared with the conventional dose group (P>0.05). Conclusion?For POR patients receiving ART, high-dose letrozole with mild ovarian stimulation protocol can improve the clinical pregnancy outcome of POR patients to some extent without obvious adverse reactions, especially for POR patients with poor ovarian reserve, which may benefit from improving oocyte quality and high MII rate suggesting improved follicle quality.     

外核苷酸焦磷酸酶/碱性磷酸二脂酶I K121Q基因多态性与多囊卵巢综合征发病相关性分析

目的:探讨外核苷酸焦磷酸酶/碱性磷酸二脂酶I基因多态性与多囊卵巢综合征发病的相关性及该突变对多囊卵巢临床表型的影响。方法:采用PCR-限制性片段长度多态性分析外核苷酸焦磷酸酶/碱性磷酸二脂酶I基因多态性并鉴定基因型,比较正常人与多囊卵巢综合征患者基因型的分布频率,并比较不同基因型之间患者的临床指标。结果:70例多囊卵巢综合征患者外核苷酸焦磷酸酶/碱性磷酸二脂酶I K121Q突变率明显高于67例对照组,差异有统计学意义(P<0.05)。无胰岛素抵抗的多囊卵巢综合征患者外核苷酸焦磷酸酶/碱性磷酸二脂酶I K121Q突变率明显高于对照组,差异有统计学意义(P<0.05)。无胰岛素抵抗的患者中外核苷酸焦磷酸酶/碱性磷酸二脂酶I基因突变组睾酮、促黄体激素均高于野生型组,差异有统计学意义(P<0.05)。结论:外核苷酸焦磷酸酶/碱性磷酸二脂酶I K121Q基因多态性与多囊卵巢发病相关,并且独立于胰岛素抵抗独立存在。