带环后月经过多机制的超微结构研究

带宫内避孕环系常用之节育措施,不正常子宫出血系常见之并发症。本文旨在研究发生出血的机制,提出改进意见,以利于带环妇女的健康,提高带环率。本文对12例带不锈钢环后月经过多妇女的子宫内膜进行超微结构研究,与6例带环而月经正常的妇女对比,结合基础体温、血雌孕激素测定等资料加以讨论。研究结果表明:(1)带环不影响卵巢功能。(2)环周围区与远离区内膜发育的不同步可能是出血过多的重要原因。(3)选择大小适宜的环(宁小勿大)既提高避孕效果又避免出血过多。     

基于Apriori算法的含丹参-当归药对的方剂用药特点与规律分析

目的 通过挖掘整理含丹参-当归的方剂,利用统计软件系统分析其用药规律。方法 检索筛选《中医方剂大辞典》中含丹参-当归药对的方剂,利用Excel软件分析中药使用频次、频率及丹参-当归配伍特征和主治中医病证频次,运用SPSS Modeler 18.0软件关联规则Apriori算法进行数据挖掘。结果 通过统计共筛选出含丹参-当归药对的方剂390首,频次统计分析发现涉及中药504味,使用频次≥60的中药共22味,除丹参、当归外,核心高频药物为川芎、甘草、白芍、肉桂、地黄、牛膝6味。通过组方规律分析得到常用中药组合有丹参-当归-川芎、丹参-当归-甘草、丹参-当归-白芍。主治病证涉及105种,频次≥10的中医病证10种,以瘀血疼痛病症、妇科病症为主。通过网络可视化得到治疗月经病的核心中药组合为丹参-当归-川芎-白芍-香附,治疗痹证的核心中药组合为丹参-当归-川芎-肉桂,治疗虚劳病核心中药组合为丹参-当归-牛膝-肉桂-防风。结论 与丹参-当归配伍的高频中药为白芍、川芎、肉桂等,优势病证为月经病、痹证和虚劳病,揭示了丹参-当归药对的用药规律,为该药对在临床合理用药及深入研究与开发提供科学依据。     

Regression of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue triptorelin: a prospective study

Endometrial hyperplasia is thought to be caused by the prolonged, unopposed oestrogenic stimulation of the endometrium. The regression of hyperplastic back to normal endometrium is the main purpose of any conservative treatment in order to prevent development of adenocarcinoma. The aim of this study was to evaluate the regression of hyperplastic to normal endometrium in patients with various forms of endometrial hyperplasia after treatment with the gonadotrophin-releasing hormone analogue (GnRHa) triptorelin for 6 months. Fifty-six patients with endometrial hyperplasia were enrolled in this trial; 39 patients (group I) presented simple hyperplasia, 14 (group II) complex hyperplasia and three (group III) atypical complex hyperplasia. All patients were treated with triptorelin for 6 months. Bleeding control during treatment was excellent. A post-treatment curettage for estimation of endometrial histology was performed on 54 out of 56 patients 100.1 +/- 44.7 days after the last triptorelin dose, following the restoration of pituitary function. Regression of hyperplastic to normal endometrium was observed in 32 (86.5%) out of 37 patients in group I and in 12 (85.7%) out of 14 in group II. Persistence of simple hyperplasia was found in five (14.5%) out of 37 patients in group I. Persistence of complex hyperplasia was found in 1 (7.1%) out of 14 patients and progression to atypical complex hyperplasia in another one (7.1%) woman in group II. In some of these cases, the presence of risk factors such as obesity, diabetes mellitus and ovulatory disturbances may contribute to the disease persistence despite therapy. On the other hand, in group III, none of the three patients had normal post-treatment endometrial histology. It seems, therefore, that in cases of endometrial hyperplasia without atypia, the administration of the GnRHa triptorelin is associated with high regression rates to normal endometrium. Conversely, the presence of atypia seems to be a poor prognostic factor. Treatment tolerance and bleeding control during therapy is excellent.     

The evolution and value of bleeding assessment tools

Summary. A personal history of excessive mucocutaneous bleeding is a key component in the diagnosis of a number of mild bleeding disorders, including von Willebrand disease (VWD), platelet function disorders (PFD), and coagulation factor deficiencies. However, the evaluation of hemorrhagic symptoms is a well‐recognized challenge for both patients and physicians, because the reporting and interpretation of bleeding symptoms is subjective. As a result, bleeding assessment tools (BATs) have been developed and studied in a variety of clinical settings. This work has been pioneered by a group of Italian researchers, and the resultant ‘Vicenza Bleeding Questionnaire’ stands as the original BAT. In this review, we will discuss the modifications of the Vicenza Bleeding Questionnaire that have taken place over the years, as well as the validation studies that have been published. Other BATs that have been developed and published will be reviewed, as will the special situations of assessing pediatric bleeding as well as menorrhagia. Lastly, the clinical utility of BATs will be discussed including remaining challenges and future directions for the field.     

Disorders of menstruation and their effect on the quality of life in women with congenital factor VII deficiency

AIMS AND OBJECTIVES: To review menstrual problems in women with congenital FVII deficiency and to study their effect on the quality of life during menstruation in women with congenital FVII deficiency. METHOD: 14 women with congenital factor VII deficiency registered with the Haemophilia Centre at the Royal Free Hospital were interviewed and their case notes reviewed. All women completed Pictorial Blood assessment Chart (PBAC) for assessment of menstrual blood loss and a quality of life questionnaire during menstruation. Similar questionnaire and PBAC was completed by an age matched healthy control group of 23 women. RESULTS: Median age of study group was 35 yrs and of control group 34 yrs. Median FVII level of the study group was 31.5 IU/dL Two women had severe FVII deficiency (FVII level < 10 IU/dL) and 12 women had mild-moderate FVII deficiency. 57% women (8/14) from study group had menorrhagia (PBAC score > 100) compared with 17% (4/23) women from the control group. Six women (43%) from the study group were diagnosed with anaemia due to heavy periods, compared to two (9%) in the control group. The quality of life scores during menstruation were significantly worse in the women with FVII deficiency, compared to controls. CONCLUSION: Women with factor VII deficiency exhibit a spectrum of bleeding symptoms, menorrhagia being one of the commonest symptoms. This has adverse effect on their quality of life.     

The outcome of endometrial ablation in women with inherited bleeding disorders

There are currently limited data on the use of endometrial ablation in the treatment of heavy menstrual bleeding (HMB) in women with inherited bleeding disorders (IBDs). A retrospective review of prospectively collected data was performed. Twelve women with IBDs who had received endometrial ablation for the treatment of HMB were identified and their records reviewed. Details of their menstrual history; quality of life (QOL) and amount of menstrual blood loss [as assessed by pictorial blood-loss assessment chart (PBAC) and haemoglobin (Hb) concentration] pre and post-ablation were collected. Twelve women were included. The median duration of follow-up post-ablation was 32 months (range, 6-76). The median duration of menstruation decreased from 11 to 0 days after treatment (P = 0.004). Median PBAC scores decreased from 1208 preop to 0 post-ablation (P = 0.002).The median Hb concentrations (10.5-13.1 g dL(-1)) and QOL scores (median, 17-54) improved significantly after endometrial ablation (P < 0.01). Endometrial ablation appears to be a safe and effective long-term treatment for HMB in women with IDBs. It significantly decreases menstrual blood loss and improves QOL.     

Cyclooxygenase enzyme expression and E series prostaglandin receptor signalling are enhanced in heavy menstruation

BACKGROUND: Although the mechanisms underlying the causes of heavy menstrualblood loss (MBL) remain to be elucidated, prostaglandins havebeen previously implicated. This study was initiated to elucidatea pattern of expression of the various components of the cyclooxygenase(COX)–prostaglandin signalling pathways present in theendometrium of women with normal and heavy MBLs. METHODS: Endometrial biopsies were collected at different stages of themenstrual cycle from women who underwent measurement of MBL.Tissue was divided for either examination of gene expressionby quantitative RT–PCR analysis or in vitro culture experimentation. RESULTS: Analysis of gene expression demonstrated a significant elevationin expression of COX-1 and COX-2 mRNA in endometrium obtainedfrom women with heavy MBL when compared with endometrium obtainedfrom women with normal MBL. Tissue culture with PGE₂ stimulationcaused a significantly elevated production of cyclic AMP (cAMP)by endometrium of women with heavy MBL when compared with normalMBL. Expression of phosphodiesterase 4B, an enzyme involvedin cAMP breakdown, was reduced in these same endometrial samplesobtained from women with heavy MBL. CONCLUSIONS: These data identify the E series prostaglandin receptors andtheir signalling pathways as potential therapeutic targets inthe treatment of heavy menstruation.     

诺舒子宫内膜去除术治疗子宫腺肌病致月经过多的临床研究

目的探讨针对子宫腺肌病致月经过多患者采用诺舒(NovaSure)子宫内膜去除术治疗的临床意义。方法选取2012年3月至2013年6月因子宫腺肌病在番禺中心医院行NovaSure子宫内膜去除术的患者29例为研究组,行宫腔镜下子宫内膜电切术的患者27例为对照组,所有患者术后门诊定期随访,根据月经失血评估图(pictorial blood loss assessment chart,PBAC)评分判定术前出血情况、手术时间、术中出血量、术后闭经率、月经减少率和月经改善率。结果研究组手术时间、术中出血量少于对照组(P0.05);两组术后并发症率、治疗有效率比较差异无统计学意义(P0.05)。结论 NovaSure子宫内膜去除术是治疗子宫腺肌病致月经过多的有效方法。     

戊酸雌二醇联合地屈孕酮治疗非器质性月经过多的疗效观察

目的观察戊酸雌二醇联合地屈孕酮治疗非器质性月经过多的临床疗效及安全性。方法选取86例非器质性月经过多患者,采用信封法随机分为2组,每组43例。对照组患者采用戊酸雌二醇联合安宫黄体酮治疗,观察组采用戊酸雌二醇联合地屈孕酮治疗,两组患者均给予补充铁剂、加强营养、注意休息等对症支持治疗,均连续治疗3个周期。按照月经失血图评分法(PBAC)评估两组患者经血量,评分>100分(经血量>80 mL)为月经过多。记录两组患者用药后出血控制时间、出血停止时间,并根据两组患者阴道出血情况进行疗效评定。治疗期间严密观察两组患者不良反应发生情况。结果观察组、对照组的总有效率分别为95.35%、81.40%,两组比较差异有统计学意义(P<0.05)。观察组、对照组的出血控制时间分别为(16.5±2.0)d、(25.6±3.0)d,出血停止时间分别为(23.5±3.8)d、(40.5±5.0)d,两组比较差异均有统计学意义(P<0.05)。观察组治疗1个周期、2个周期、3个周期后,PABC评分明显低于对照组(P<0.05)。观察组、对照组分别有4例(9.30%)、5例(11.63%)发生不良反应,两组比较差异无统计学意义(P>0.05)。结论采用戊酸雌二醇联合地屈孕酮治疗非器质性月经过多,可迅速控制出血,减少月经出血量,不良反应少而轻微。