益肾活血法联合中医周期疗法治疗抗精子抗体阳性不孕患者的临床观察

【目的】观察益肾活血法联合中医周期疗法治疗抗精子抗体(AsAb)阳性不孕的临床疗效。【方法】采用随机数字表法将86例患者随机分为治疗组和对照组各43例。治疗组采用益肾活血法联合中医周期疗法治疗,对照组采用强的松治疗,2组均以治疗1个月为1个疗程,共治疗3个疗程。观察2组AsAb转阴时间、转阴率及转阴后1年内的妊娠情况。【结果】治疗组转阴率为72.50%,对照组为78.95%,2组比较,差异无统计学意义(P>0.05)。治疗组的妊娠率为45.0%,对照组为23.7%,治疗组妊娠率显著高于对照组,2组比较差异有统计学意义(P<0.05)。【结论】益肾活血法联合中医周期疗法治疗抗精子抗体阳性不孕患者疗效显著,值得进一步研究。     

The Impact of Bariatric Surgery on Menstrual Patterns

Background: Obesity and anovulation are common medical problems in the United States. Anovulation in obese patients primarily manifests with irregular, sporadic or absent menstrual bleeding. Weight loss of at least 5% has been shown to reverse obesity-related anovulation. The aim of this study was to assess the impact of bariatric surgery on infertility in morbidly obese women and to identify factors associated with return of normal menses following bariatric surgery. Methods: A survey of patients was collected from the bariatric surgery data-base at the Hospital of the University of Pennsylvania. 410 women under the age of 40 were sent questionnaires. 195 patients completed the questionnaire, and 29 patients had incorrect addresses without a forwarding address, resulting in a 51.2% response rate. Patients who reported menstrual cycle lengths >35 days were considered abnormal. 92 of the 195 responders were considered anovulatory preoperatively, based on menstrual history. Results: There was no significant difference in postoperative BMI, BMI decrease or age at surgery between the survey responders and non-responders. There was a significant difference between these 2 groups in time since surgery (P=.01). Both groups had a decrease in BMI of >18 kg/m². The mean menstrual cycle length preoperatively among those categorized as ovulatory and anovulatory was 27.3 and 127.5 days, respectively. Of the 98 patients who were anovulatory preoperatively, 70 patients (71.4%) regained normal menstrual cycles after surgery. Those patients who regained ovulation had greater weight loss than those who remained anovulatory (61.4 kg vs 49.9 kg, P=0.02). Conclusions: Anovulation resulting in abnormal menses is a common problem in morbidly obese premenopausal women. The menstrual cycle disorders may completely resolve after bariatric surgery. Thus, infertility due to anovulation among morbidly obese women could potentially be viewed as an additional indication for bariatric surgery.     

自体移植法子宫内膜异位症模型大鼠妊娠功能的研究

[目的] 观察自体移植法子宫内膜异位症模型大鼠的妊娠功能,以评价该模型是否能代表人类子宫内膜异位症不孕的病理状态。[方法] 取大鼠子宫内膜自体移植复制子宫内膜异位症动物模型,观察模型大鼠的内分泌与免疫功能状态;继而使之与雄性大鼠同笼研究其生殖功能,并与正常大鼠比较。[结果]在免疫功能方面,子宫内膜异位症模型大鼠血中肿瘤坏死因子(TNF)含量升高(与假手术组比较,P<0.01);在生殖内分泌方面,动情前期模型大鼠血中促黄体生成素(LH)水平降低、催乳素(PRL)水平升高,动情后期的血中孕激素(P)水平降低(与假手术组比,均P<0.01);且模型大鼠的排卵数、活胎数、着床率等均低于正常大鼠(与假手术组比,P<0.05或P<0.01)。[结论]自体移植法子宫内膜异位症模型大鼠出现生殖功能低下,可作为子宫内膜异位症不孕的模型动物;该模型模拟子宫内膜异位症患者的不孕,可用来进行助孕实验研究及助孕药物研究。     

Thyroid autoimmunity and infertility

We aimed to study the prevalence of thyroid autoimmunity in infertile women; to assess whether thyroid autoantibodies were associated with non-organ-specific autoantibodies; and to investigate the influence of this dysfunction on the couples' chances of pregnancy. We assayed serum levels of thyroid stimulating hormone (TSH) ,free thyroxine ,and microsomal and thyroglobulin autoantibodies in 149 infertile women. In patients with serum TSH levels in the hypothyroid or hyperthyroid range and/or with thyroid autoantibodies ,we performed thyroid ultrasound examinations and assayed some non-organ-specific autoantibodies. We compared the duration of infertility in infertile patients with normal thyroid (control group) ,with thyroid abnormalities ,and with thyroid autoantibodies in euthyroidism. Thirty infertile patients (20.1%) had thyroid abnormalities. The prevalence of thyroid autoantibodies was 17.4%. In infertile patients with thyroid autoantibodies ,we found a poor association with non-organ-specific autoantibodies. Only the women with thyroid abnormalities and ovulatory dysfunction had a mean duration of infertility significantly longer than that of the control group. When the data were analyzed for euthyroid women with thyroid autoantibodies ,we found no significant variation in the duration of infertility. Although we found a high prevalence of thyroid autoantibodies in infertile patients ,the presence of these autoantibodies per se did not reduce the chance of pregnancy.     

穴位注射治疗排卵障碍性不孕症临床观察

应用促性腺激素（ＨＭＧ）穴位注射治疗排卵障碍性不孕症３６例、６４个周期,并与以前用传统方法治疗的２６例、３９个周期比较。通过基础体温测定,Ｂ超监测卵泡发育及排卵现象统计受孕率进行比较。结果２组疗效相近（Ｐ＞００５）,用药量及副反应差异有极显著意义（Ｐ＜００１）。提示用ＨＭＧ穴位注射用药量少,费用低,副反应轻,明显优于传统给药方法。     

自拟输通汤治疗输卵管阻塞149例临床分析

输卵管阻塞引起的不孕症是妇科常见的疑难杂症。笔者根据中医理论,经多年实践,自拟“输通汤”(药物组成:太子参、丹参、王不留行子、荔枝核各15g,乳香、没药、赤芍、桃仁、皂刺、川楝、路路通、刘寄奴各10g),每日一剂,共煎三次。第一次浓煎成100ml保留灌肠,第二、三次煎液为口服,最后药渣趁热装袋敷小腹,同时结合辨证调周施治等方法,治疗因输卵管阻塞而致不孕者149例,获得较好疗效。其中治愈105例,占70.47%,受孕66人,占44.3％.提示“输通汤”是中医治疗输卵管阻塞的较为理想方药。     

抗精子抗体对不育症及自然流产的影响

本文应用试管—玻片凝集试验对480对不育夫妇和178对自然流产夫妇进行血清和/或精浆抗精子抗体(ASAb)测定。不育组ASAb总阳性率为23.12％,其中女方血清ASAb阳性率为14.6％,高于正常对照组(P<0.01):男方血清ASAb阳性率为12.6％,精浆ASAb阳性率为0.9％,后者低于前者(P<0.01)。自然流产组ASAb总阳性率为15.17％,其中女方血清ASAb阳性率为9.0％,亦高于正常对照组(P<0.01);男方血清ASAb阳性率为8.3％,精浆ASAb阳性率为3％。研究结果提示,ASAb是导致不育症及自然流产的重要原因之一,应引起临床医生的高度重视。     

针药结合疗法对免疫性不育大鼠血清抗精子抗体的影响

【目的】观察针药结合疗法对免疫性不育大鼠模型血清抗精子抗体的影响。【方法】将 80只SD大鼠分为 4组 ,采用主动免疫法建立血清抗精子抗体 (ASAb)阳性大鼠模型 ,并于造模时同期分别用针刺 (取穴关元俞、次 )、归肾液 (由熟地、菟丝子、女贞子、淮山、枸杞子、桑寄生、山萸肉等组成 )及针药结合治疗。【结果】针刺结合归肾液治疗组SD大鼠血清ASAb阴性率明显高于归肾液、针刺治疗组 (P <0 .0 5及P <0 .0 1)。【结论】说明针药结合有抑制ASAb产生的作用。     

针灸为主治疗不孕症20例

针灸为主治疗不孕症２０例钱淳宜（中国中医研究院针灸所，北京１００７００）主题词不育症，女性／针灸疗法Ｔｒｅａｔｍｅｎｔｏｆ２０ＣａｓｅｓｏｆＩｎｆｅｒｔｉｌｉｔｙＭａｉｎｌｙｗｉｔｈＡｃｕｐｕｎｃｔｕｒｅ￥ＱｉａｎＣｈｕｎｙｉ（Ｉｎｓｔｉｔｕｔｅｏｆ...     

针药并用治疗不孕症314例总结

针药并用治疗不孕症３１４例总结郭向勤（山西省吕梁地区医院，０３３０００）主题词不育症、女性／针灸疗法，针药并用ＳｔｅｒｉｌｉｔｙＣａｓｅｓＴｒｅａｔｅｄｂｙＢｏｔｈＡｃｕｐｕｎｃｔｕｒｅａｎｄＭｅｄｉｃｉｎｅ￥ＣｕｏＸｉａｎｇｑｉｎ（ＬｕｌｉａｎｇＲ...