继发性高促性腺激素性闭经妇女的骨代谢状况

目的：探讨继发性高促性腺激素性闭经妇女的骨代谢状况。方法：对１２例继发性高促性腺激素性闭经妇女，１２例同龄正常妇女及８例自然绝经妇女的空腹２小时尿钙与肌酐比值（Ｃａ／Ｃｒ）、尿羟脯氨酸与肌酐比值（ＯＨＰｒ／Ｃｒ）、血碱性磷酸酶（ＡＫＰ）、血骨钙素（ＢＧＰ）、血降钙素（ＣＴ）、血白细胞介素Ⅵ（ＩＬ－６）及血雌二醇（Ｅ２）水平进行测定与比较。结果：继发性高促性腺激素性闭经组与正常对照组相比，＜Ｅ２血ＣＴ水平显著降低（Ｐ＜００１），尿Ｃａ／Ｃｒ、尿ＯＨＰｒ／Ｃｒ比值及血ＡＫＰ、血ＢＧＰ、血ＩＬ－６水平均明显增高（Ｐ＜００１）。继发性高促性腺激素性闭经组与自然绝经组相比，尿Ｃａ／Ｃｒ比值及血ＢＧＰ水平明显低于自然绝经组（Ｐ＜００５），血Ｅ２水平，尿ＯＨＰｒ／Ｃｒ比值、血ＡＫＰ、血ＣＴ及血ＩＬ－６水平无明显统计学差异（Ｐ＞００５）。结论：继发性高促性腺激素性闭经妇女与同龄正常妇女相比，骨代谢呈高转换负钙平衡状态，此状态的出现与其ＣＴ分泌减少、ＩＬ－６产生增多有关     

绝经前乳腺癌患者新辅助化疗相关闭经的影响因素及临床意义探讨

目的分析绝经前乳腺癌患者接受新辅助化疗后闭经的相关影响因素,了解新辅助化疗相关的闭经（NCRA）与新辅助化疗后肿瘤降期的关系。方法回顾性随访观察我院2006年3月至2011年3月期间224例绝经前乳腺癌患者接受新辅助化疗后月经状态的改变及新辅助化疗后彩超下乳房肿瘤的变化情况,分析新辅助化疗时患者年龄、化疗方案、肿瘤病理组织学特征（ER/PR和Her-2）、术后服用他莫昔芬（tamoxifen,TAM）与NCRA及其随后月经恢复的关系,以及新辅助化疗后肿瘤的变化与NCRA的关系。结果 224例患者中有166例（74.11%）患者出现NCRA,其中有15例停经但雌激素水平增高而行卵巢切除或接受戈舍瑞林治疗,余151例NCRA患者中有40例（26.49%）出现月经恢复。单因素及多因素分析结果显示,NCRA的发生及随后的月经恢复均与患者的年龄有关（P〈0.001,P=0.001）;不同化疗方案对NCRA的发生无明显影响（P〉0.05）,但是对NCRA后月经恢复有重要影响（P〈0.001）;肿瘤的ER/PR和Her-2表达和是否服用TAM对NCRA发生及其随后的月经恢复均无明显影响（P〉0.05）。发生NCRA时的化疗周期数随患者年龄的增长而减少,与NCRA后月经的恢复无关（P〉0.05）。NCRA的发生与新辅助化疗后肿瘤的降期无关（P〉0.05）。结论大多数绝经前乳腺癌患者接受新辅助化疗后会出现闭经,年龄越大的患者越容易发生NCRA,而且发生NCRA时接受化疗的周期数更少;年龄和化疗方案都会影响NCRA后月经的恢复;NCRA的发生未影响新辅助化疗的近期疗效。     

中医论治青春期肥胖型多囊卵巢综合征的疗效观察

目的:观察中医治疗青春期肥胖型多囊卵巢综合征的临床疗效。方法:选取经西医治疗后仍月经稀发或闭经患者共19例,给予口服苍附导痰汤配合针灸治疗,比较治疗前后的相关指标。结果:治疗3个月后,显效者10例(53%);有效者6例(32%);无效者3例(15%);总有效率为85%。结论:采用苍附导痰汤配合针灸治疗,可以重建正常的月经周期,有效降低雄激素水平,改善患者卵巢功能、胰岛素抵抗及临床症状,疗效较好,值得临床推广。     

Plasma kisspeptin levels in lactational amenorrhea

The kisspeptin is a neuropeptide to play physiological roles in regulating gonadotropin-releasing hormone secretion in the hypothalamus. In human plasma, the kisspeptin concentration is measured, but gonadotropin-releasing hormone is not. This study aims to understand the physiological roles of the circulating kisspeptin in lactational amenorrhea in humans because prolactin reduces the kisspeptin expression and luteinizing hormone secretion resulting in anovulations in rodent brains. Plasma kisspeptin levels were measured in 11 subjects in lactational amenorrhea and in four cases with pathological amenorrhea by different etiologies for comparison using the enzyme immunoassay specific for human kisspeptin. The plasma kisspeptin levels in the 11 women with lactational amenorrhea were 15.2?±?2.5?fmol/mL (mean?±?SD) which were not significantly different as compared with 16.5?±?4.8?fmol/mL (mean?±?SD) in four age-matched women with menstrual cycles as we reported previously. In the four cases with pathological amenorrhea, their plasma kisspeptin levels were from 5.8 to 13.7?fmol/mL. This study demonstrated that the plasma kisspeptin levels were not totally reduced in lactational or pathological amenorrhea. These results suggest the physiological roles of the circulating kisspeptin are different from the role in the brain.     

Unique Case of Imperforate Hymen

BackgroundImperforate hymen typically presents in adolescence with pain, hematocolpometra and primary amenorrhea. This case documents a previously unreported etiology for an atypical presentation with a history of recent menstruation.CaseA female adolescent presented with symptoms of urinary retention and leg pain. She reported a history of irregular, painful menses. Clinical examination revealed a pelvic mass and imperforate hymen. Sonography was consistent with hematocolpometra. Before a planned hymenectomy, the patient began to pass dark blood through a fistulous opening in her vulva. Hymenectomy resulted in complete resolution of the pain and hematocolpometra.Summary and ConclusionIdentification of the fistulous tract explained the patient's history of menstrual bleeding despite an imperforate hymen. Spontaneous rupture of hematocolpometra through a fistulous tract to the vulva is a previously unreported atypical presentation of imperforate hymen in a “menstruating” adolescent with pain and a pelvic mass.     

细胞遗传学检查在诊断闭经患者中的作用

目的 分析闭经患者的染色体核型,了解闭经与染色体异常的相关性,为临床治疗提供科学依据。方法 对158例闭经患者进行外用血淋巴细胞染色体棱型分析。结果 158例患者中有染色体异常者40例,占受检者25.3％(40/158)。原发性闭经患者中染色体异常检出率26.6%(33/124);继发性闭经患者中检出率为20.6％(7/34),染色体异常类型包括:X染色体数目异常13例,结构异常5例,嵌合体11例,含Y染色体13例。结论 性染色体决定着女性性腺及生殖器官的发育,性染色体异常是导致闭经的重要原因。对于闭经患者常规行染色体检查是必要的。     

异常月经周期与多囊卵巢综合征的相关性分析

目的分析异常月经周期与多囊卵巢综合征的相关性。方法调查2009年10月-2010年1月期间,在北京妇产医院和北医三院生殖中心的门诊病人810例并采用2003年鹿特丹标准诊断多囊卵巢综合征,分析两者间的关系。结果 1.810名妇女中月经周期异常占68.9%(558/810)。月经稀发和闭经占异常月经周期的99.1%(553/558),月经稀发所占比例最高(65.6%,366/558),月经频发比例最小(0.9%,5/558)。2.随着年龄的增加,月经稀发与闭经的发生率呈逐渐降低的趋势,而正常月经周期所占的比例则逐渐增加(P=0.000)。3.多囊卵巢综合征有523例。在月经稀发患者中多囊卵巢(PCO)占83.3%(305/366);高雄激素血症(HA)占52.7%(193/366)。闭经患者中多囊卵巢占90.4%(169/187);高雄激素血症占61.5%(115/187)。月经稀发和闭经PCOS患者中,均以月经稀发/闭经(O)+多囊卵巢(P)+高雄(H)最多见。O+H亚型与O+P+H比较,O+H主要以月经稀发为主,而O+P+H的闭经率则显著高于经典型O+H。结论月经稀发与PCOS关系密切,可以作为PCOS的第一步筛查指标。要重视月经周期超过35天的妇女。     

The Dangers of Hymenotomy for Imperforate Hymen: A Case of Iatrogenic Pelvic Inflammatory Disease with Pyosalpinx

BackgroundComplications associated with imperforate hymen include cyclical abdominal pain, acute urinary retention, endometriosis, and even iatrogenic infections.CaseA 14-year-old young woman was diagnosed with an imperforate hymen, hematocolpos, and right hematosalpinx. A hymenotomy was performed, followed by a hymenectomy 3 days later. On postoperative day 7, she was admitted for pelvic inflammatory disease with a right pyosalpinx. The infection was refractory to intravenous gentamicin, ampicillin, and clindamycin so the patient underwent computed tomography-guided drainage of the pyosalpinx. Two days later, she was discharged home in good condition.Summary and ConclusionSmall incisions and punctures into imperforate hymens without immediate definitive management should be avoided because inoculation of the newly introduced bacteria can ascend the gynecologic tract and lead to serious infections.