卵巢组织冻存(OTC)与移植目前主要用于青春期前或需尽快接受抗癌治疗的年轻肿瘤患者生育力保存,至今已有二十余年的历史,通过冻存卵巢组织再移植获得的活产已有超过200例的报道,近年来OTC与移植得到了快速发展,但仍存在许多亟待解决的问题.有效性方面,大部分患者自体冻存卵巢组织再移植后,卵巢内分泌功能可恢复至正常,活产率高达40％,然而冻存卵巢组织的回输利用率仍处于较低水平.安全性方面,通过卵母细胞体外成熟、人工卵巢等新兴技术减少肿瘤细胞在卵巢组织移植中转移、复发的风险是近年来众多研究者关注的方向.如何最大限度地保证OTC与移植过程中卵泡的存活也一直是研究的重点,目前有添加生长因子、激素、抗凋亡药物、干细胞等多种方法防治卵泡的凋亡和丢失.然而这些新兴技术大多尚处于实验室阶段,未来期待更多基础和临床研究来为OTC与移植这项生育力保存技术提供更多的有效性和安全性保障.
Objective:To investigate the clinical value of micro-vascular flow(MV-flow)imaging in evaluating the difference of endometrial micro-flow vascularization index(ⅥMV)between recurrent spontaneous abortion and normal reproductive age women.Methods:From June 2022 to June 2023,87 patients with unexplained recurrent spontaneous abortion in West China Second University Hospital,Sichuan University were selected as the abortion group,including 51 patients with 2 miscarriages,26 patients with 3 miscarriages,and 10 patients with≥4 miscar-riages.In addition,90 normal women of childbearing age who did not have a history of miscarriage and visited our hospital during the same period were selected as the healthy group.Endometrial ⅥMV was measured by transvag-inal ultrasound using MV-flow imaging technology in mid-luteal phase of the two groups.The mean values of en-dometrial ⅥMV in 177 women was measured repeatedly within and between observers.The endometrial ⅥMVand clinical data were compared between the two groups.The differences of endometrial ⅥMV and clinical data in pa-tients with different miscarriage times in the abortion group were compared simultaneously.Results:There was no statistically significant difference in age,body mass index,follicle stimulating hormone and luteinizing hormone be-tween the healthy group and the abortion group(P＞0.05).The ⅥMV of endometrium in healthy group was higher than that in abortion group,and the difference was statistically significant(6.10％vs.3.70％,P＜0.05).In the abortion group,endometrial ⅥMV in patients with 2 miscarriages(5.30％)was higher than that in patients with 3(3.25％)miscarriages and≥ 4(3.30％)miscarriages,and the difference was statistically significant(P＜0.05).There was no statistically significant difference in endometrial ⅥMV between patients with 3 miscarriages and ≥4 miscarriages(P＞0.05).The intraobserver and interobserver correlation coefficients of endometrial ⅥMV were 0.978 and 0.945,respectively.Conclusions:MV-flow imaging technology can effectively evaluate the difference of endometrial ⅥMV between recurrent spontaneous abortion and normal childbearing age women,and endometri-al ⅥMV may decrease with the increase of miscarriage frequency.
下丘脑-垂体-性腺轴调控系统、内分泌器官(胰岛、肾上腺、甲状腺)功能及卵巢自分泌和旁分泌等任何一个环节出现异常,均可导致排卵障碍(ovula-tion disorder),其主要表现为月经紊乱(如月经频发、稀发、闭经或异常子宫出血)及不孕[1].2022年FI-GO排卵障碍新的分类系统为HyPO-P系统,分别对应Ⅰ型:下丘脑;Ⅱ型:垂体;Ⅲ型:卵巢;Ⅳ型:PCOS.而针对排卵障碍的病因,HyPO-P系统进行二级分类,分别为GAIN(遗传、自身免疫、医源性、肿瘤)-FIT(功能性、感染或炎症、创伤和血管)-PIE(生理性、特发性、内分泌),并最终形成了以HyPO-P及GAIN-FIT-PIE的缩写组成的FIGO分类系统[2],用以规范排卵障碍的分类及临床应用.
外泌体是细胞外囊泡的一种亚型,广泛存在于机体的各种体液中,含有核酸、蛋白质、脂质等,是细胞间交流的重要介质.在正常生理和病理条件下,其内容物的种类和数量会发生变化,与免疫反应、癌症进展及心血管、神经相关疾病发生发展有关.配子形成、受精卵发育及着床是胚胎早期发育的重要过程,任何影响该过程的因素均可导致不孕或早期流产.本文阐述了外泌体在参与调节配子发育及成熟、受精、早期胚胎发育和母胎交流等多种生殖生理功能中的作用机制.由于外泌体具有较高的稳定性和保守性,有望成为生殖生物学中具有前景的诊断和治疗新手段.
1病例报告 患者,30岁,因卵巢囊肿8年,明显增大3+月,腹胀半月,于2021年11月8日入河北医科大学第二医院治疗.8年前患者孕前检查行超声检查发现卵巢囊肿,直径约2 cm,未处理,间断复查未见明显增大.1年前患者在接受辅助生殖助孕监测排卵过程中发现囊肿增大至5 cm,遂行经阴道注水腹腔镜检查,术中未见明显异常.3+月前患者孕前检查行超声检查示卵巢囊肿增大约14.5 cm,无腹痛、腹胀,未处理.半月前患者出现腹胀,进食减少,偶有胸闷,遂就诊于本院.门诊超声检查提示盆腹腔巨型包块,以卵巢肿瘤收入院.患者月经规律,G6P0,自然流产或胚胎停育共6次.末次妊娠于2021年9月因胚胎停育行清官术.2010年于本院确诊为肝豆状核变性(hepatolenticular degeneration,HLD),药物治疗后震颤症状消失,但3年前自行停药且未复查,自诉无症状.2020年体检发现亚临床甲状腺功能减退,口服左甲状腺素钠片(优甲乐)50µg,每日1次,服药至今.
