Chronic endometritis is associated with the imbalance of female reproductive tract microbiota and pathogenic microbial infection. This study aimed to identify the specific changes in the endometrial microbiome in patients with endometritis and to explore how Clostridium tyrobutyricum (C.t) influences the progression of endometritis in mice for further elucidating endometritis pathogenesis. For this purpose, endometrial tissues from 100 participants were collected and divided into positive, weakly positive, and negative groups based on CD138 levels, while endometrial microbiome differences were detected and analyzed using 16S rRNA gene sequencing. Staphylococcus aureus (S. aureus)-induced endometritis mouse model was established, followed by treatment with C.t, and inflammatory response, epithelial barrier, and TLR4/NF-κB pathway were evaluated. Results showed that α- and β-diversity was significantly lower in the positive group compared with the weakly positive or negative groups, where the negative group had more unique operational taxonomic units. The abundance of Proteobacteria was found to be increased, while that of Actinobacteria, Firmicutes, and Bacteroidetes was found to be reduced in the positive group, while the area under the curve value was found to be 0.664. Furthermore, C.t treatment resulted in the alleviation of S. aureus-induced inflammatory response, epithelial barrier damage, and activation of the TLR4/NF-κB pathway in mice. Clinical samples analysis revealed that the diversity and abundance of microbiota were altered in patients with endometritis having positive CD138 levels, while mechanistic investigations revealed C.t alleviated S. aureus-induced endometritis by inactivating TLR4/NF-κB pathway. The findings of this study are envisaged to provide a diagnostic and therapeutic potential of microbiota in endometritis.

ObjectiveThe aim of the study is to assess the effect of maternal prolonged oxygen exposure during labor on fetal acid–base status, fetal heart rate tracings, and umbilical cord arterial metabolites.DesignThe study was conducted as a secondary analysis.Setting(s)The study was set in three tertiary teaching hospitals in Beijing, China.ParticipantsApproximately 140 women in the latent phase of labor with no complications participated in the study.InterventionParticipants were randomly allocated in a 1:1 ratio to receive either 10 L of oxygen per minute in a tight-fitting simple facemask until delivery or room air only.Main outcome measuresThe primary outcome was the umbilical cord arterial lactate.ResultsBaseline demographics and labor outcomes were similar between the oxygen and room air groups; the time from randomization to delivery was 322 ± 147 min. There were no differences between the two groups in the umbilical cord arterial lactate (mean difference 0.3 mmol/L, 95% confidence interval −0.2 to 0.9), the number of participants with high-risk category II fetal heart rate tracings (relative risk 0.94, 95% confidence interval 0.68 to 1.32), or the duration of those high-risk tracings (mean difference 3.6 min, 95% confidence interval −9.3 to 16.4). Prolonged oxygen exposure significantly altered 91 umbilical cord arterial metabolites, and these alterations did not appear to be related to oxidative stress.ConclusionMaternal prolonged oxygen exposure during labor did not affect either the umbilical cord arterial lactate or high-risk category II fetal heart rate tracings but might result in alterations to the umbilical cord arterial metabolic profile.Clinical trial registrationwww.clinicaltrials.gov, identifier NCT03764696.

Objective To observe the effect of gestational weight gain（GWG） on glucose metabolism and pregnancy outcomes in patients with gestational diabetes mellitus（GDM）. Methods The clinical data of 1667 single pregnant women with GDM diagnosed in the Department of Obstetrics and Gynecology of the Sixth Medical Center of Chinese PLA General Hospital from January 2019 to December 2021 were collected and retrospectively analyzed. According to the degree of GWG, all the GDM pregnant women were divided into three groups: little weight gain group（n=882）, moderate weight gain group（n=566）and excessive weight gain group（n=219）. The levels of glycosylated hemoglobin（HbA1c）, fasting plasma glucose（FPG）, fasting insulin（FIN）, Homeostatic Model Assessment of Insulin Resistance（HOMA-IR）, homeostasis model assessment β cell function（HOMA-β） and neonatal birth weight were compared among the three groups. Logistic regression was used to analyze the correlation between GWG and adverse pregnancy outcomes. Results The levels of HbA1c, FPG, FIN, HOMA-IR and HOMA-β in excessive weight gain group were significantly higher than those in little weight gain group and moderate weight gain group（P＜0.05）,and the levels of FIN, HOMA-IR and HOMA-β in little weight gain group were significantly lower than those in moderate weight gain group（P＜0.05）. The neonatal birth weight in excessive weight gain group was significantly higher than that in little weight gain group and moderate weight gain group（P＜0.05）, and the neonatal birth weight in little weight gain group was significantly lower than that in moderate weight gain group（P＜0.05）. Logistic regression analysis showed that both excessive weight gain and little weight gain were independent factors of hypertensive disorders of pregnancy（HDP）, macrosomia and large for gestational age（LGA）（P＜0.05）. Conclusion Irrational weight gain during pregnancy may increase the incidence of glucose metabolism disorders and adverse pregnancy outcomes in pregnant women with GDM.

Background Preimplantation genetic testing for aneuploidy (PGT-A) was demonstrated to be superior to conventional IVF in reducing the incidence of miscarriage and abnormal offspring after the first embryo transfer (ET). PGT-A requires several embryo trophectoderm cells, but its negative impacts on embryo development and long-term influence on the health conditions of conceived children have always been a concern. As an alternative, noninvasive PGT-A (niPGT-A) approaches using spent blastocyst culture medium (SBCM) achieved comparable accuracy with PGT-A in several pilot studies. The main objective of this study is to determine whether noninvasive embryo viability testing (niEVT) results in better clinical outcomes than conventional IVF after the first embryo transfer. Furthermore, we further investigated whether niEVT results in higher the live birth rate between women with advanced maternal age (AMA, > 35 years old) and young women or among patients for whom different fertilization protocols are adopted. Methods This study will be a double-blind, multicenter, randomized controlled trial (RCT) studying patients of different ages (20–43 years) undergoing different fertilization protocols (in vitro fertilization [IVF] or intracytoplasmic sperm injection [ICSI]). We will enroll 1140 patients at eight reproductive medical centers over 24 months. Eligible patients should have at least two good-quality blastocysts (better than grade 4 CB). The primary outcome will be the live birth rate of the first embryo transfer (ET). Secondary outcomes will include the clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, cumulative live birth rate, ectopic pregnancy rate, and time to pregnancy. Discussion In this study, patients who undergo noninvasive embryo viability testing (niEVT) will be compared to women treated by conventional IVF. We will determine the effects on the pregnancy rate, miscarriage rate, and live birth rate and adverse events. We will also investigate whether there is any difference in clinical outcomes among patients with different ages and fertilization protocols (IVF/ICSI). This trial will provide clinical evidence of the effect of noninvasive embryo viability testing on the clinical outcomes of the first embryo transfer. Trial registration Chinese Clinical Trial Registry (ChiCTR) Identifier: ChiCTR2100051408. 9 September 2021.

Background The relationship between maternal folic acid supplementation and the birth weights of offspring remains inconclusive. Aim To examine the associations between maternal supplementation with folic acid only (FAO) or multiple micronutrients containing folic acid (MMFA) and newborn birth weights, as well as the risk of small for gestational week age (SGA) and large for gestational week age (LGA) newborns. Methods Data on 31,107 births from 2015 to 2018 were extracted from the population-based prenatal health care system in a district of Beijing. Generalized linear and logistic regression models were used to evaluate the association between maternal periconceptional folic acid supplementation and birth weights or with risk of small for gestational week age (SGA) and large for gestational week age (LGA). Results Compared with newborns whose mothers did not use any folic acid supplements, the newborns with maternal periconceptional folic acid supplementation had similar median birth weight but had a lower risk of SGA [adjusted odds ratio ( aOR ) = 0.81 ( 95% CI : 0.68–0.97)], however newborns born to mothers who took multiple micronutrients with folic acid (MMFA) with high compliance had a 25.59 g (95% CI: 6.49–44.69) higher median birth weight. Periconceptional women took folic acid only (FAO) (a OR = 0.83; 95% CI: 0.67–1.01) or MMFA (a OR = 0.74; 95% CI : 0.60–0.91) with high compliance decreased the risk of SGA, but has no impact on the risk of LGA. Conclusion Periconceptional FAO supplementation has no impact on the median birth weight of offspring and the risk of LGA. Compared with FAO, MMFA supplementation may increase the average birth weight, and a high compliance of supplementation with FAO or MMFA may reduce the risk of SGA, with MMFA having ad stronger effect than FAO.

BACKGROUND: There are limited data to guide the duration and dose of oxygen supplementation for pregnant women undergoing labor. OBJECTIVE: To assess the effect of maternal long-duration high-concentration oxygen administration during labor on umbilical cord venous partial pressure of oxygen. STUDY DESIGN: This randomized clinical trial was conducted between January and October of 2021 in the obstetrics wards of 3 tertiary teaching hospitals in Beijing, China. Women undergoing the latent phase of labor with no existing medical conditions or obstetrical complications who were admitted for delivery were eligible. The women who met inclusion criteria with category I fetal heart rate tracings in labor were randomized in a 1:1 ratio to oxygen or room air. The oxygen group received 10 L of oxygen per minute by simple, tight-fitting face mask until delivery. The room-air group received room air only, without a face mask. The primary outcome was the umbilical cord venous partial pressure of oxygen. RESULTS: A total of 661 women were screened, and 521 were excluded; 140 participants with category I fetal heart rate tracings were enrolled and randomized to oxygen (N=70) or room air (N=70). A total of 135 women with valid paired umbilical cord venous and arterial gas values were included in the umbilical cord venous partial pressure of oxygen and arterial pH analyses. All 140 women were included in the fetal heart rate tracings analysis. Baseline characteristics were similar between the oxygen and room-air groups. The duration of oxygen exposure was approximately 322 +/- 147 minutes. There were no differences between the oxygen and room-air groups in the umbilical cord venous partial pressure of oxygen (mean difference, 1.1 mm Hg; 95% confidence interval, -1.0 to 3.2; P=.318) or the proportion of participants with category II fetal heart rate tracings (81.4% vs 78.6%; relative risk, 1.04; 95% confidence interval, 0.88-1.22; P=.672). However, the umbilical cord arterial pH was significantly lower in the oxygen group than in the room-air group (median, 7.23; interquartile range, 7.20-7.27 vs median 7.27; interquartile range, 7.20-7.30; P=.005). CONCLUSION: Maternal long-duration high-concentration oxygen administration during labor did not affect either the umbilical cord venous partial pressure of oxygen or fetal heart rate pattern distribution but resulted in a deterioration of the umbilical cord arterial pH at birth.

Androgen deprivation therapy (ADT) is a gold standard treatment for advanced PCa. However, most patients eventually develop the castration-resistant prostate cancer (CRPC) that progresses rapidly despite ongoing systemic androgen deprivation. While early studies indicated that high physiological doses of androgens might suppress rather than promote PCa cell growth in some selective CRPC patients, the exact mechanism of this opposite effect remains unclear. Here we found that Enzalutamide-resistant (EnzR) CRPC cells can be suppressed by the high-dose-androgen (dihydrotestosterone, DHT). Mechanism dissection suggested that a high-dose-DHT can suppress the circular RNA-BCL2 (circRNA-BCL2) expression via transcriptional regulation of its host gene BCL2. The suppressed circRNA-BCL2 can then alter the expression of miRNA-198 to modulate the AMBRA1 expression via direct binding to the 3'UTR of AMBRA1 mRNA. The consequences of high-dose-DHT suppressed circRNA-BCL2/miRNA-198/AMBRA1 signaling likely result in induction of the autophagic cell death to suppress the EnzR CRPC cell growth. Preclinical studies using in vivo xenograft mouse models also demonstrated that AMBRA1-shRNA to suppress the autophagic cell death can weaken the effect of high-dose-DHT on EnzR CRPC tumors. Together, these in vitro and in vivo data provide new insights for understanding the mechanisms underlying high-dose-DHT suppression of the EnzR CRPC cell growth, supporting a potential therapy using high-dose-androgens to suppress CRPC progression in the future.

目的:观察八珍汤加味联合放疗对中晚期宫颈癌患者细胞免疫水平及营养状态的影响.方法:将92例中晚期宫颈癌患者随机分为对照组和观察组,各46例.对照组采用放疗,观察组采用放疗联合加味八珍汤,连续服用6周.观察对比两组治疗前后的中医证候积分、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6),免疫球蛋白IgA、IgG、IgM,免疫细胞CD4+、CD8+、CD4+/CD8+水平以及血红蛋白(Hb)、白蛋白(ALB)、前白蛋白(PA)变化,评估两组临床总有效率、营养状态达标率和不良反应发生率.结果:两组治疗前的中医证候积分、CD4+、CD8+、CD4+/CD8+、IgA、IgG、IgM、Hb、ALB、PA水平比较差异均无统计学意义(均P>0.05).观察组治疗后的细胞免疫指标CD4+、CD4+/CD8+、体液免疫指标IgA、IgG、IgM和营养状态指标Hb、ALB、PA水平均高于对照组,差异有统计学意义(均P<0.05).观察组治疗后的中医症候积分、CD8+水平均较对照组降低,差异有统计学意义(均P<0.05).观察组总有效率为95.65％高于对照组的58.70％(P<0.05);营养状况合格率为91.30％高于对照组的80.44％(P<0.05);两组不良反应发生率比较,差异无统计学意义(均P>0.05).结论:采用八珍汤加味联合放疗治疗中晚期宫颈癌,可改善免疫功能指标,增强患者免疫力,提高Hb、ALB、PA水平,改善营养状态和临床总有效率.

BACKGROUND:Adenomyosis refers to a pathological damage resulting from local and diffuse lesions in endometrium, caused by invasive endometrial gland and its mesenchyme. Our study aimed to reveal miR-183's role in the development of adenomyosis. METHODS:In this context, we separated the epithelium cells of patients with adenomyosis, detected matrix metalloprotein 9 (MMP-9) expression by immunohistochemistry (IHC), and then treated them separately with miR-183 over-expression and miR-183 interference. The effects on epithelium cells funcions with transfections were evaluated by cell viability, migration and invasion assays. Based on that observation, we conducted double luciferase reporting system detection to the screening and the validation of miR-183's target genes. RESULTS:It turned out that miR-183 over-expression had a powerful repressive effect on epithelium's viability, migration and invasion; however, the interference in miR-183 contributed a reverse result. Our dual-luciferase assay confirmed that MMP-9 is a target gene of miR-183 in endometrial tissue. Immunohistochemical staining reconfirmed that the fact that MMP-9 was highly expressed in the endometrial tissue of adenomyosis. Importantly, we found that the miR-183 expression in the endometrial tissue of adenomyosis was distinctly lower than normal endometrium. CONCLUSION:In general, we are the first to disclose the distinction of miR-183 and MMP-9 expressions in adenomyosis after we elucidated miR-183's role in epithelium's viability, migration and invasion .

目的 探讨胎母输血综合征(FMH)的发病机制、临床特点、诊断与治疗方案.方法 对解放军总医院第六医学中心2008年1月至2020年12月收治的13例FMH患者的临床资料进行回顾性分析及相关文献复习.结果(1)13例患者中有3例妊娠期糖尿病,2例合并轻度贫血,1例亚临床甲减,1例高龄孕妇在妊娠晚期合并羊水过多;4例因高龄做过羊膜腔穿刺,1例行无创DNA产前筛查;(2)6例患者胎动频次减少,5例患者胎动力量减弱,其余2例无异常主诉;(3)13例患者胎心监护均为异常:1例正弦曲线,3例无反应,6例晚期减速,3例变异减速.所有患者血清中的甲胎蛋白(A FP)均升高;(4)13例新生儿均贫血:3例新生儿为重度贫血,最终放弃抢救,新生儿死亡率为23.08％(3/13);10例新生儿为轻、中度贫血,经抗贫血或输血等治疗后转归良好.结论 FMH发病隐匿,无特异性临床表现,新生儿预后差.临床工作中应对可疑病例仔细问诊,结合胎心监护、多普勒超声及A FP检查,可做到早期诊断,提高围产儿的预后.

Objective: Preimplantation Genetic Testing - Aneuploidy (PGT-A) for embryo selection has undergone significant advancements in the last 2 decades and yet many studies still fail to demonstrate any clinical benefits over traditional embryo morphology selection (Mo-S). To understand this conundrum, we performed a multicenter clinical study of PGT-A patients, where Mo-S and euploid selection (Eu-S) outcomes were directly compared. Method: All suitable blastocysts were biopsied and analyzed for chromosome copy number. Outcomes (positive beta hCG, implantation, ongoing pregnancy, and live birth rates) for Eu-S were compared to Mo-S using single embryo transfers. Results: Compared to Eu-S embryos, Mo-S embryos resulted in significant reduction of outcomes for positive beta hCG (p = 0.0005), implantation (p = 0.0008), ongoing pregnancy (p = 0.0046), livebirth (p = 0.0112), babies per transfer (p = 0.0112), and babies per embryo transferred (p = 0.0112). Morphology selection resulted in patients of all age groups having non-euploid embryos chosen for transfer. Post-hoc evaluation of individual clinic performances showed variable transfer outcomes that could potentially confound the true benefits of PGT-A. Conclusion: Embryo chromosome status is central to improved embryo transfer outcomes and sole reliance on current morphology-based selection practices, without Eu-S, will always compromise outcomes. Often overlooked but a major effector of successful PGT-A outcomes are individual clinic performances.

目的 探究妊娠晚期合并心功能衰竭患者的分娩期处理策略.方法 回顾性分析2007年12月至2018年12月间我院心脏外科与妇产科联合治疗的23例妊娠晚期合并心功能衰竭(心功能Ⅲ～Ⅳ级)患者的临床资料,探讨心功能衰竭孕妇的分娩处理及临床急救策略.结果 23例孕妇均以全身麻醉剖宫产术作为结束妊娠的方式.17例患者单纯行剖宫产术,顺利度过围产期,另择期行心脏手术或进行内科治疗.6例患者在剖宫产过程中出现心脏停搏或心室颤动,紧急插管,行外周型体外膜肺氧合转机并辅助循环:2例患者转机2h内心脏恢复自主跳动;1例患者转机6h心脏出现自主跳动;3例患者虽有自主心跳但室颤反复发作,其中2例剖宫产术后第3天分别行心脏瓣膜置换和室间隔封堵,1例严重心肌病患者体外膜肺撤机困难,转机12 d后死于肺部感染.结论 心脏病患者妊娠晚期发生心功能衰竭是导致孕产妇死亡的主要原因之一,加强孕期保健及多学科合作,及时终止妊娠,可改善患者的预后.

目的 探讨丙酮酸脱氢酶复合物E2亚基(PDC-E2)内硫辛酰区域(ILD)环化后在原发性胆汁性胆管炎(PBC)患者抗线粒体抗体(AMA)检测中的抗原性变化及临床意义.方法 利用质粒pTWIN1提供的内含肽自我剪切技术,构建、表达和纯化环状ILD(cILD),采用Western blot法鉴定线状ILD和cILD的抗原性;选择PBC患者316例、类风湿性关节炎(RA)患者34例及健康对照36例,分别以PDC-E2、线状ILD及cILD为包被抗原,ELISA法比较检测受试者血清中AMA的阳性率.结果 Western blot结果显示,重组获得的线状ILD和cILD蛋白均具有与AMA结合的免疫原性;分别用PDC-E2、线状ILD及cILD为包被抗原,ELISA法检测AMA阳性率分别为93.04％ (294/316)、91.46％ (289/316)和85.76％(271/316),其中,cILD为包被抗原检测AMA阳性率低于PDC-E2检测阳性率(85.76％vs93.04％,P=0.003)和线状ILD检测阳性率(85.76％ vs 91.46％,P=0.024);PDC-E2和线状ILD检测AMA的阳性率差异无统计学意义(93.04％ vs 91.46％,P=0.744).PDC-E2和线状ILD检测AMA均呈阴性的21例PBC患者中,cILD检测出38.10％ (8/21)的AMA阳性率.结论 cILD对AMA的抗原性虽有所下降,但在传统检测AMA呈阴性的PBC患者临床诊断中,可能潜在新的临床实用价值.

目的 探讨难治性产后出血围产期急症子宫切除术的原因、时机、术后并发症及孕产妇结局.方法 回顾性分析2016年7月至2019年12月本院收治的因难治性产后出血行急诊子宫切除术19例患者的临床资料.结果 19例患者平均年龄(33.4±4.2)岁,平均孕次(2.8±12)次,平均孕周(36.4±44)周.子宫切除术原因为胎盘因素7例,宫缩乏力为5例,宫缩乏力合并边缘性胎盘产前出血2例,软产道损伤形成大血肿2例,羊水栓塞2例,晚期产后出血合并感染1例.子宫切除术前平均出血量(4 697.2±1 868.5)ml,平均血红蛋白(56.3±21.7) g/L.除1例羊水栓塞患者死亡外,18例患者痊愈出院.结论 围产期急症子宫切除是治疗难治性产后出血的重要措施,胎盘异常及宫缩乏力是两大主要原因.

目的 分析男性不育症患者的染色体核型及Y染色体微缺失情况.方法 回顾性分析2018年9月-2020年12月于解放军总医院第六医学中心生殖中心就诊的550例男性不育症患者的临床检验资料,其中无精子症187例,少精子症363例(极严重90例、严重101例、轻中度172例).同时纳入健康男性246名作为对照.对所有男性进行染色体核型及Y染色体微缺失检测分析精子浓度与染色体核型、Y染色体微缺失的关系.对其中156例无精子症、70例极严重少精子症、75例严重少精子症及75例正常男性进行性激素(促黄体生成素、卵泡刺激素、催乳素、睾酮)检测,进而比较不同精子浓度及有无Y染色体微缺失人群的性激素水平.结果 550例男性不育症患者及246名健康男性中共有62例染色体核型异常或染色体正常多态性,其中染色体异常28例,染色体正常多态性34例.550例不育症患者中共检出Y染色体微缺失38例,其中无精子症17例、极严重少精子症18例、严重少精子症2例、轻中度少精子症1例,AZFc区缺失为最常见类型.无精子症、极严重少精子症及严重少精子症患者中,Y染色体微缺失者的卵泡刺激素水平高于无Y染色体微缺失者(P=0.032).结论 男性不育症患者可发生染色体异常,且Y染色体微缺失发生率较高;遗传学检查有助于明确是否患有遗传学疾病,从而选择合适的治疗方法及辅助生殖方式.

目的 探究体外受精胚胎行植入前遗传学非整倍体检测(PGT?A)是否有助于改善高龄和复发性流产(RPL)患者的临床结局.方法 本研究回顾性分析总结2017年1月至2019年6月来解放军总医院第六医学中心妇产科辅助生殖中心行PGT?A和未行PGT?A的相关病例.行PGT?A的116例患者共132个单囊胚冻融移植周期,其中高龄(≥35岁)患者74例,共完成85个冻融移植周期;RPL患者66例,共完成78个冻融移植周期.未行PGT?A的202例患者共216个单囊胚冻融移植周期,其中高龄(≥35岁)患者119例,共完成124个冻融移植周期;PRL患者23例,共完成32个冻融移植周期.根据女方年龄分为年龄≥38岁,年龄35～37岁,年龄<35岁3组.结果 在年龄≥38岁组中,PGT?A可显著提高患者的临床妊娠率(P<0.01)和活产率(P<0.01),流产率有所下降但无统计学差异(P>0.05).PGT?A并不能改善35～37岁和年龄<35岁组的临床结局.在RPL患者中,行PGT?A可降低早期流产率(P<0.05)和生化妊娠损失率(P<0.05),临床妊娠率和活产率有所升高但差异无统计学意义(P>0??05).结论 辅助生殖技术中,PGT?A有改善年龄大于38岁高龄患者妊娠结局的潜力,并能够降低RPL患者的早期流产率,减少妊娠损失.

Objective This study assesses the prevalence and characteristics of dens invaginatus (DI) in a sample of Chinese population by using cone-beam computed tomography (CBCT) images. Methodology A retrospective study was conducted by using the CBCT images of 1,004 patients. The whole dentition was evaluated for the presence and characteristics of DI. Periapical pathosis status and bilateral feature of affected teeth were also examined. Results Dens invaginatus was observed in 85 of 1,004 subjects, with a prevalence of 8.47% and a tooth prevalence of 0.494%. Males presented a higher prevalence of DI than females (p = .011). Type I DI was the most commonly observed type of dens invaginatus, followed by type II and type III. The structure form of different types of DI was various. Overall 2.48% of the patients with type I DI, 5.88% of the patients with type II DI, 100% of the patients with type III DI had apical pathosis. Bilateral DI was found in 63.53% of the affected patients. Conclusions This study indicates that DI was not rare, and clinicians should be aware of its existence. CBCT examination can provide an accurate representation of dental anatomy and should be incorporated into early diagnosis and treatment planning for teeth with DI.

目的:观察不同孕前体质量指数(BMI)对妊娠期糖尿病(GDM)孕妇糖代谢和妊娠结局的影响.方法:对709例GDM孕妇进行回顾性分析,根据孕前BMI指数将GDM孕妇分为4组,低BMI组(BMI＜18.5 kg/m2)57例、正常 BMI 组(18.5 kg/m2≤BMI＜24.0 kg/m2)460例、超重组(24.0 kg/m2≤BMI＜28.0 kg/m2)142例和肥胖组(BMI≥28.0 kg/m2)50例,比较4组孕期糖代谢相关指标及妊娠不良结局.结果:①超重组和肥胖组的糖化血红蛋白(HbA1c)、OGTT空腹血糖(OGTT-FPG)、餐后1小时血糖(OGTT-1 h)、空腹胰岛素(FIN)、稳态模式胰岛素抵抗指数(HOMA-IR)、胰岛β细胞分泌指数(HOMA-β)水平明显高于低BMI组和正常BMI组(P＜0.05).②超重组和肥胖组的孕期增重明显低于低BMI组和正常BMI组(P＜0.05),但其孕期过度增重比例明显高于低BMI组和正常BMI组(P＜0.05).而超重组的新生儿出生体质量显著高于低BMI组和正常BMI组(P＜0.05).③4组GDM孕妇剖宫产、产后出血(PPH)、妊娠期高血压疾病(HDP)、大于胎龄儿(LGA)发生的比例差异均有统计学意义(P＜0.05),且与孕前BMI呈正相关关系(r＞0,P＜0.05).结论:孕前BMI的异常增加了 GDM孕妇孕期糖代谢紊乱和特定不良产科预后的发生.

目的:探讨妊娠期糖尿病(GDM)妇女孕早期甲状腺功能指标与孕中期胰岛素抵抗水平及胰岛β细胞功能相关性.方法:收集676例GDM女性,分为未合并胰岛素抵抗GDM组(NIR-GDM,397例)和合并胰岛素抵抗GDM组(IR-GDM,279例),早孕期检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、抗甲状腺球蛋白抗体(TgAb)及甲状腺过氧化物酶抗体(TpoAb).妊娠24～28周行75g OGTT及检测空腹胰岛素(FIns).分析孕早期甲状腺功能指标与孕中期胰岛素抵抗水平及胰岛β细胞功能的关系.结果:IR-GDM组的孕早期体质量指数(BMI)、FPG、HbA1c及孕中期胰岛β细胞功能指数(HOMA-β)均高于NIR-GDM组(P<0.05).Spearman相关分析显示,胰岛素抵抗指数(HOMA-IR)与T3、FT3、TSH呈正相关(P<0.05),与FT4呈负相关(P<0.001);HO-MA-β与T3、FT3/FT4呈正相关(P<0.05),与FT4呈负相关(P<0.001).多元线性回归分析显示,年龄、孕早期BMI、T3及FT4是HOMA-IR、HOMA-β的影响因素.结论:孕早期甲状腺功能对GDM妇女孕中期胰岛素抵抗水平和胰岛β细胞功能产生重要影响.