OBJECTIVE:To investigate the relationship between angiotensin Ⅰ-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and the genetic risks for polycystic ovary syndrome (PCOS) and to evaluate the impact of ACE I/D genotypes on clinical, hormonal, metabolic and oxidative stress parameters in patients with PCOS.METHODS:This was a retrospective case-control study involving a total of 1 020 PCOS patients and 825 female controls who visited the outpatient clinic of the Department of Reproductive Endocrinology, West China Second Hospital of Sichuan University between 2006 and 2019. The ages of the subjects ranged between 17 and 44. The ACE I/D genotypes were determined by polymerase chain reaction (PCR) and gel electrophoresis. 667 PCOS patients and 527 controls were selected for an analysis of their genotypes and the hormonal, metabolic and oxidative stress parameters.RESULTS:The genotype distributions of the ACE I/D single nucleotide polymorphism was in Hardy-Weinberg equilibrium in both the PCOS group and the control group (all P>0.05), which was representative of the population. There were no statistically significant differences in genotype and allele frequencies between the PCOS and the control groups ( P>0.05). After adjusting for both age and body mass index (BMI), there was no statistically significant difference in clinical characteristics among all genotypes in either the PCOS group or the control group. In the PCOS group, compared with the II genotype subgroup, the ID genotype subgroup had lower luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio, while the DD genotype subgroup had higher homeostatic model assessment of insulin resistance (HOMA-IR) and malondialdehyde (MDA) levels. Compared with the ID genotype subgroup, the DD genotype subgroup had lower serum sex hormone binding globulin (SHBG) level, but higher total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels ( P<0.05). In the control group, II genotype subgroup had a higher level of total oxidant status (TOS) than that of the DD genotype subgroup.CONCLUSION:ACE I/D genetic polymorphism is not associated with risks for PCOS. The I/D variation of ACE gene may be related to insulin resistance, dyslipidaemia, hyperandrogenemia and oxidative stress in PCOS patients.

复发性流产(recuuent sponteneous abortion,RSA)是妇产科临床难题,其诊治是研究热点.虽然研究及检测技术不断进步,仍有近一半的病例不能明确原因.感染因素与流产有一定关系,能够造成菌血症或病毒血症的严重感染均可引起偶发性流产(sporadic abortion),但与RSA的关系相对较少.生殖道各种病原体感染及TORCH与RSA虽有一定关系,但不一定存在因果关系.细菌性阴道病(bacterial vaginosis,BV)是晚期流产和早产的高危因素,但与早期流产的关系尚不明朗.由于感染性疾病的高发生率及治疗的可及性,应引起足够的重视,减少由此因素再次给患者带来的伤害,本文就其处理进行阐述,重在对后续妊娠的保护.

目的:探讨9 ～13岁快速青春发育期女性外阴阴道感染特征.方法:回顾性分析390例2015年7月至2018年6月在四川大学华西第二医院就诊的9 ～13岁快速青春发育期女性外阴阴道感染状况,并按年龄分为9岁、10岁、1 1岁、12岁、13岁5个年龄组.采用X2检验分析其假丝酵母菌外阴阴道病(VVC)总发生率、细菌性阴道病(BV)发生率、炎症反应率、优势菌异常率,及不同年龄组上述四者的差异.结果:研究对象中BV发生率、VVC总发生率、炎症反应率、优势菌异常率分别为:37.95％、19.24％、16.15％、8.21％,BV发生率显著高于VVC总发生率,差异有统计学意义(P＜0.05).VVC中白假丝酵母菌和非白假丝酵母菌阳性检出率分别为:15.39％、3.85％,两者比较差异有统计学意义(P＜0.05).5组间经两两比较,发现不同年龄组BV发生率和炎症反应率差异无统计学意义(P＞0.05);9岁组VVC总发生率(7.56％)显著低于其他年龄段组(分别为20.75％、29.51％、25.42％、24.44％),差异有统计学意义(P＜0.05);10岁组优势菌异常率(12.26％)显著高于13岁组(4.44％),差异有统计学意义(P＜0.05).乳杆菌数量1+/油镜随年龄增长呈下降趋势,而乳杆菌3+ ～4+/油镜随年龄增长呈上升趋势.结论:快速青春发育期女性外阴阴道感染好发BV和VVC,且BV比VVC更易感,而VVC中以白假丝酵母菌感染为主;9岁女性VVC总发生率最低;10岁女性优势菌异常率高于13岁,波动尚无规律.乳杆菌数量随年龄增长呈规律性增加.

排卵障碍性异常子宫出血是常见的生殖内分泌疾病,其临床表现复杂多变,病程长且个体差异较大,基层医院普遍存在诊疗困难和管理不规范的现象.为提高基层医院对排卵障碍性异常子宫出血的诊疗效率,西部地区妇科内分泌专家联合提出此针对基层医院妇科门诊的初级诊疗规范及转诊建议,从诊断要点、止血和周期调整策略、辅助治疗等方面梳理出排卵障碍性异常子宫出血的基本诊疗流程,尤其对低龄青春期和绝经过渡期患者提出了个体化的治疗建议,同时拟定出双向转诊的基本原则,以期作为西部地区基层医院规范化初级诊疗和双向转诊的重要参考.

目的 了解女性生殖内分泌继续医学教育学员的基本情况及其对专业知识的需求,探讨适合成人的继续教育模式.方法 选取2011-2016年参与四川大学华西第二医院“生殖内分泌痰病规范诊治”国家级继续医学教育培训的326名学员作为研究对象,采用问卷调查方式了解学员对该继续医学教育项目的评价.结果 99.39％的学员完全或基本认为授课内容是生殖内分泌学科最新发展、最新成果或亟待解决的问题;92.94％的学员表示只知道部分授课内容;98.46％的学员对教师授课情况表示满意;45.71％的学员对教学计划及自编教材表示很满意;55.83％的学员认为学习收获很大,主要体现在临床诊治能力(41.41％)和理论水平(28.53％)的提高.结论 针对学员基本情况,应优化课程设置,课程内容不宜过多,其难度应以基础为主、前沿为辅,且要结合具体病例、采用多种方式相结合的形式进行授课.

多囊卵巢综合征合并不孕症患者散布于各级医疗机构,其临床表现呈现高度异质性,诊治面临重重困难.多囊卵巢综合征合并不孕症的助孕治疗在预处理、促排卵、黄体支持、孕期管理及并发症防治方面仍存在诸多争议,基层医院初级诊疗缺乏规范性.本文通过综合分析归纳近年来发表的相关文献,并总结区域专家的临床经验共识,以期成为基层医疗机构规范化初级诊疗和双向转诊的重要参考内容.

目的 评价在空腹和餐后条件下健康绝经期女性单次口服阿那曲唑受试制剂与参比制剂的生物等效性.方法 采用开放、随机、双周期、自身交叉试验设计,各纳入24例健康绝经后期女性志愿者,分别在空腹和餐后服用1 mg阿那曲唑受试制剂和参比制剂后,采用高效液相色谱-串联质谱(LC-MS/MS)法测定阿那曲唑的血药浓度.使用Phoenix WinNonlin 6.3版中的非房室模型分析,计算药代动力学参数并评价两种阿那曲唑空腹及餐后服用的生物等效性.结果 在空腹和餐后条件下健康绝经后期女性志愿者口服受试制剂和参比制剂后的主要药代动力学参数(AUCo-∞、AUC0-tCmax)的几何均数比值90％置信区间均在80.00％～125.00％的范围内.餐后给药与空腹给药相比,tmax延长,Cmax降低,而AUC和t1/2基本一致.结论 在空腹和餐后条件下阿那曲唑受试制剂与参比制剂具有生物等效性.

Objective: To evaluate the efficacy, bleeding profile and safety of low-dose levonorgestrel-releasing intrauterine system (LNG-IUS 8) in Chinese healthy women of childbearing age. Methods: A multi-center, open-label, single-arm clinical trial conducted at 16 centres in China enrolled 773 healthy women of childbearing age (mean age 31.6 years old, range 18 to 40 years old) , who demanded contraception, from April 2006 to June 2013. All women placed LNG-IUS 8 for 3 years and then been followed up at 3, 6, 9, 12, 18, 24, 30, 36 months. The efficacy variables including pregnancy rate and expulsion rate were analyzed using life table, while observing adverse events (AE) to evaluate the safety. The bleeding profile happened during the study was assessed using 90-day reference intervals (World Health Organization criteria) . Results: Eight pregnancies occurred among 773 women, resulting in a overall Pearl index of 0.42 per 100 women years. The 3-year cumulative pregnancy rate was 0.37 per 100 women years and the 3-year cumulative expulsion rate was 1.99 per 100 women years. The number of women with bleeding/spotting reduced and the bleeding/spotting days declined over time. Totally 219 AE were reported related to LNG-IUS 8 placements. The most common AE were vaginal bleeding (8.2%, 63/773) and the ovarian cyst (6.2%, 52/773) . LNG-IUS 8 had an improving effect on dysmenorrhea that the percentage of women with dysmenorrhea as well as the days of dysmenorrhea decreased over time. The percentage of women satisfied or very satisfied with LNG-IUS 8 was 87.2% (622/713) . Conclusion: LNG-IUS 8 is highly effective and safe for Chinese healthy women of childbearing age.

The uncertain safety and effectiveness of test drugs and medical instruments in clinical trials might pose risks to the subjects, and pregnancy events emerging in clinical trials will increase the risks. At present, most of pregnancy events are recorded and reported as an adverse event, but due to their particularity, it is inappropriate to record and handle them with other adverse events. Pregnancy event closely is related to the interests of the sub-jects and the risk it might face, besides, it is also related to the interest and risk of their spouses and offspring. In order to handle pregnancy event, this paper elaborated responsibilities of researchers, sponsors and subjects accord-ing to the purpose of trials in three aspects, including experiment design, informed consent, and test expand, so that the interest of the subjects could get better protection.

阴道是女性下生殖道的重要部分,承担着经血排出、性生活、分娩的重任,在临床上也是妇产科检查、部分手术的入路.阴道内存在着众多微生物,是人体微生态系统的重要部分,阴道内的微生物菌群、内分泌调节系统、阴道解剖结构和局部免疫系统共同组成了女性阴道微生态系统.阴道微生物菌群种类繁多,相互共生和拮抗,受到体内、外各种因素的影响,参与形成结构复杂的微生态系统.正常的阴道微生物菌群以乳杆菌为优势菌,可伴有少量其他杂菌共生.功能正常的阴道微生态系统是维护女性生殖健康的重要门户.然而阴道是一个开放的管道,直接与外界相通,易受各种内、外因素的影响,导致阴道微生态失衡,进而可能引起感染等疾病[1].其中内因主要是与女性不同生殖内分泌状态下的性激素水平有密切关系.

Polycystic ovary syndrome (PCOS ) is one of common female endocrine metabolic disorders ,characterized by oligo-ovulation and/or anovulation (OA ) , clinical and/or biochemical hyperandrogenism (HA ) and polycystic ovaries (PCO ) . The clinical manifestations of PCOS are highly complex and heterogeneous . Aside from menstrual and reproductive dysfunctions , PCOS is often associated with long-term health risks ,such as obesity ,insulin resistance (IR) ,dyslipidaemia , increased oxidative stress (OS ) , subclinical chronic inflammation , elevated risks of metabolic syndrome ,type 2 diabetes ,and future cardiovascular diseases . HA plays an important role in the pathogenesis of PCOS .Increased OS is not only an important factor leading to atherosclerosis and cardiovascular diseases ,but also potentially related to the occurrence and progress of PCOS .Recent studies have shown that there was a strong association between HA and increased OS in PCOS .In this article ,we focus on the sources of OS molecules and the antioxidant defense mechanisms ,the OS status in PCOS and its relationship with HA ,the interaction and its impossible mechanisms between HA and OS ,and the current status and future prospects of OS prevention and treatment in patients with PCOS .

Polycystic ovarian syndrome(PCOS) is one of the most common endocrine metabolic disorders. It is often associated with obesity, insulin resistance, dyslipidemia, increased oxidative stress, systemic low-grade chronic inflammation, elevated prevalences of metabolic syndrome and type 2 diabetes, and potentially increased the risks of atherosclerosis and cardiovascular disease. Paraoxonase (PON) 1 is one of high-density lipoprotein(HDL)-associated antioxidant enzymes. It possesses antioxidant, anti-inflammatory and anti-atherogenic properties. In this article, we will summarize the research progress on the genetic variations, enzyme activities and physiological functions of PON1 and their relationship to PCOS. Key words: Polycystic ovarian syndrome; Paraoxonase 1; Oxidative stress; Genetic polymorphism

目的 探讨半水合雌二醇贴片(商品名松奇)治疗围绝经期综合征的临床疗效.方法 2009年12月至2011年6月应用多中心前瞻性研究方法在全国4家医院共纳入124例绝经后妇女,给予松奇贴片24周治疗,有子宫者加用孕激素,于治疗第4、12、24周检测血清雌二醇(E2)水平,并进行Kupperman评分以评价更年期症状,同时记录乳房胀痛、阴道流血和皮肤过敏等不良反应.结果 (1)生殖激素水平:E2在治疗前为(61.09±50.33)pmol/L,治疗4周时上升为(198.85±307.29)pmol/L(P=-0.0003);治疗12周时进一步上升至(258.87±220.40)pmol/L(P=-0.0001);治疗24周时为(219.86±190.21)pmol/L(P=-0.0000).(2) Kupperman评分:治疗前Kupperman评分为23.91±8.11,治疗4周后,Kupperman评分较基线时大大下降,为9.05±7.56 (P=-0.0000);治疗12周时,Kupperman评分又进一步下降,为5.73±5.42 (P=-0.0000);治疗24周时,Kupperman评分基本维持不变,为5.76±7.03 (P=-0.0000).(3)研究期间未观察到严重副反应.结论 松奇贴片单独使用或加用口服微粒化孕酮或地屈孕酮能安全有效缓解围绝经期综合征.

OBJECTIVE:To study the relationship between the lactonase activities and status of paraoxonase 1 (PON1) and its association with the PON1 genetic polymorphisms in women with polycystic ovarian syndrome (PCOS).DESIGN:A case-control study.METHODS:A total of 455 PCOS patients and 441 control women were included in this study. The lactonase activities and concentrations of PON1 were assayed using 5-thiobutyl butyrolactone (TBBL) and 7-O-diethylphosphoryl-3-cyano-4-methyl-7-hydroxycoumarin (DEPCyMC) respectively. A normalized lactonase activity (NLA) was estimated based on the ratio of TBBLase:DEPCyMCase activity. The PON1 genotypes, serum malondialdehyde (MDA) levels and total antioxidant capacity were analyzed.RESULTS:The lactonase activities and levels of PON1 were higher in PCOS patients than in the control women. However, the NLA did not significantly differ between groups. The -108C→T variation of the PON1 gene showed decreased lactonase activities and levels of PON1 in a genotype-dependent manner (CC>CT>TT); the 192Q→R variation of the PON1 gene showed increased PON1 lactonase activities and NLA; and the 55L→M variation of the PON1 gene showed decreased lactonase activities and levels of PON1 but an increased NLA. A multivariable regression analysis showed that the -108C/T, 192Q/R, and 55L/M variations of the PON1 gene, serum apolipoprotein A1, and MDA levels were significant predictors of PON1 lactonase activity, PON1 level, and NLA.CONCLUSIONS:The serum lactonase activities and concentrations of PON1 are increased in PCOS patients. The increased oxidative stress and the -108C/T, 192Q/R, and 55L/M genetic polymorphisms of PON1 may be associated with these changes.

1 病历摘要 患者,26岁,因剖宫产术后3月,恶心、呕吐、乏力2月,加重7天,于2006年2月14日入院.患者于2005年10月28日于当地医院行剖宫产术,术后发生产后大出血,出血量约2000 ml,予输血治疗后好转出院.2月余前因恶心、呕吐、乏力再次于当地医院就诊,诊断为"浅表性胃炎",予输液、止吐等对症支持治疗后好转出院.

<正>目前超声检测与内分泌检测和功能试验一样被用于评估卵巢储备功能。预测卵巢储备功能的超声指标有多种,最常用的指标有基础窦卵泡数(antral follicle count,AFC)、卵巢体积(ovarian volume)、卵巢基质血流1盆腔超声检查与卵巢功能超声检查是目前妇产科医生观察卵巢解剖及功能的重要手段。卵泡监测与辅助生殖技术中多使用经阴道超声,它避免了经腹检查时声束经腹壁产生的

OBJECTIVEThe aim of this study was to investigate the relationship between 192Q/R and 55L/M polymorphisms of paraoxonase 1 (PON1) gene and polycystic ovarian syndrome (PCOS) in Chinese women.DESIGNA case-control study.METHODSA total of 1113 subjects (610 patients with PCOS and 503 control women) from a population of Chinese Han nationality in Chengdu area were included in this study. PON1 genotypes were studied using PCR and restriction fragment length polymorphism analysis. Clinical and metabolic parameters were analyzed.RESULTSThe frequencies of PON1 192RR genotype and R allele were significantly higher in patients with PCOS than in control women (44.6 vs 36.4%, 0.667 vs 0.610 respectively). The 192RR genotype remained a significant predictor for PCOS (odds ratio (RR/QR)(+)(QQ): 1.656, 95% confidence interval: 1.156-2.371) in prognostic models including age, body mass index, insulin resistance index, triglyceride, HDL, and LDL as covariates. Compared with patients with QQ genotype, patients with RR or QR genotype had significantly higher waist circumference and fasting insulin and triglyceride levels, patients with RR genotype had significantly higher waist-to-hip ratio, and patients with QR genotype had significantly higher homeostasis model assessment of insulin resistance. Such relationships were not detected in the control women. No significant differences were found in the frequencies of PON1 55L/M genotype and allele between PCOS and control groups.CONCLUSIONSThe 192Q/R, but not 55L/M, polymorphism in PON1 gene is associated with the risk of PCOS in south-west Chinese women.

Polycystic ovarian syndrome(PCOS) is one of the most common endocrine diseases in women of reproductive age.Lower HDL-cholesterol is prominent lipid abnormality,furthermore,elevated levels of TG and LDL-cholesterol may also occur in PCOS.Hyperandrogenism,insulin resistance and anovulation are correlated with dyslipidemia in PCOS.So,controlling weight,improving dyslipidemia and preventing long-term complications play important roles in PCOS treatment.

BACKGROUND Conjugated equine estrogen (CEE) treatment, a hormone replacement therapy, is restricted for use in perimenopausal and postmenopausal women because of security issues. Consequently, traditional Chinese herbal medicine has become an alternative choice for the patients with contraindications to hormone replacement therapy. OBJECTIVE To evaluate the efficacy and safety of Kuntai Capsule and CEE in treating cognitive function disorder and mental symptoms of early postmenopausal women. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS A total of 57 cases of early postmenopausal women from Outpatient Department of West China Women and Children's Hospital were included. The subjects were randomly divided into two groups: Kuntai group with 28 cases and CEE group with 29 cases. The patients in Kuntai group received 6 g Kuntai capsules three times a day. The patients in CEE group received CEE 0.3 mg and 0.6 mg alternately once a day (average dose of 0.45 mg/d). The patients with intact uterus in CEE group were treated with 2 mg medroxyprogesterone acetate daily. MAIN OUTCOME MEASURES In one-year treatment course, the recognition function and mental symptoms of each patient were investigated by questionnaires of Mini-Mental State Examination (MMSE), Kupperman, and quality of life (QOL) every three months. Both intention-to-treat (ITT) and per-protocol set (PPS) analyses were done. RESULTS The MMSE, Kupperman index and QOL scores at each time point were improved as compared with those before treatment (P<0.05), however there were no statistical differences between the two groups (P>0.05). The MMSE scores showed a tendency to escalate while mental symptoms investigated by Kupperman index and QOL scale showed a downtrend. No severe adverse effects occurred in the study phase and no statistical difference in incidence of side effects between the two groups was found except for vaginal bleeding. The incidence rates of vaginal bleeding in CEE and Kuntai groups were 39.3% and 11.1% respectively (P=0.029). CONCLUSION Both Kuntai Capsule and CEE may contribute to maintain the cognitive function and ameliorate mental symptoms of early postmenopausal women.

Objective To investigate the feasibility and effectiveness of public selective course of Reproductive Health for non-medical speciality university student to improving their reproductive health knowledge. Methods The survey was conducted before and after having the Reproductive Health course by using the self-designed questionnaire Reproductive Health Knowledge Investigation anonymously among the university students who had taken the Reproductive Health course during the spring semester of 2009 in Sichuan University. The questionnaire included the following items: concept of reproductive health, common diseases of male and female reproductive system, contraceptive methods, birth defects, clinical manifestations of sexually transmitted diseases and their prevention, etc. Meanwhile, general information of the students such as gender, specialty, approach to obtain the related knowledge and reasons for choosing the course were also collected. Informed consent was obtained from all participants. Results There were 155 questionnaires were collected (before and after the end of Reproductive Health course, 58 and 97 questionnaires were collected, respectively) with the rate of return was 77.5%. ①69.0% of the university students who selected the course was male and 71.7% of them were from science and engineering specialties. ②Internet (68.04%) and magazines/books(73.2%) were the main approaches for university students to obtain the reproductive health knowledge before attending the class. ③ After having the course, the university students understood the knowledge much better than they did before the course and the results had statistic difference(P=0.000). Conclusion Making Reproductive Health an selective course for the non-medical university students is an effective and acceptable way to give them more correct and systematic reproductive health knowledge, which can also elevate their integral quality. Key words: university student; reproductive health; education