目的 探讨外周血自然杀伤(natural killer,NK)细胞比例差异与反复种植失败(repeated implantation failure,RIF)的关联性,外周血NK细胞比例对RIF患者胚胎移植后妊娠结局的预测价值. 方法 选取2016年6月至2018年6月在桂林医学院附属医院生殖医学中心行休外受精胚胎移植(in vitro fertilization and embryo transplantation,IVF-ET)的RIF患者(77例)与非RIF患者(59例),用流式细胞仪检测两组患者月经期外周血CD3-CD16+ CD56+ (NK)细胞群占淋巴细胞的比例.本研究通过回顾性分析,根据妊娠结局再将RIF患者分为妊娠失败组(49例)和妊娠组(28例),比较RIF患者妊娠失败组与妊娠组间月经期及胚胎种植日NK细胞比例差异. 结果 月经期RIF组较非RIF组患者外周血NK细胞比例增高,差异有统计学意义[(20.78±7.64)％ vs (16.37±6.59)％,P＜0.05];RIF患者妊娠失败组与妊娠组月经期、胚胎移植日NK细胞比例相比较无明显差异[(21.16±8.15)％ vs(20.37±8.48)％,(19.69±8.15)％ vs (19.03 ±4.36)％,P＞0.05]. 结论 RIF的发生与月经期外周血NK细胞比例的异常增高具有一定的相关性,然而月经期及胚胎移植日NK比例水平对RIF患者胚胎种植结局无明显预测价值.

目的 比较肥胖及非肥胖型多囊卵巢综合征患者冷冻胚胎移植后妊娠期风险及结局. 方法 纳入2015年1月至2017年12月在桂林医学院附属医院生殖中心行体外受精-胚胎移植助孕并行冻融胚胎移植的多囊卵巢综合征患者265例,根据体重指数分为肥胖组(体重指数≥25 kg/m2)患者80例,非肥胖组(体重指数＜ 25 kg/m2)患者185例. 结果 1.肥胖组多囊卵巢综合征患者基础E2水平明显高于非肥胖组[(59.72±14.36) pg/mLvs(35.41±9.28) pg/mL,P＜0.05],ET日内膜厚度、ET胚胎数目、生化妊娠率、异位妊娠率和流产率两组均无明显差异(P＞0.05).2.非肥胖组临床妊娠率(36.22％ vs 23.75％)和活产率(35.14％ vs 22.50％)均高于肥胖组(P＜0.05).3.妊娠期高血压、早产、胎膜早破及胎盘早剥发生率两组均无明显差异(P＞0.05).4.肥胖组多囊卵巢综合征患者与非肥胖型PCOS患者相比孕期体重增加[(17.98±3.15) kgvs(12.46±2.36) kg],妊娠合并糖尿病(33.33％vs6.15％),剖宫产率(55.56％vs26.15％)均高于非肥胖组,差异有统计学意义(P＜0.05).5.肥胖组新生儿出生体重明显高于非肥胖组[(3884±415)gvs(3027±436)g,P＜0.05];而胎龄、身长、性别比、新生儿畸形等两组均无明显差异(P＞0.05). 结论 肥胖型多囊卵巢综合征患者冷冻胚胎移植临床妊娠率、活产率均降低,妊娠期糖尿病发病率增加,剖宫产率增加,新生儿体重也增加,临床上应重视肥胖多囊卵巢综合征患者管理,以降低妊娠期合并症和改善产科、新生儿结局.

卵胞浆内单精子注射(ICSI)是现阶段解决不孕不育问题的有效治疗措施,2次或者2次以上ICSI仍然不能受精则被认为是反复ICSI受精失败,此类患者约占ICSI周期总量的1％ ～3％.ICSI受精失败大致分为精子因素和卵子激活因素,除此之外,也与受精过程、体外环境以及不孕等其他因素有关.笔者就精子因素对受精的影响进行综述.

目的 探讨非多囊卵巢综合征患者在体外受精控制性促排卵过程中预测卵巢高反应的临床指标. 方法 对96例非多囊卵巢综合征的不孕症患者进行回顾性分析,分为卵巢高反应组(43例)及卵巢正常反应组(53例).两组患者均接受黄体期长方案体外受精治疗.比较两组患者的一般情况、促性腺激素用量、控制性促排卵中的临床指标,探讨其与卵巢高反应的关系. 结果 与正常反应组相比,高反应组体重指数、促性腺激素起始量及促性腺激素总量明显降低,而基础促黄体生成素/促卵泡生成素、控制性促排卵第4日雌二醇、控制性促排卵第6日E2、控制性促排卵第7日E2、控制性促排卵第7日直径≥8 mm卵泡个数、控制性促排卵第7日直径≥10 mm卵泡个数、人绒毛膜促性腺激素注射日E2、获卵数、受精数及正常受精数均明显升高;相关性分析发现,控制性促排卵第4日E2、控制性促排卵第6日E2、控制性促排卵第7日E2、控制性促排卵第7日直径≥8 mm卵泡个数、控制性促排卵第7日直径≥10 mm卵泡个数与人体绒膜促性腺激素日E2和获卵数呈正相关;受试者工作特征曲线示:控制性促排卵第4日E2、控制性促排卵第6日E2、控制性促排卵第7日E2、控制性促排卵第7日直径≥8 mm卵泡个数、控制性促排卵第7日直径≥10 mm卵泡个数与卵巢高反应均具有相关性,最佳临界点分别为:664.10 pmol/L、3 732 pmol/L、7 348 pmol/L、14.5个和10.5个. 结论 控制性促排卵过程中第4日E2、第6日E2、第7日E2、第7日直径≥8 mm卵泡个数、第7日直径≥10 mm卵泡个数在一定程度上可预测卵巢高反应.

目的:评价、分析子宫内膜异位症伴不孕患者自然妊娠率与腹腔镜术后联合药物治疗及内异症生育指数(EFI)评分的相关性.方法:回顾性分析182例腹腔镜手术治疗的子宫内膜异位症伴不孕患者临床资料并计算EFI.患者术后分三组:GnRH-a组为腹腔镜术后联合亮丙瑞林针治疗;孕三烯酮组为腹腔镜术后联合孕三烯酮胶囊治疗;对照组仅单纯腹腔镜手术治疗,术后采用药物.分析术后自然妊娠率与是否联合药物治疗及EFI的相关性.结果:术后1年GnRH-a组总体妊娠率为38.98％ (23/59);孕三烯酮组总体妊娠率为30.77％(20/65);期待组总体妊娠率为31.03％(18/58).组间比较差异无统计学意义(P＞0.05).EFI评分0～4分术后妊娠率为8.82％;EFI评分5～7分术后妊娠率为29.4％;EFI评分8～10分术后妊娠率为60.9％,术后EFI评分越高,其妊娠率越高,差异有统计学意义(P＜0.05).结论:子宫内膜异位症合并不孕患者腹腔镜术后联合或醋酸亮丙瑞林针和孕三烯酮胶囊不能提高术后妊娠率.子宫内膜异位症r-AFS分期不能预测患者生育结局,而生育指数(EFI)评分具有较好的预测性.

OBJECTIVES:To investigate the expression of miR-429 and its target gene heat shock protein A4L (HSPA4L) in sperms from asthenospermia patients.METHODS:Twenty semen samples from healthy and fertile adults and 20 semen samples from asthenospermia patients were collected,and normal sperm parameters were defined according to World Health Organization criteria.The expression levels of miR-429 and HSPA4L mRNA were determined by qRT-PCR,and the bioinformatics tool (Targetscan) was used to predict the target of miR-429.Luciferase reporter assay and transfection study were performed to confirm target gene of miR-429.The expression levels of HSPA4L mRNA and protein were further determined by qRT-CPR and Western blot,respectively.RESULTS:The motility and viability of sperms from asthenospermia patients were lower than that in control group,and miR-429 was up-regulated in sperms from asthenospermia patients.Bioinformatics analysis revealed that HSPA4L was a target of miR-429.Luciferase reporter assay and transfection study further confirmed that miR-429 suppresses the expressions of HSPA4L mRNA and protein via directly targeting HSPA4L 3'UTR.Results from clinical samples also demonstrated that HSPA4L mRNA and protein were down-regulated in sperms from asthenospermia patients and the expression level of miR-429 was inversely correlated with the expression level of HSPA4L mRNA (r=-0.725, P<0.05).CONCLUSIONS:miR-429 is up-regulated in sperms from asthenospermia patients,and it may modulate the motility and viability of sperms via suppressing the expression of HSPA4L.

Objective To investigate the clinical efficacy on dysfunctional uterine bleeding during peri -menopausal period of levonorgestrel intrauterine system.Method Seventy -two cases of patients who were diagnosed dysfunctional uterine bleeding during peri -menopausal period were placed with mirenas during menstrual period.The menstrual conditions,endometrium width, hemoglobin,blood lipid,sex hormone level changes of these cases were measured before and after the insertion of mirena.Results After the insertion of mirena the menstrual quantity decreases,thinning of the endometrium,hemoglobin was increased.These were statistically significant(P <0.05).But little changes had happened in blood lipid,sex hormone.These were not stastically significant(P >0.05).Conclusion Levonorgestrel intrauterine system can efficiently reduce the amount of blood and correct a-nemia but does not affect blood lipid metabolism and ovarian function.

目的：比较三种方法治疗青春期功能失调性子宫出血（青春期功血）的止血效果。方法：选择2009年1月—2014年12月收治的148例青春期功血患者，随机分三组，A 组（苯甲酸雌二醇针组）58例，B 组（戊酸雌二醇片组）42例，C 组（妈富隆组）48例，观察三组临床止血疗效。结果：三种方法治疗青春期功血均有效，C 组和 A 组效果相当，有效率均高于 B 组，控制出血时间和完全止血时间均短于 B 组，疗效好，但妈富隆使用方便且不良反应少，治疗青春期功血有优势。结论：口服妈富隆片治疗青春期功血较口服或肌肉注射雌激素制剂疗效明显，使用方便，且不良反应少，治疗青春期功血有优势。

Doctor of medicine/doctor of philosophy (MD/PhD) program ,which aims to train the elite of medical profession , is the highest levels of medical education .Based on the training models in Shanghai Jiaotong University , the Chinese University of Hong Kong and Taiwan University ,we reviewed the differences and characteristics of MD /PhD training model among Mainland ,Hong Kong and Taiwan .And special emphasis was focused on admission ,objective ,courses , scholarship and degree requirements .In the context of medical education internationalization ,this comparison will provide useful information for educational reform in MD /PhD training .

目的 探讨多囊卵巢综合征(PCOS)患者依从性与临床治疗结局的关系. 方法 选取2011年11月至2013年11月在本院生殖医学中心就诊的225例肥胖型PCOS合并不孕患者,对其进行减重健康宣教、监测指导同房,并对体重指数(BMI)、性激素、助孕方案及妊娠结局等临床资料进行分析比较. 结果 除去随访丢失病例外,共有118例纳入本研究,根据患者治疗的依从性判定分为依从性好/差两组.依从性好患者临床妊娠率显著高于依从性差组(41.0％ vs.11.4％,P＜0.01);依从性好组BMI下降幅度显著高于依从性差组[(1.96±1.18)kg/m2 vs.(0.57±1.00)kg/m2,P＜0.01],而黄体生成素(LH)、睾酮(T)、黄体生成素/卵泡刺激素(LH/FSH)等性激素变化,两组无显著性差异(P＞0.05). 结论 肥胖型P-COS合并不孕患者治疗依从性影响患者减重效果及妊娠结局.

Objective:To investigate the intrauterine insemination(IUI)impact factors of pregnancy and improve the success rate of pregnancy.Methods:Comparison of IUI treatment 69couples a total of 139cycle clinical data,analyzed the relationship of ovulation period,the number of ovulation and different adaptation disease and pregnancy rate.Results:(1)The pregnancy rate of natural cycle 17.2%,was higher than that of ovulation induction cycle with 12.5%,which was significant differences(P0.05).(2)The pregnancy rate of ovulation 2was higher than that of ovulation 1.(3)Pregnancy rate was 16.2%for 44cases of semen abnormalities,10.3%for 18cases of the ovulation obstacle,which was statistical difference(P0.05).Conclusion:IUI is best fit for male infertility,and the high success rate of pregnancy.IUI is the best fit for male factor infertility,and natural cycle pregnancy rate is highter.

<正>目前我国大陆高等医学教育根据修业年限和要求可分为医学学士、医学硕士和医学博士3个阶段。根据1983年卫生部、教育部联合制定的《关于培养临床医学硕士、博士学位研究生的试行办法》要求,我国的医学研究生培养分为两种类型:即专业学位型(又称临床型)和科学学位型(又称科研型)。

Objective:To investigate the effective method of interrupting the vertical transmission of the hepatitis B virus(HBV)from father to infant.Methods:120couples with serum HBV-DNA positive in men and anti-HBs positive in women were selected as subjects and they were divided into GroupⅠand GroupⅡ based on whether they were injected with hepatitis B specific immunoglobulin.Women in Group Ⅰ were injected with hepatitis B specific immunoglobulin 200IU monthly since the 28th week duration of pregnancy;and women in GroupⅡ weren't injected with hepatitis B specific immunoglobulin.Another 60couples with serum HBV-DNA positive in men and without hepatitis virus infection in women were selected as the control group(GroupⅢ).The anti-HBs and HBV-DNA of the neonates in the 3groups were all determined after birth by testing the serum of cord blood.Results:Positive rate of anti-HBs of infants in GroupⅠ,GroupⅡand GroupⅢ were55.00%,51.67%,0.00%respectively.The positive rate of anti-HBs in GroupⅠandⅡ was obviously higher than that in the control group(P0.05).23.33%of neonates in Group I and 25.00% of neonates in GroupⅡand 43.33%of neonates in GroupⅢ were infected by HBV.The infection rate of HBV in the observation group was significantly lower than that in control group(P0.05). Conclusions:Successful passive immunity of women whose husbands were with HBV-DNA positive before pregnancy is an important way to block the paternal-fetal transmission of HBV.

Objective: To detect the expressions of estrogen receptor(ER) and progesterone receptor(PR) in endometrial polyps and discuss their pathogenesis mechanism in endometrial polyps.Methods: Prospective study was performed on 40 patients.All the patients had received the transcervical resection of polyps,and their endometrial polyps and adjacent normal endometrial tissues had been removed in the operations.ER and PR expression levels in endometrial polyps and adjacent normal endometrial tissues were detected by immunohistochemical assay(IHCA).Results: The expression of ER was higher whereas the expression of PR was lower in endometrial polyps than those in the adjacent normal endometrial tissues(P0.05).Conclusion: The abnormal expressions of ER and PR might be involved in the pathogenesis of endometrial polyps.

Objective:To explore the pathogenesis of endometrial polyps,through detecting the expression of insulin-like growth factor I(IGF-I)and insulin-like growth factor-I receptor(IGF-IR)in endometrial polyps. Methods:Prospective study was performed for the 40 patients who had transcervical resection of polyps were rolled.Endometrial polyp and pieces of endometrium had been removed in all operations.Routine pathological diagnosis to all specimens and immunohistochemical staining studies for IGF-I,IGF-IR in endometrial polyp and endometrium. Results:Expressions of IGF-I were significantly increased in endometrial polyp group(P0.05),expressions of IGF-I R in the two groups show no significant difference(P0.05),the expression of IGF-I was negatively correlated with that of IGF-IR(P0.05). Conclusion:High expression of IGF-I may be involved in pathogenesis of endometrial polyps.

目的:分析输卵管妊娠保守性手术治疗后患者的生育状况,探讨其影响因素.方法:对2002年1月～2006年1月在桂林医学院附属医院接受保守性手术治疗的318例输卵管妊娠患者,采用Logistic回归分析盆腔炎等因素对生育状况的影响.结果:318例患者术后宫内妊娠185例,占58.2%;再次输卵管妊娠72例,占22.6%;术后仍不孕61例,占19.2%.多因素Logistic回归分析术后宫内妊娠率与盆腔炎、既往异位妊娠史、不孕、既往盆腔手术史、流产次数、盆腔粘连情况、患侧输卵管破裂与否、术前血β-HCG水平相关(P＜0.05).结论:积极预防盆腔病变是改善输卵管妊娠术后生育状况的重要手段.

Objective:To access the values of glycosylated hemoglobin A1c(HBA1c)test in treating women with recurrent vulvovaginal candidiasis(RVVC).Methods:65 non-diabetes women with diagnosed RVVC were selected as subjects in the experimental group,and 60 candidia-negative patients,some of whom were healty without infections and the others contracted recurrent bacterial vaginosis(BV)were put in the control group.All patients were underwent fasting and 2 hours' post-prandial blood glucose test,and the body mass index were counted.58 RVVC patients whose HBA1c concentration ≥5% were randomly divided into 2 experimental groups:group I and group II.Patients in group I were treated with anti-fungus combined with glucose metabolism modfication,while patients in group II received the therapy with only anti-fungus.within 1 year after being cured,the relapse rate of all the subjects were statistically analyzed.Results:the proportion of patients with HBA1c≥5% in two experimental groups was significantly higher than that in the control group(89.23% vs 8.33%,P0.001).Women with RVVC had a significantly higher mean level in HBA1c,fasting glucose and body mass index than those in the control group,they were(5.49±0.41)% vs(4.36±0.66)%,(5.77±0.50)mmol/L vs(5.27±0.41)mmol/L and(22.87±4.47)kg/m2 vs(20.47±1.62)kg/m2 respectively,(P0.001).The 2 hours' post-prandial blood glucose level of the patients in the experimental group and the control group was(6.21±1.04)mmol/L and(5.86±0.95)mmol/L,and there was no obvious difference between the two groups(P0.05).The recurrence rate of those RVVC patients whose HBA1c was higher than or equal to 5% within 1 year after being cured in group I and group II was 6.90%(2/29)and 48.28%(14/29)respectively.There was significantly difference between the two experimental groups(P0.01).Conclusions:The plasma concentration of glycosylated HBA1c should be assayed,and HBA1c≥5% is suggested to be a critical point to limit sugar diet for patients,which will be of values to guide the clinical treatment in women with RVVC.

Objective:To explore the effect and safety of laparoscope in treatment of endometrial polyps.Methods: 80 cases of endometrial polyps were carried out the laparoscopic operation and followed up for one year.Results: The operation time were(13.88±1.07)min,bleeding volume were(15.25±2.17)ml while the endometrial polyps were excised by laparoscope.No complications were found during and after the operation.There were no relaps in these patients.Conclusion:The laparoscopic operation for endometrial polyps has the small invasion,less bleeding and low relaps rate.It is the best choice for the treatment of endometrial polyps.

Objective: To investigate the relationship between the expression of PTEN and carcinogenesis,development and prognosis of endometrial carcinoma.Methods: The expression of PTEN in the specimens of 50 cases with endometrial carcinoma,20 cases with atypical hyperplasia and 20 cases with normal endometrium were determined by immunohistochemistry.Results: The postitive expression rate of PTEN in cases with endometrial carcinoma,atypical hyperplasia and normal endometrium were 100%,80% and 46%,respectively.There was significant difference between carcinoma and normal endometrium(P0.05).The expression of PTEN was correlated with surgical stage and myometrial invasion(P0.05).Conclusion: The expression of PTEN may play a role in the carcinogenesis and development of endometrial carcinoma.PTEN might be an useful prognostic marker in endometrial carcinoma.

目的 对桂林地区建卡的孕妇进行α地中海贫血筛查,对双方都是α地中海贫血携带者的夫妇进行产前基因诊断,以杜绝重型α地中海贫血患儿的出生.方法 在孕16～24周时对高危孕妇行羊膜腔穿刺术获得胎儿细胞,运用多重PCR法确定胎儿α地中海贫血基因型.结果 1 574例建卡孕妇中,179例为α地中海贫血携带者,其中8例其配偶亦为α地中海贫血携带者,对这8对高危夫妇进行了产前诊断,其中Hb Bart's胎儿水肿综合征(基因型:-SEA/-SEA)3例,α地中海贫血携带者(基因型αα/-SEA、αα/-α3.7)3例,正常(αα/αα)2例.结论 运用分子生物学技术可快速、准确地确定α地中海贫血的基因型和进行产前诊断,达到优生优育的目的.