目的 染色体微阵列分析对一例同源性染色体罗伯逊易位单亲二倍体发生机制的探讨.方法 针对一例妻子反复自然流产的男性,其染色体核型为45,XY,rob(22;22)(q10;q10),为同源性染色体罗伯逊易位.外周血进行微阵列分析,检测是否为单亲二倍体.结果 该男性染色体微阵列分析提示为22号染色体单亲二倍体.结论 对于同源性染色体罗伯逊易位的携带者,增加了单亲二倍体的风险.而染色体微阵列为单亲二倍体的检测提供高效的技术平台.

目的 调查复发性流产(RSA)患者的焦虑、抑郁情况并分析其与社会支持的相关性,为采取相应干预措施提供依据. 方法 选取2017年1月至2018年6月在深圳市妇幼保健院就诊的RSA患者300例为RSA组、同期已婚育龄妇女130例为对照组,采用一般情况调查表、焦虑自评量表(SAS)、抑郁自评量表(SDS)及社会支持评定量表(SSRS)对患者进行调查,对结果进行SPSS统计及Pearson相关性分析. 结果 RSA组和对照组分别发放调查问卷300份和130份,分别收回有效问卷286份(95.33％)和122份(93.85％).RSA组的SAS、SDS得分分别为(44.698 4±7.801 1)及(47.878 8±10.393 1),均高于对照组的(41.260 2±7.284 3)及(45.406 5±9.738 5),差异有统计学意义(P＜0.05).RSA组65例(22.73％)发生焦虑,显著高于对照组13例(10.66％,P＜0.05);84例(29.37％)发生抑郁,略高于对照组30例(24.59％,P=0.088).RSA组SSRS总分(40.68±7.86)显著低于对照组(45.64±6.78,P=0.04).Pearson相关性分析结果显示,RSA组的SAS、SDS得分与其SSRS总分均呈显著负相关(P＜0.05). 结论 RSA患者焦虑、抑郁水平较高,而且与社会支持呈密切负相关.关注RSA人群的心理问题,积极的心理干预及心理支持显得尤为重要;重视患者家属的宣教,构建完善的社会支持系统,促进患者康复.

神经皮肤黑色素沉着序列征(NCM)是一种罕见的皮肤、软脑膜、蛛网膜黑色素细胞错构病,主要表现为外胚层的组织器官受累,中胚层、内胚层的组织也有不同程度受累[1].该病在1861年首次被ROKI-TANSKY描述[2],国内也有报道[3],现将本院收治的1例报道如下.

目的 探讨槲皮素(Que)对紧密连接蛋白6(CLDN6)的表达及子宫内膜异位症细胞增殖、迁移和侵袭的影响,并初步分析其可能作用机制.方法 选取40例子宫内膜异位症患者为研究对象,活检时切取异位子宫内膜组织,分离与培养异位子宫内膜间质细胞(EcSCs).以不同浓度(0、12.5、25、50 μmol/L) Que干预EcSCs,通过MTT法检测不同浓度Que对EcSCs细胞增殖的影响,Western blot检测增殖细胞核抗原(PCNA)与CLDN6蛋白表达.应用Tran-swell迁移及侵袭实验检测细胞迁移及侵袭情况.EcSCs中转染阴性对照(si-control)、si-CLDN6,并分析沉默CLDN6表达对EcSCs细胞增殖、迁移和侵袭的影响.后续实验分为4组:NC组、Que组、Que+ pcDNA组、Que+ pcDNA-CLDN6组,MTT与Transwell迁移及侵袭实验分别检测各组EcSCs增殖、迁移及侵袭能力,Western blot法检测PCNA、基质金属蛋白酶-2(MMP-2)、MMP-9、上皮-间质转化(EMT)及整合素连接激酶(ILK)信号通路相关蛋白表达.结果 Que干预后EcSCs增殖、迁移及侵袭能力受到抑制,且呈剂量依赖性,可抑制CLDN6、PCNA、MMP-2、MMP-9蛋白表达;沉默CLDN6表达后能够抑制EcSCs增殖、迁移及侵袭能力;Que可抑制神经型钙黏蛋白(N-cadherin)、波形蛋白(Vimentin)、ILK、磷酸化蛋白激酶B(p-AKT)蛋白表达,促进E-cadherin蛋白表达,但转染CLDN6过表达载体后可逆转Que对EcSCs增殖、迁移及侵袭的抑制作用.结论 Que可通过抑制CLDN6表达而抑制子宫内膜异位症细胞增殖、迁移及侵袭,其可能作用机制为抑制ILK信号通路活化及EMT转换进程.

目的 分析不明原因复发性流产(URSA)患者及人工流产患者流产蜕膜组织CD3-CD (56+16)+NK细胞数量的变化,探讨早孕期蜕膜组织CD3 CD (56+16)+NK细胞与稽留流产的关系.方法 选取不明原因复发性流产患者20例作为URSA组,人工流产患者10例作为人工流产组,流式细胞仪检测两组的蜕膜组织CD3-CD (56+16)+NK细胞数量.结果 URSA组患者的流产蜕膜组织CD3-CD (56+16)+NK细胞比例显著少于人工流产组患者(P＜0.05).结论 早孕期蜕膜组织CD3-CD (56+16)+NK细胞比例失调可能是孕早期胚胎丢失的病因之一.

目的:探讨宫腔灌注人绒毛膜促性腺激素(HCG)共培养自体外周血单个核细胞(PBMCs)治疗对原因不明复发性流产(URSA)患者妊娠结局的影响并对其作用机制进行初步研究.方法:选取46例URSA患者,随机选取23例为试验组(另23例作为对照组),进行HCG共培养自体PBMCs宫腔灌注治疗,随访妊娠结局,对其中21例患者宫腔灌注治疗前后取少许子宫内膜组织检测IL-2、IL-10、INF-γ、单核细胞趋化蛋白-1,(MCP-1)、T细胞活化后表达和分泌的调节蛋白(RANTES)的变化.结果:试验组23例患者中9例持续妊娠,妊娠率达到39.13％,显著高于对照组的13.04％(P<0.05).持续妊娠者宫腔灌注治疗后子宫内膜IL-2、INF-γ、MCP-1的质量浓度较治疗前下降,而IL-10、RANTES的质量浓度较治疗前升高,差异均有统计学意义(P<0.05);未持续妊娠者治疗前后子宫内膜IL-2、IL-10、INF-γ、MCP-1、RANTES的质量浓度无明显变化(P>0.05).结论:HCG共培养自体PBMCs宫腔灌注治疗能够改善URSA患者的妊娠结局.

目的:探讨人绒毛膜促性腺激素(hCG)共培养自体外周血单个核细胞(PBMCs)宫腔灌注对反复种植失败(RIF)患者妊娠结局的影响及宫腔内相关细胞因子的改变.方法:选择在我院生殖中心行冻融胚胎移植(FET)的RIF患者65例,接受移植前自体PBMCs宫腔灌注治疗及取宫腔液的患者28例为实验组,于排卵前抽取自体外周血分离PBMCs,与hCG混合共培养于移植前3天行宫腔灌注;另外37例为对照组,两组患者行常规FET,随访妊娠结局;Bio-plex悬液芯片分析系统检测灌注前、后宫腔液相关细胞因子.结果:两组患者年龄、不孕年限、体质量指数(BMI)、基础性激素水平(FSH、LH、E2)、既往移植周期数、平均内膜厚度和移植胚胎数比较,差异均无统计学意义(P＞0.05).实验组与对照组比较临床妊娠率(42.86％ vs 16.22％)和胚胎种植率(25.86％ vs 9.21％),实验组均高于对照组,差异有统计学意义(P＜0.05).宫腔灌注后宫腔液中Eotaxin表达水平升高,而INF-γ表达降低,差异有统计学意义(P＜0.05).结论:宫腔灌注hCG共培养PBMCs是一项针对RIF患者安全有效的治疗方法,可以提高此类患者FET周期的临床妊娠率,改善RIF患者宫腔局部细胞因子的表达,促进胚胎种植.

目的 探讨绒毛膜促性腺激素(HCG)培养自体淋巴细胞宫腔灌注治疗对原因不明复发性流产(URSA)的临床效果及相关作用机制.方法 选取46例URSA患者,随机分为观察组和对照组各23例.对照组常规治疗;观察组于排卵前4～5d分离外周血淋巴细胞,与HCG混合共培养24h后分离淋巴细胞,并于排卵前3d宫腔灌注,共2个月经周期.嘱患者备孕,半年后比较两组妊娠结局(持续妊娠、再次流产、未妊娠).治疗1个周期后,比较观察组不同妊娠结局者治疗后子宫内膜组织中白细胞介素2(IL-2)、肿瘤坏死因子α(TNF-α)、IL-8、T细胞活化后表达和分泌的调节蛋白(RANTES)水平.结果 观察组持续妊娠9例、再次流产3例、未妊娠11例,临床妊娠率为39.13％;对照组持续妊娠2例、再次流产6例、未妊娠15例,临床妊娠率8.69％,两组临床妊娠率比较P＜0.05.与治疗前相比,观察组中持续妊娠者治疗后IL-2、TNF-α水平下降,IL-8、RANETS水平升高(P均＜0.05);再次流产与未妊娠者相关细胞因子水平治疗前后水平比较差异无统计学意义(P均＞0.05).结论 HCG培养自体淋巴细胞宫腔灌注治疗可通过调节子宫内膜局部相关细胞因子的水平,促使免疫耐受的形成,从而改善URSA患者的妊娠结局.

目的:探讨临床治疗原因不明复发性流产的理想方式,为原因不明复发性流产的相关实践提供借鉴和参考.方法:选取2015年1月至2016年12月期间产科收治的原因不明复发性流产患者172例,按照治疗情况把患者分成两组,观察组患者111例(进行主动免疫治疗),对照组患者61例(进行安胎治疗).结果:(1)观察组患者111例,妊娠96例,20周以前流产16例,妊娠成功80例,妊娠成功率为72.07％;对照组患者61例,妊娠50例,20周以前流产37例,妊娠成功13例,妊娠成功率为21.31％,观察组妊娠成功率高于对照组(P<0.05);(2)组间妊娠结局比较差异无统计学意义(P>0.05).结论:采用主动免疫疗法治疗原因不明复发性流产的临床效果较好.

Vascular endothelial growth factor (VEGF) is an important angiogenic factor.Vascular endothelial growth factor receptors (VEGFR) belong to the tyrosine kinase receptors,including VEGFR-1,VEGFR-2,VEGFR-3.VEGFR-1 and VEGFR-2 are high-affinity VEGF receptors,which VEGF mainly binding to and plays roles through them.In recent years there are increasing studies on the soluble fms-like tyrosine kinase receptor-1 (sFlt-1),which is a soluble form of transmembrane receptor VEGFR-1.SFit-1 binding competitively to VEGF with VEGF membrane receptors that blocks the signal transduction pathway could inhibit the proangiogenic role of VEGF.The pathogenesis of unexplained recurrent spontaneous abortion (URSA) has not been clear so far.Studies have shown that USRA has an inseparable relationship with angiogenesis disorder.VEGF and its receptor are important regulators of angiogenesis,which is closely related to the occurrence of URSA.Recent studies have shown that the dysfunction or lack of expression of VEGF,VEGFR-1,VEGFR-2,or increased expression of sFlt-1 may lead to the occurrence of URSA.

目的 分析孕早期免疫治疗不明原因复发性流产(URSA)效果.方法 89例URSA患者,采用早期淋巴细胞免疫治疗,观察患者疗效.结果 治疗3次后封闭抗体(BA)阳性患者妊娠成功率为87.64％(78/89),显著高于治疗后阴性患者的54.55％(6/11),差异有统计学意义(P<0.05);治疗6次后阳性患者妊娠成功率为96.63％(86/89),显著高于治疗3次后妊娠成率,差异有统计学意义(P<0.05).结论 为不明原因复发性流产患者提供孕早期免疫治疗的方法,有效的提高患者妊娠率,治疗效果较好.

目的 探讨主动免疫联合孕激素治疗对原因不明复发性流产患者抗核抗体的影响.方法 选取我院收治的126例复发性流产患者,随机分为观察组和对照组各63例.对照组给予主动免疫治疗,观察组在此基础上采用孕激素治疗.比较两组患者的妊娠成功率及IL-6、IL-10、TNF-α、IFN-γ 水平.结果 治疗后,两组的抗核抗体阴性者妊娠成功率均高于阳性者(P<0.05).治疗前,两组患者的IL-6、IL-10、TNF-α、IFN-γ 水平比较均无统计学差异(P>0.05);治疗后,两组的IL-6、IL-10水平均显著升高,TNF-α、IFN-γ 水平均显著降低,观察组的IL-6、IL-10、TNF-α、IFN-γ 水平均明显优于对照组,差异均有统计学意义(P<0.05).结论 主动免疫联合孕激素治疗可有效提高抗核抗体阳性不明原因复发性流产患者的妊娠成功率.

Objective To investigate the efficacy and safety of combination of different drug on adolescent polycystic ovary syndrome (PCOS).Methods Sixty adolescent patients with polycystic ovary syndrome from January 2015 to January 2017 were randomly divided into group A,B and C,with 20 ca-ses in each group.Patients in group A were given estrogen (Diane-35 )treatment,patients in group B were given metformin plus Diane-35 treatment,patients in group C were given combined regimen (Diane-35 +metformin and pioglitazone)treatment.The clinical efficacy,adverse reactions,fasting in-sulin (FIN)and fasting blood sugar (FBS)levels and serum sex hormones were compared cross the three groups.Results The total effective rate in group A,B,C was 75. 00%,60. 00%,95. 00%,respec-tively,there was a significant difference among the three groups (P＜0. 05 );though the total incidence of adverse reactions in group A and B was higher than that in group C,there was no significant difference among the three groups (P＞0. 05 ).After treatment,levels of FIN and FBS of patients in the three groups all were improved,and group C got most remarkable improvement,and there were significant differences in FIN and FBS level among the three groups (all P＜0. 05 ).After treatment,the plasma sex hormone (testosterone,luteinizing hormone,follicle-producing hormone,luteinizing hormone/follicle-producing hormone)levels in group C were all decreased,and were lower than those of another two groups (P＜0. 05 ).Conclusions Diane 35 ,metformin and pioglitazone combination method has excel-lent clinical curative effect and certain degree of security.At the same time,it can improve insulin resist-ance and androgen levels in patients,which is worth promoting.

目的 研究促卵泡生成激素受体基因多态性与卵巢过度刺激综合征的相关性,为临床防治提供参考依据.方法 选取2015年1月-2016年12月期间在我院接受体外受精(卵胞浆内单精子显微注射ICSI)治疗的120例不孕症患者作为研究对象,所有患者均在就诊当天采集血液标本,并对血液样本实施FSHR基因680位点、307位点分型鉴定.结果 本研究120例患者中出现28例OHSS,在OHSS组、非OHSS组中患者的680位点基因型GA、AA、GG与等位基因频率A、G分布比较,差异有统计学意义(P＜0.05);在OHSS组、非OHSS组中患者的307位点基因型GA、AA、GG与等位基因频率A、G分布比较,差异无统计学意义(P＞0.05).结论 卵巢过度刺激综合征发生可能与促卵泡生成激素受体基因的Asn680Ser位点有关,而关于Thr307Ala位点与卵巢过度刺激综合征发生的相关性有待进一步研究.

Objective To reveal the mechanism of lymphocyte immunization therapy (LIT) by analyzing CD3+ CD (56+ 16) + NK T cell ratio in peripheral blood and endometrium of unexplained recurrent spontaneous abortion (URSA) patients after LIT.Methods Twenty URSA patients treated in the hospital from April to September in 2016 were selected,flow cytometry was used to analyze CD3+CD (56+ 16) +NK T cell ratio in peripheral blood and endometrium before and after LIT.Results CD3+CD (56+16) + NK T cell ratio in endometrium after LIT increased significantly (P＜0.05);CD3+CD (56+ 16) + NK T cell ratio in peripheral blood after LIT didn't change significantly (P ＞0.05);there was no correlation between CD3 + CD (56 + 16) + NK T cell ratio in peripheral blood and endometrium.Conclusion The change of CD3+CD (56+16) +NK T cell ratio after LIT mainly occurs in endometrium;LIT can increase CD3+CD (56+16)+NK T cell ratio in endometrium by changing the balance of cytokines in endometrium,which may be one of the mechanisms of LIT;CD3 + CD (56+ 16) + NK T cell ratio in endometrium is a potential index for evaluating LIT effect.

Objective To explore the factors influencing the effectiveness of post-abortion care services in Shenzhen and to provide basis for improving women' s post-abortion care services and increasing its utilization .Methods Fourteen different health care institutions were randomly selected in Shenzhen from 2014 to 2015 .The data of 2881 women receiving abortion were collected and the influencing factors were analyzed by logistic regression analysis .Results Among the subjects , 72 (2 .5％ ) had recurrent abortion ,and 52 (1 .8％ ) had abortion complications .The rate of consistent use of contraception and satisfaction of PAC service were 96 .3％ and 99 .7％ , respectively .Old age , Shenzhen local household registration , the higher level of education , being married ,the higher the value of contraceptive knowledge awareness ,and postoperative contraception were relative factors for PAC service (OR value was 0 .64 ,0 .58 ,2 .28 ,0 .44 ,4 .44 and 1 .44 ,respectively ,all P < 0 .05) .Conclusion PAC intervention can improve the awareness rate of contraceptive knowledge ,improve the efficiency of contraceptive measures and reduce the incidence of recurrent abortion and medical affairs .

Objective:To study the relationship between the gene polymorphism of methylene tetrahydrofolate reductase (MTHFR) and the unexplained recurrent spontaneous abortion (URSA).Methods:83 patients with unexplained recurrent spontaneous abortion (the URSA group) and 90 normal women of reproductive age (the control group) were recruited.Fluorescence quantitative PCR was used to detect the MTHFR gene C677T,A1298C single nucleotide polymorphisms (SNP).The frequency distribution of genotype and allele was compared,and the risk of different genotypes to URSA was evaluated.Results:The distribution of MTHFR genotypes in both groups was consistent with the Hardy-Weinberg balance.There were significant differences in the frequencies of C677T genotype and alleles between the URSA group and the control group (P＜0.05).There were no significant differences in the frequencies of A1298C genotype and alleles between the two groups (P＞0.05).The frequency of homozygous genotype in the URSA group was higher than that in the control group (30.1％ vs.13.3％,x2=7.237,P=0.007).The risk of URSA in those patients with TT homozygous genotype was 3.289 times higher than that in the patients with CC homozygous genotype (OR=3.289,95％CI:1.342-8.063).Conclusions:The gene polymorphism of MTHFR C677T site is a risk factor of URSA,and the TT homozygoous genotype increases the risk of URSA.

目的 分析血浆D-二聚体水平与血小板聚集功能在反复自然流产患者中的诊断价值.方法 102例反复自然流产患者为观察组,对其血浆D-二聚体水平与血小板聚集功能进行检测,另选取100例健康妇女(无自然流产史、非孕期)为对照组,对两组进行对比.结果 观察组患者血浆D-二聚体中位值为0.27 mg/L,对照组中位值为0.15 mg/L,比较差异具有统计学意义(P<0.05).两组二磷酸腺苷(ADP)诱导血小板凝集率异常比较差异无统计学意义(P>0.05),D-二聚体水平异常比较差异具有统计学意义(P<0.01).结论 反复自然流产患者血小板处于高凝状态,对血浆D-二聚体水平与血小板聚集功能进行检测,具有临床诊断价值,为疾病的进一步治疗提供一定参考价值.

目的 探讨反复自然流产(recurrent spontaneous abortion,RSA)患者血清中孕激素诱导阻断因子(PIBF)及Th1/Th2型细胞因子的异常表达及其临床意义.方法 采用酶联免疫吸附法检测94例RSA患者血清中PIBF和Th1(IL-2、TNF-α、IFN-γ)/Th2(IL-10)型细胞因子水平,同时以72例正常未孕妇女及92例正常健康早孕妇女作为对照.结果 3组研究对象外周血血清中各细胞因子的表达水平组间比较均有显著性差异,RSA组血清中IL-2、TNF-α、IFN-γ的水平显著高于正常健康早孕组,差异有统计学意义(P<0.05),而PIBF、IL-10水平显著低于正常健康早孕组,差异有统计学意义(P<0.05).结论 RSA患者血清中PIBF表达水平降低可导致反复自然流产,可作为预测反复自然流产的检测指标;Th1/Th2型细胞因子间平衡的改变与反复自然流产有关,而PIBF在调节Th1/Th2型细胞因子的平衡中起重要的作用.

Objective To investigate the impact of lymphocyte immunization therapy (LIT)on Treg/Th17 paradigm in patients with unexplained recurrent spontaneous abortion (URSA). Methods The proportion of Tregs and Th17 cells in peripheral blood lymphocytes were measured by flow cytometry,and the concentration of IL-10,TGF-β1,and IL-17 in serum were measured by ELISA. Results In 40 URSA patients,the proportions of CD4 +CD25 +Treg and CD4 +CD25 +CD127 low Treg cells in peripheral blood were significantly increased after LIT treatment (both P <0.05).The proportion of CD8-CD3 +IL-17A +Th17 cell was significantly reduced after treatment (P <0.05),and the number of this cell was negatively correlated with the former two (r =-0.724,P <0.01;r =-0.571,P <0.01).The concentrations of IL-10 and TGF-β1 in serum were both significantly increased after LIT treatment (both P <0.05),and the increments of IL-10 and TGF-β1 were positively correlated to the change of CD4 +CD25 +Treg ratio (r =0.654,P <0.01;r =0.658, P <0.01,respectively).The concentration of IL-17 in serum was markedly decreased after LIT treatment (P <0.05), and its decrement showed a positive correlation with the change of CD8-CD3 +IL-17A +Th17 cell ratio (r =0.693, P <0.01). Conclusion LIT may work through affecting the Treg/Th17 paradigm and increasing the function and amount of Treg cells while reducing Th17 cells.