目的 比较绝经后女性子宫内膜息肉、息肉周围内膜组织和宫腔内远离息肉内膜组中TNF-α和COX-2的表达情况,并分析研究炎性因子TNF-α与COX-2的相关性,探讨子宫内膜息肉的相关发病机制,为临床治疗提供理论依据.方法 选取河北医科大学第三医院2019年01月2020年10月诊治的子宫内膜息肉患者30例.宫腔镜直视下用活检钳钳取息肉组织或宫腔镜下电切息肉组织、息肉周围内膜组织和宫腔内远离息肉内膜.利用Western Blot方法检测组织内TNF-α和COX-2的表达水平,并统计分析.结果 息肉组织相比于息肉周围内膜组织和远离息肉内膜组织,TNF-α和COX-2的表达均升高(P<0.05),并且二者具有相关性(P<0.05).提示TNF-α和COX-2与子宫内膜息肉的发病密切相关.结论 子宫内膜息肉的形成,可能是局部炎症刺激多种因子共同作用的结果.

Objective To observe and compare the therapeutic effects of diffetent medication ways on missed abortion.Methods A total of 200 patients with missed abortion were enrolled in the study.According to the different doses of estradiol valerate combined with different doses of mifepristone and misoprostol by means of medication ways,these patients were divided into four groups: experimental group A, B,C groups and control group (mifepristone with misoprostol). The complete abortion rate,vaginal bleeding volume after abortion,vaginal bleeding time after abortion,abortion failure rate,the second time curettage rate and the second time pregnancy rate were observed and compared among the four groups.Results The complete abortion rate in three experimental groups were obviously higher than that in control group,however,the abortion failure rate and the second time curettage rate in three experimental groups were significantly higher than those in control group,moreover,the average vaginal bleeding volume,postpartum vaginal bleeding time, menstrual resurgence time in three experimental groups were significantly shorter than those in control group (P <0.05). However there were no significant differences in these indexes mentioned above among three experimental groups(P>0.05).In addition there was no significant difference in the second pregnancy rate between the three experimental groups and control group (P>0.05).Moreover there was no significant difference in the second time pregnancy rate among the three experimental groups(P>0.05).Conclusion The therapeutic effects of combination application of estradiol valerate with mifepristone and misoprostol on missed abortion are superior to those by simple mifepristone or simple misoprostol,however,there are no significant differences in different doses of estradiol valerate combined with mifepristone and misoprostol by means of different medication ways,and none of the four treatment modes has unique advantages on the second pregnancy.

Objective To investigate the risk factors of missed abortion to decrease the incidence of repeated abortions.Methods A questionnaire survey was performed for 200 patients with missed abortion who were treated firstly in our hospital from January 2013 to December 2014.The results were statistically analyzed by SPSS 11.0 software.Results The common cause of missed abortion was the infection factors,which accounted for 31.5％.The incidence of missed abortion was significantly increased in the age range of 26 ～ 30 years and 31 ～ 35 years.The more the number of times of artificial abortion,the higher the probability of incidence of missed abortion.Among 200 patients,the patients whose serum levels of calcium,iron,zinc and lithium were lower than the normal value accounted for 90％,and the difference was statistically significant (P ＜ 0.05).Among 200 patients,the patients with lower levels of progesterone who had missed abortion accounted for 48 ％,the patients with high levels of lactotropin accounted for 30％,and the patients with low levels of estrogens accounted for 30％,the difference was statistically significant (P ＜ 0.05).Conclusion Preventing genital tract infection,improving the immune status of pregnant women and avoiding high radiation environment can reduce the incidence rate of missed abortion in early pregnancy.The sufficient trace element concentration and sex hormone levels play an important role in embryo development and maintenance of pregnancy.It is suggested that the best child-bearing age should be 25 ～ 29 years,and it is important to cherish every chance of conception and reduce blindly induced abortion.

Objective To analyze the hemodynamics charateristics of patients with missed abortion and early pregnant women by color Doppler ultrasonography in order to provide the basis for early diagnosis of missed abortion.Methods The transvaginal color Doppler examination was performed in 200 cases of missed abortion and 200 cases of normal early pregnancy.The hemodynamic indexes of uterine artery and spiral artery including pulsatility index (PI),resistance index (RI),systolic/diastolic flow rate ratio (S/D) were detected and statistically analyzed.Results RI and PI in uterine arteries and spiral arteries in missed abortion group were significantly higher than those in normal early pregnancy group (P ＜ 0.05),and the S/D in uterine arteries and spiral arteries in missed abortion group was higher S/D than that in normal early pregnancy group,but there was no significant difference between two groups (P ＞ 0.05) Conclusion The monitoring of uterine artery hemodynamic parameters has important clinical significance in.diagnosis of missed abortion.

目的：研究卵巢冠囊肿发病因素，从临床特征及生活方式方面探讨卵巢冠囊肿发生的可能危险因素。方法采用病例对照研究，调查2010年3月至2011年3月经临床和病理确诊为卵巢冠囊肿80例（病例组）和以同期收入院经临床和病理确诊为非卵巢冠囊肿80例（对照组），由专人在手术前采用统一表格进行问卷调查，通过卡方检验、Logistic 回归进行单及多因素分析，探讨卵巢冠囊肿发生的可能危险因素及其危险度的大小。结果卵巢冠囊肿好发于生育年龄的女性，肥胖、不孕及居住地在城市或繁华路段妊娠均可影响卵巢冠囊肿的发生（ P ＜0.05）。结论生育年龄的女性发现盆腔肿物考虑到卵巢冠囊肿的可能，降低体重、减少不孕的发生及改变生活环境有助于降低卵巢冠囊的发生。

目的：通过对比卵巢冠囊肿患者与非卵巢冠囊肿患者的各项指标，分析卵巢冠囊肿患者相关危险因素，并统计患者的临床诊断情况。方法选取诊断治疗的卵巢冠囊肿患者125例作为研究对象，再选取同期体检的非卵巢冠囊肿患者125例作为对照组，通过问卷调查方式对2组患者的体重指数、初潮年龄、月经周期、经期、经量、痛经、孕次、产次、避孕史、婚姻状况、血型、卵巢囊肿家族史、吸烟史、文化水平、是否居住在城市或繁华地段、是否经常吃烧烤以及家中是否烧煤等，分析卵巢冠囊肿的危险因素，并统计其临床诊断情况。结果根据单因素分析对比显示，卵巢冠囊肿可能与体重指数、孕次以及是否居住在城市或繁华地段有关（ P ＜0．05）。根据Logistic回归分析显示，体重指数越大、孕次为0、居住在城市或繁华地段是卵巢冠囊肿的危险因素（ P ＜0．05）。结论降低体重、减少不孕、改变居住环境有利于降低卵巢冠囊肿的发生率。

目的：对比卵巢冠囊肿患者与非卵巢冠囊肿患者的相关影响因素，统计卵巢冠囊肿患者的诊断情况，分析误诊原因。方法选取2013年1月至2015年12月诊断治疗的卵巢冠囊肿患者125例作为研究对象，再选取同期来医院诊断治疗的非卵巢冠囊肿妇科病患者125例作为对照组，通过问卷调查的方式对2组患者进行卵巢冠囊肿影响因素的分析，并统计卵巢冠囊肿患者的临床诊断情况。结果单因素分析结果显示，2组患者的体重指数、孕次以及是否居住在城市及繁华地段比较差异具有统计学意义（ P ＜0．05）；2组患者在初潮年龄、月经周期、经期、经量、痛经、产次、避孕史、婚姻状况、吸烟史、文化水平以及是否存在卵巢肿瘤家族史等方面比较差异无统计学意义（P ＞0．05）。 Logistic回归分析显示，体重指数越高、孕次为0以及居住在城市及繁华地段的偏回归系数均大于0，OR值均大于1，表明以上三种因素是卵巢冠囊肿的危险因素。125例卵巢冠囊肿术前诊断准确82例，准确率为65．6％；误诊43例，误诊率为34．4％。结论生育年龄的女性降低体重、减少不孕的可能、改变生活环境有助于降低卵巢冠囊肿的发生率，同时在诊断过程中注意与卵巢黄体囊肿、卵巢子宫内膜异位囊肿、卵巢囊腺瘤以及输卵管积液等的鉴别，提高临床诊断率。

目的：通过比较卵巢反应不良和卵巢反应正常患者血清及卵泡液中抑制素B（ INH-B）及相关的因素的差异，探讨抑制素B及相关因素预测卵巢功能的临床价值。方法选择45例接受IVF-ET／ICSI 治疗的不孕患者进行回顾性研究，根据获卵数及HCG日雌二醇水平分为卵巢反应不良组21例和卵巢反应正常组24例。比较2组基础血清卵泡刺激素（ FSH）、黄体生成素（ LH ）、雌二醇（ E2）水平、FSH／LH 比值、年龄、窦卵泡数（ AFC ）、平均卵巢体积（OVVOL）、血清及取卵日卵泡液抑制素B水平的差异，评价这些指标对卵巢反应性的预测价值。结果（1）基础血FSH、年龄、AFC、OVVOL、血清及卵泡液INH-B，两组间比较差异有统计学意义（ P ＜0吵．05），卵巢反应不良组血清FSH及年龄均高于正常对照组，AFC、OVVOL、血清及卵泡液INH-B水平均低于正常对照组。基础血清LH、E2及FSH／LH比值比较差异无统计学意义（ P ＞0．05）；（2）基础血FSH与FSH／LH比值、年龄呈正相关（ r ＝0．36， P ＜0．05；r ＝0．31， P ＜0．05），与血清INH-B呈负相关（ r ＝－0．31， P ＜0．05）；血INH-B与卵泡液INH-B呈正相关（ r ＝0．33， P＜0．05）；AFC与OVVOL呈正相关（ r ＝0．37， P ＜0．05）；（3）单变量分析基础血FSH水平是预测卵巢反应性较好的独立指标（OR＝0．64， P ＜0．05），多变量回归分析年龄与卵泡液INH-B对卵巢反应性的预测差异有统计学意义（P＜0．05），年龄的评价作用优于卵泡液INH-B。结论血清及卵泡液中抑制素B水平结合相关因素可以更好的预测卵巢反应性，更准确的评价卵巢功能，对实现个性化用药，提高临床妊娠率提供依据。

Objective To compare the differences of plasma Mir-21 expression and granular cell apoptosis between patients with hypovaria and healthy people,and to explore the influence of Mir-21 on ovarian function in order to provide theoretical basis for pathogenesis of ovarian function decline.Methods According to basic FSH,the subjects were divided into hypovaria group (FSH >10 U /L,n =20)and control group (FSH < 8 U /L,n =23).According to the database and previous study,the expression levels of Mir-21 were detected by Real-time quantitative PCR,and the apoptosis rate of granulosa cells was compared between two groups.Results The expression levels of Mir-21 in hypovaria group were significantly lower than those in control group (P <0.05),however,the apoptosis rate of granular cell was significantly higher than that of control group (P <0.05 ).The hoechst 33258 staining showed that the granulosa cells in hypovaria group were brightly stained,with karyopyknosis and irregular granular apoptotic body in cell nucleus.Conclusion The expression levels of Mir-21 in peripheral blood of patients with hypovaria are down-regulated,as compared with those in healthy people,which may result in the increase of granular cell apoptosis and abnormal development of oocyte,so as to result in hypovaria.

目的：比较卵巢功能减退患者和卵巢功能正常女性颗粒细胞凋亡及 Bcl－2表达情况，探讨卵巢功能减退的发病机制。方法选择接受体外受精－胚胎移植（IVF－ET）治疗的不孕患者48例，其中卵巢功能减退患者23例，卵巢功能正常对照患者25例。于取卵日收集卵泡液，离心收集颗粒细胞培养，用 TUNEL 检测颗粒细胞凋亡情况。免疫组化分析颗粒细胞 Bcl－2蛋白的表达情况。结果卵巢功能减退组和卵巢功能正常组颗粒细胞凋亡率分别为（27±13）％、（18±8）％，卵巢功能减退组颗粒细胞凋亡率较对照组增高（ P ＜0．05）；免疫组化分析显示 Bcl－2主要在颗粒细胞胞浆中表达，卵巢功能减退组 Bcl－2蛋白表达较正常对照组下调（ P ＜0．05）。结论 Bcl－2可能通过调节颗粒细胞凋亡情况，影响卵泡发育及卵巢的功能。

目的：回顾性分析180例子宫内膜癌患者的临床资料，探讨子宫内膜癌患者在发病年龄，病例特征，临床表现的特点。方法2007年9月至2012年9月就诊的180例子宫内膜癌患者作为研究对象，分为未绝经组（ A组， n ＝52）；绝经组（B组， n ＝128），比较2组在年龄，临床表现，子宫内膜癌的临床特点及病理类型的区别，收集数据进行统计学处理。结果 B组患病率显著高于A组（ P ＜0 U．05），A组合并不孕，多囊卵巢综合征，子宫内膜增生高于B组（ P ＜0．05），而B组合并糖尿病，高血压者明显高于A组（ P ＜0．05）。2组在临床病理类型上基本相似，但在细胞分化程度及肌层浸润率A组好于B组（ P ＜0．05）。结论子宫内膜癌的发病与年龄，月经生育史有相关性，A组（绝经前组）分期较早，肌层浸润率低，愈合较好。

宫内节育器是我国育龄女性广泛采用的避孕措施，具有安全、经济、疗效显著、可逆等特点。临床可见到少数女性长期放置节育器，待绝经后才取出。绝经后女性因生殖内分泌功能逐渐减退，雌激素水平下降，宫颈、阴道等开始萎缩，宫颈质地变硬、宫颈管明显变窄，取环常较困难。为提高手术成功率，减少患者痛苦，对来我院自愿要求取环的绝经后女性应用戊酸雌二醇配伍米索前列醇治疗，报告如下。

<正>围绝经期出血病因复杂,大多为卵巢功能逐渐衰退,引起激素水平波动所致的功能失调性子宫出血。可表现为三不规:月经周期长短不规;出血量多少不定;经期长短不一。近年内膜病变所致出血呈高发状态,但即使为恶性变,及早发现和治疗也会有好的预后,因此明确病因及早治疗,对患者身心健康,

患者,女,41岁,主因进行性痛经2+年伴经量增多1年入院.既往体健,17岁初潮,6～8/24 d,G3P1.查体:体温36.2℃,血压130/90 mm Hg,心肺无异常.