绒毛染色体核型和病原体检测与胚停育的关系

目的探讨绒毛染色体核型和宫颈分泌物病原体检测在胚停育中的作用。方法对49例胚停育组,30例对照组(正常早孕要求行人工流产的妇女)采用①胚胎绒毛组织行染色体检查;②取宫颈分泌物,用培养法行解脲支原体(UU)检测;用免疫层析法,行沙眼衣原体(CT)检测。结果胚停育组染色体异常占61%(30/49),对照组占19%(6/31),胚停育组明显高于对照组,差异有统计学意义(P<0.01)。支原体感染同时伴染色体异常占24%(12/49),对照组占3%(1/31),胚停育组明显高于对照组,差异有统计学意义(P<0.01)。支原体感染胚停育组与对照组相比,差异无统计学意义(P>0.05)。原体感染胚停育组与对照组相比,差异无统计学意义(P>0.05)。结论染色体异常在胚停育中起重要作用,染色体异常时支原体感染也起一定作用。

基于测定血清雌二醇的早期补佳乐补充在有多次胚停史妇女再次妊娠预后的应用

目的:通过检测有多次胚停史妇女再次妊娠后50d内血雌二醇的变化特点,以期获得发现早期胚停及预防胚停的有效指标及治疗方法。方法:选择102例曾经有两次及以上不明原因早期胚停及空胚囊的有生育要求的患者,严格检查治疗,发现怀孕后采用化学发光分析法隔日检测血清血绒毛膜促性腺激素(β-h CG)水平、孕酮(P)水平四次,在第2、3、4次同时检测雌二醇(E2)水平,并给予外源性雌激素(补佳乐)1~2片口服治疗。结果:99例患者未出现再次胚停情况,治愈率97%,3例患者分别在54d、62d、70d观察到空胚囊或胚停;99例继续妊娠患者血β-h CG动态变化和P动态变化与3例胚停患者之间均未出现明显规律,而99例E2的变化曲线为持续上升趋势,3例胚停患者补充外源性雌激素(补佳乐)后E2持续上升不明显或者下降趋势,两组之间规律差别明显。结论:E2是早期妊娠预后的有效敏感指标,适当应用外源性雌激素(补佳乐)能有效预防胚停的发生。早期妊娠患者在常规检查β-h CG水平、P水平的同时应该常规连续检测E2的水平。

米非司酮配伍米索前列醇用于胚停育过期流产及死胎引产

目前，临床上巳使用米非司酮(Ru486)配伍米索前列醇抗早孕，由于其方便、简单，痛苦小日益受到育龄妇女的青睐，自1993年7月开始，我院将这一方法用于胚停育，过期流产厦死胎引产的治疗中，取得了较好的疗效。

瘦素和瘦素长受体在胚胎停止发育中的表达

目的:探讨瘦素(Leptin)和瘦素长受体(OB-RL)mRNA及蛋白在胚胎停止发育(胚停育)中的表达及意义。方法:应用RT-PCR检测48例胚胎停育妇女(胚停育组)及30例正常早孕人工流产妇女(对照组)绒毛组织的Leptin、OB-RLmRNA。应用免疫组化技术检测两组妇女绒毛的Leptin和OB-RL蛋白。结果:RT-PCR检测表明,胚停育组Leptin mRNA及OB-RLmRNA表达明显低于对照组,有统计学意义(P<0.01,P<0.01)。免疫组化法检测Leptin及OB-RL蛋白,胚停育组及对照组呈阳性至强阳性表达,胚停育组Leptin、OB-RL蛋白均明显低于对照组(P<0.01)。经两种方法检测,Leptin、OB-RLmRNA和蛋白均明显低于对照组。结论:瘦素在胚胎发育中起重要作用,瘦素和瘦素长受体降低,可能预示胚胎停止发育。

重视不良环境因素对早期胚胎停止发育的影响

目的:探讨环境因素对早期胚胎发育的影响。方法:采用问卷调查的方式,分析比较250例诊断为早期胚胎停止发育(以下简称胚停育)要求终止妊娠的患者(胚停育组)和250例正常生育的妇女(对照组)的日常生活、工作环境情况,以及其对孕前、孕早期环境因素的重视程度情况。结果:胚停育组与对照组比较差异有显著性。结论:不良环境因素是胚胎停止发育的危险因素。孕前及孕早期重视环境因素,积极规避不良环境因素,可以提高妊娠的成功率。

100例早孕胚胎停育绒毛染色体核型分析

目的:分析早孕胚胎停育与绒毛染色体异常的关系。方法:选择2010年～2011年3月安徽医科大学100例胚胎停育患者,对其进行绒毛染色体核型分析。结果:100例胚胎停育患者,孕周最长15周,最短6周。绒毛培养失败5例,培养成功率95.0%;检出异常核型34例,检出率35.8%,其中单纯染色体数目异常占55.9%,异常类型有:染色体数目异常23例,三倍体4例,四倍体1例,结构异常2例,嵌合体4例。95例早孕胚胎停育中,女性胚胎51例,占53.7%;男性胚胎44例,占46.3%。结论:胚胎染色体异常是胚胎停育的重要原因。

Curative effect of assisted reproduction technology by Traditional Chinese Medicine multi-channel interventional therapy on 95 cases of in vitro fertilization and embryo transfer failure

OBJECTIVE: To evaluate the curative effect of Traditional Chinese Medicine(TCM) multi-channel interventional therapy on women with Assisted Reproductive Technology(ART) failure, to compare the curative effect of the dual therapy and triple therapy on women with ART Failure, and to choose the best TCM interventional therapeutic plan.METHODS: The 95 cases with ART Failure from West China second University Hospital of Sichuan University meeting the inclusion criteria were randomly divided into three groups:dual therapy group(31 cases), triple therapy group(33 cases)and control group(31 cases). According to the intervene treatment of in vitro Fertilization and Embryo Transfer(IVF-ET) long cycle scheme, the control group wait naturally for 3 months before IVFET. The dual therapy group take TCM prescriptionⅡ of cultivating emotion and assisting reproduction and auricular acupoint therapy for 3 months before IVF-ET, then Western Medicine treatment progestin supporting as well as auricular application and Antai Recipe after IVF-ET transplantation.The triple therapy group take TCM prescription Ⅱof cultivated emotion and assisted reproduction,auricular acupoint therapy and retention enema of TCM, and combination treatment the same as dual therapy group after transplantation. The natural pregnancy number, the period condition of secondary IVF-ET and the improvement of the kidney deficiency, liver depression and blood stasis syndrome among those three groups were compared.RESULTS: It was showed from analysis in 95 cases with ART failure that the number of natural preg-nancy was as followings: 3 patients from the dual therapy group, 10 patients from the triple therapy group, and no patient from the control group. The comparison among three groups have statistical significance(P < 0.05). The treatment group is superior to the control group, while the triple therapy is superior to the dual therapy. The comparison of the condition of the fertility rate, clinical pregnancy rate, biochemical pregnancy rate and early abortion rate during the period of secondary IVF-ET between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance(P < 0.05). The comparison of the improvement of the kidney deficiency,liver depression and blood stasis syndrome between pre-therapy and post-treatment of both the dual therapy group and the triple therapy group have statistical significance(P < 0.05). The comparison between three groups after treatment have statistical significance(P < 0.05).CONCLUSION: TCM multi-channel interventional therapy can increase the natural pregnancy rate of patients with ART Failure(the triple therapy is superior to the dual therapy); it can increase the fertility rate, clinical pregnancy rate, and decrease the early abortion rate during the period of secondary IVF-ET; it can improve syndromes of kidney deficiency, liver depression and blood stasis.