Risk Prediction Model for Surgical Treatment of Ruptured Corpus Luteum in the Ovary

Objective: To explore the related factors of surgical treatment of patients with corpus luteum rupture and establish a risk prediction model of surgical treatment of corpus luteum rupture. Methods: 222 patients with corpus luteum rupture treated in Jingzhou First People’s Hospital from January 2015 to March 2022 were analyzed retrospectively, including 45 cases of surgery and 177 cases of conservative treatment. The training set and validation set were randomly assigned according to 7:3. We collected the basic information, laboratory and ultrasonic examination data of 222 patients. Logistic regression analysis was used to determine the independent risk factors and combined predictors of surgical treatment of corpus luteum rupture. The risk prediction model was established and the nomogram was drawn. The discrimination and calibration of the prediction model were verified and evaluated by receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness of fit test;Decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the prediction model. Results: Univariate logistic regression showed that whole abdominal pain (OR: 2.314, 95% CI: 1.090 - 4.912), abdominal muscle tension (OR: 2.379, 95% CI: 1.112 - 5.089), adnexal mass ≥ 4 cm (OR: 3.926, 95% CI: 1.771 - 8.266), hemoglobin Conclusion: The nomogram prediction model containing three predictive variables (hemoglobin, depth of pelvic effusion under ultrasound and cervical lifting pain) can be used to predict the risk of surgical treatment in patients with corpus luteum rupture.

Comparative Study of the Therapeutic Effects of Two Corpus Luteum Support Regimens on Patients with Frozen Embryo Transfer

Aim: To investigate the efficacy of two corpus luteum support programs in patients with frozen embryo transfer (FET). Methods: A retrospective analysis of the complete clinical data of 340 patients undergoing in vitro fertilization embryo transfer in the Department of Reproductive Medicine, Jingzhou Central Hospital from September 2016 to July 2018. These patients were divided into group A and B according to the luteal support program. We compared the clinical outcomes of the two corpus luteum preparations by comparing the laboratory parameters of the two groups of patients with clinical pregnancy indicators. Results: We found there was no significant difference in the results of general conditions in the two groups of patients, such as infertility age and duration, body mass index (BMI), basal follicle stimulating hormone (FSH), basal luteinizing hormone (LH), basal estrogen (E2) levels, the endometrial thickness, the number of transplanted high-quality embryos on the day of transplantation and so on (P > 0.05). We found that the implantation rate (32.55%), biochemical pregnancy rate (53.57%), and clinical pregnancy rate (51.78%) in group B were significantly higher than those in group A (25.26%, 35.11%, and 34.66%, respectively) (P 0.05). Conclusion: We conclude that patients who are scheduled for frozen embryo transfer use progesterone vaginal sustained release capsules combined with luteal progesterone luteal support, have improved clinical pregnancy rates.

Observations on the Diagnostic Effects of CT Examination(Enhanced Scan)on Hemorrhage Corpus Luteum Cyst

Objective:To investigate the diagnostic effects of enhanced CT scan on hemorrhage corpus luteum cyst(HCLC).Methods:The clinical data of 24 patients with hemorrhage corpus luteum cyst diagnosed by surgery and pathology in our hospital were collected.All patients received enhanced CT scan to evaluate the diagnostic value of CT.Results:The average diameter of the cysts in this group of patients was 5.1cm by CT.Further detection of the ruptured cyst wall showed that there was a liquid lowdensity shadow.Some of the cysts were accompanied by signs of increased density,indicating the presence of blood clots;all patients received surgical treatment.Intraoperative ultrasound examination of the cysts had an average diameter of 5.2cm and a wall of 0.2~0.4mm.Among them,19 cases of cysts contained"coffee-colored"liquid with varying degrees of blood clots,and 5 cases had no blood clots in the cysts but there were a lot of blood clots beside the cysts.Conclusion:The application of enhanced CT scan in patients with hemorrhage corpus luteum cyst is of great value.It can provide accurate data reference for clinical treatment and is worthy of promoting its clinical application.

Purification and Properties of Cold-active Metalloprotease from Curtobacterium luteum and Effect of Culture Conditions on Production

Curtobacterium luteum, a gram-positive psychrotrophic bacterium, secreting an extracellular protease was isolated from the soil of Gangotri glacier, Western Himalaya. The maximum enzyme production was achieved when isolate was grown in a pH-neutral medium containing skim milk at 15oC over 120 hour. The metal ions such as Zn2+ and Cr2+ enhanced enzyme production. The specific activity of purified enzyme was 8090 u/mg after 34.1 fold purification. The 115 kD enzyme was a metalloprotease (activity inhibited by EDTA and EGTA) and showed maximum activity at 20oC and pH 7. The enzyme was active over a broad pH range and retained 84% of its original activity between pH 6–8. There was no loss in enzyme activity when exposed for 3 hours at 4oC-20oC. However, lost 65% of activity at 30oC, and was almost inactivated at 50oC, but was resistant to repeated freezing and thawing. The enzyme activity was stimulated by manganese ions; however, it was inactivated by copper ions.

Ultrasonographic Monitoring of Previous Pregnant Corpus Luteum in Postpartum Cow

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卵巢扭转常规超声表现

目的观察卵巢扭转的常规超声表现。方法回顾性分析32例经手术证实的卵巢扭转,观察其常规超声表现。结果32例中,6例为原发性卵巢扭转,26例继发于卵巢肿物。常规超声中,8例(8/32,25.00%)患侧卵巢不同程度增大、内部回声不均匀;6例(6/32,18.75%)卵巢皮质内窦状卵泡呈放射状排列并见“滤泡环征”;10例(10/32,31.25%)卵巢位置异常;8例(8/32,25.00%)卵巢扭转蒂部见“漩涡征”;32例(32/32,100%)卵巢血流信号均减少。结论卵巢扭转常规超声表现具有一定特征性,包括患侧卵巢增大、位置异常,出现“滤泡环征“”漩涡征”及血流减少。

Temporal and spatial expression of MMP-2,-9,-14 and their inhibitors TIMP-1,-2,-3 in the corpus luteum of the cycling rhesus monkey

The corpus luteum (CL) is a transient endocrine organ that secretes progesterone to support early pregnancy. If implantation is unsuccessful, luteolysis is initiated. Extensive tissue re-modeling occurs during CL formation and luteolysis. In this study, we have studied the possible in-volvement of MMP-2, -9, -14, and their inhibitors, TIMP-1, -2, -3 in the CL of cycling rhesus monkey at various stages by in situ hybridization, immunohistochemistry and microscopic assessment. The re-sults showed that the MMP-2 mRNA and protein were mainly expressed in the endothelial cells at the early and middle stages of the CL development, while their expressions were observed in the luteal cells at the late stage during luteal regression. MMP-9 protein was detected in the CL at the early and middle stages, and obviously increased at the late stage. The expressions of MMP-14 and TIMP-1 mRNA were high at the early and late stages, and low at the middle stage. TIMP-2 mRNA was high throughout all the stages, the highest level could be observed at the late stage. The TIMP-3 produc-tion was detected throughout all the stages, but obviously declined during CL regression. MMP-9, -14 and TIMP-1, -2, -3 were mainly localized in the cytoplasm of the steroidogenic cells. The results suggest that the MMP/TIMP system is involved in regulation of CL development in the primate, and the coordinated expression of MMP-2, -14 and TIMP-1, -3 may have a potential role in the CL forma-tion and the functional maintaining, while the interaction of MMP-2, -9, -14 and TIMP-1, -2, -3 might also play a role in CL regression at the late stage of CL development in the primate.

Expression of steroidogenic acute regulatory protein and its regulation by interferon-gamma in rat corpus luteum

The steroidogenic acute regulatory protein (StAR) is the key regulatory protein of steroidogenesis. De novo synthesis of StAR protein is required for intramitochondrial translocation of cholesterol to the cytochrome P450 side chain cleavage enzyme which is located on the matrix side of the inner mitochondrial membrane. This is the rate-limiting step of steroid biosynthesis. Using in situ hybridization and immunohistochemistry we studied StAR expression in various stages of the corpora luteal and its regulation by interferon-gamma (IFNγ) in the adult pseudopregnant rat. The results indicated that expression of StAR in the corpora luteal was correlated with progesteron production and IFNγ was capable of inhibiting its expression.

Expression and regulation of metalloproteinases-2,-9 and tissue inhibitors of metallo-proteinases in rat corpus luteum

The expression and regulation of metallopro-teinases-2, -9 (MMP-2, -9) and their tissue inhibitors TIMP-1, -2, -3 mRNA were studied in this experiment. In the PMSG-hCG primed pseudopregnant rat, MMP-2, -9 mRNA levels were the highest at Day 1, decreased from Day 4, and reached the minimal level at Day 8, then increased at Day 14; no significant changes were observed in TIMP-2 mRNA expression from Day 1 to Day 14; TIMP-3 mRNA expression was the lowest at Day 1, increased from Day 4, reached the maximal level at Day 8, and persisted to Day 14. TNF-α could significantly increase the expression of MMP-2, -9 and TIMP-1 mRNA in the in vitro perfused pseudopregnant CL, and decrease the expression of TIMP-3 mRNA, but had no effect on TIMP-2 mRNA expression. The results indicate that MMP-2, -9 and TIMP-1, -2, -3 might be involved in the regulation of CL function and maintenance of CL structure via their coordinated gene expression. TNF-a could inhibit luteal regression via increasing MMP-2, -9 and TIMP-1 mRNA

Expression of gelatinases and tissue inhibitors of metallo-proteinases in the rhesus monkey(Macaca mulatta) corpus luteum

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are believed to play important roles in the formation and regression of corpus luteum (CL). This study is to investigate the expression of gelatinases (MMP-2, -9) and TIMPs in the rhesus monkey CL in both early and late luteal phases and during the early stages of pregnancy. Ovaries were collected from regularly cycling rhesus monkey at D5 and D15 following ovulation and at D12, D18 and D26 of pregnancy. In situ hybridization revealed that in the CL MMP-2 niRNA was expressed during both formation and regression, while MMP-9 mRNA was mainly localized in the late luteal phase. Reduction of MMP-2, -9 transcripts in the CL was observed during pregnancy. MMP-2 mRNA in the CL reduced to an undetectable level at D26 of pregnancy. TIMP-1 mRNA was highly expressed in the CL in both early and late luteal phases and persisted throughout the early stages of pregnancy. Strong signal for TIMP-2 mRNA was also detected in both luteal phases, and the

超声影像检查在妇产科急腹症诊断中的应用价值研究

目的 探讨超声影像检查在妇产科急腹症诊断中的应用价值。方法 86例妇产科急腹症患者作为研究样本,均应用彩色多普勒超声诊断仪开展经腹部超声检查、阴道超声检查。诊断金标准为宫腔镜检查结果 ,对于在妇产科急腹症诊断时应用不同超声技术对于异位妊娠、卵巢囊肿蒂扭转、黄体破裂诊断的结果进行对比,分析不同超声方法诊断结果与宫腔镜检查结果之间的一致性情况。结果 宫腔镜诊断:86例妇产科急腹症患者中,经宫腔镜检查确诊45例异位妊娠、21例卵巢囊肿蒂扭转、20例黄体破裂。腹部超声诊断异位妊娠的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为71.11%、70.73%、70.93%、72.73%、69.05%,阴道超声分别为88.89%、90.24%、89.53%、90.91%、88.10%,腹部超声联合阴道超声诊断分别为100.00%、100.00%、100.00%、100.00%、100.00%。腹部超声、阴道超声联合检查的灵敏度、特异度、准确率、阳性预测值、阴性预测值均比单一检查更高(P<0.05)。而阴道超声单一检查的灵敏度、特异度、准确率、阳性预测值、阴性预测值均比腹部超声单一检查更高(P<0.05)。对于异位妊娠,腹部超声联合阴道超声、阴道超声单一检查与诊断金标准之间的一致性分析均达到高度, Kappa=0.884、0.740,而腹部超声单一检查与诊断金标准之间的一致性分析仅为中度, Kappa=0.657。腹部超声诊断卵巢囊肿蒂扭转的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为66.67%、83.08%、79.07%、56.00%、88.52%,阴道超声分别为76.19%、87.69%、84.88%、66.67%、91.94%,腹部超声联合阴道超声诊断分别为100.00%、98.46%、98.84%、95.45%、100.00%。腹部超声联合阴道超声的灵敏度、特异度、准确率、阳性预测值、阴性预测值均比单一检查更高(P<0.05)。对于卵巢囊肿蒂扭转,腹部超声联合阴道超声与诊断金标准之间的一致性分析达到高度, Kappa=0.879,而阴道超声单一检查、腹部超声单一检查与诊断金标准之间的一致性分析仅为中度, Kappa=0.646、0.562。腹部超声诊断黄体破裂的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为70.00%、84.85%、81.40%、58.33%、90.32%,阴道超声分别为80.00%、89.39%、87.21%、69.57%、93.65%,腹部超声联合阴道超声诊断分别为100.00%、98.48%、98.84%、95.24%、100.00%。腹部超声联合阴道超声的灵敏度、特异度、准确率、阳性预测值、阴性预测值均比单一检查更高(P<0.05)。对于黄体破裂,腹部超声联合阴道超声与诊断金标准之间的一致性分析达到高度, Kappa=0.875,而阴道超声单一检查、腹部超声单一检查与诊断金标准之间的一致性分析仅为中度, Kappa=0.630、0.551。结论 经阴道超声在妇产科急腹症诊断时的应用价值良好,可准确检出异位妊娠、卵巢囊肿蒂扭转、黄体破裂,尤其是从阴道和腹部两个途径进行联合超声扫描,其诊断价值更高,可更加灵敏、准确地判断患者急腹症类型。

未破裂型输卵管妊娠与妊娠黄体囊肿的超声图像特征比较

目的:比较未破裂型输卵管妊娠与妊娠黄体囊肿的超声图像特征。方法:回顾性分析2022年2月至2023年3月该院收治的68例未破裂型输卵管妊娠患者的临床资料,设为观察组;另选取同期40例妊娠黄体囊肿患者的临床资料,设为对照组。两组均行阴道彩色多普勒超声检查,比较两组超声图像特征、包块血流分布情况、包块血流频谱形态、包块与同侧卵巢位置变化率。结果:经阴道彩超检查结果显示,两组包块大小、环壁厚度比较,差异均无统计学意义(P>0.05);观察组阻力指数(RI)、环壁高回声率均高于对照组,环壁低回声率低于对照组,差异有统计学意义(P<0.05);两组包块血流分布情况比较,差异有统计学意义(P<0.05);观察组高阻力型、低阻力型血流频谱均高于对照组,极低阻力型血流频谱率低于对照组,差异有统计学意义(P<0.05);变换体位后,观察组包块与同侧卵巢位置变化率为88.24%,高于对照组的0,差异有统计学意义(P<0.05)。结论:未破裂型输卵管妊娠患者超声图像特征中的RI、环壁高回声率、高阻力型血流频谱率、低阻力型血流频谱率、包块与同侧卵巢位置变化率均高于妊娠黄体囊肿患者,环壁低回声率、极低阻力型血流频谱率均低于妊娠黄体囊肿患者,且包块血流分布不丰富。

前列腺素D 2对山羊黄体细胞内分泌功能及其凋亡相关基因表达的影响

旨在研究前列腺素家族中生殖领域鲜有报道的PGD 2成员对单一环境下黄体细胞内分泌功能及其凋亡相关基因表达的影响,并解析其在黄体退化中的作用机理,为全面探析前列腺素家族成员的生物学作用提供新的理论依据。采集空怀母山羊黄体中期的卵巢组织,通过胶原酶II消化和胰酶差速离心法分离纯化以获得山羊黄体细胞。采用DMEM/F12进行离体培养,观察不同离体培养时间的黄体细胞生长状态;采用免疫组化法和细胞形态特征鉴定黄体细胞,将PGD 2设置三个不同梯度确定其对黄体细胞作用效果的剂量依赖性关系。最后,通过PGD 2最佳依赖性剂量处理黄体细胞,利用ELISA法检测黄体细胞的内分泌功能变化,流式细胞术测定黄体细胞的凋亡率及qRT-PCR/Western blot法检测凋亡相关基因mRNA/蛋白表达水平。结果显示,经突触素(synaptophysin,SYP)特异性表达蛋白鉴定,成功分离并获得了山羊原代黄体细胞。细胞形态实时观察和ELISA检测结果显示,离体培养5 d时黄体细胞胞质饱满、外形紧凑、形态清晰可见,并且黄体细胞的内分泌P 4水平最高。此时,细胞生长曲线结果也证实,离体培养5 d时细胞生长到达峰值,细胞生长曲线呈倒置的“S”形。接种对数期峰值点细胞后,经PGD 2处理48 h,发现与对照组相比,不同剂量组别中的黄体细胞分泌P 4水平排序为2μg组<3μg组<1μg组。同时,在2μg剂量处理组中,与对照组相比,培养基中P 4浓度呈极显著下降(P<0.01);类固醇急性应激调节蛋白(steroidogenic acute regulatory protein,StAR)和3β-羟-甾体脱氢酶(3-beta-hydroxysteroid dehydrogenase,3β-HSD)基因表达呈显著性下调(P<0.05)。此外,流式细胞仪检测和Flow Jo软件分析结果显示,黄体细胞凋亡率明显增加(P<0.05);qRT-PCR和Western blot结果证实,抗凋亡因子B淋巴细胞瘤-2(B-cell lymphoma-2,BCL-2)mRNA和蛋白呈显著性下调(P<0.05)、促凋亡因子半胱氨酸天冬氨酸特异性蛋白酶-3(cysteinyl aspartate-specific proteinase-3,Caspase-3)mRNA和蛋白呈显著性上调(P<0.05)。以上结果表明,PGD 2不仅可通过下调StAR/3β-HSD基因表达抑制黄体细胞内分泌功能水平,还可通过下调抗凋亡BCL-2基因表达和上调促凋亡Caspase-3基因表达加速黄体细胞凋亡进程,最终以双重途径的形式参与黄体细胞的分子调控作用,这为进一步完善前列腺素家族成员的生物学功能效应及后续全面探析家畜黄体维持与退化的分子调控网络机制奠定了坚实基础。

D-氯前列醇钠注射液对奶牛持久黄体的临床治疗试验

奶牛持久黄体是造成奶牛繁殖障碍的一种主要疾病,严重制约着畜牧业的发展。为探究D-氯前列醇钠治疗此病的临床疗效,将患持久黄体的奶牛随机分成4组(每组10头)进行治疗,分别为D-氯前列醇钠低剂量组(0.075 mg/头)、中剂量组(0.15 mg/头)、高剂量组(0.3 mg/头)和氯前列醇钠对照组(0.2 mg/头),采用肌肉注射的方式进行给药,以临床症状是否消失,B超探查持久黄体是否消失以及奶牛是否能恢复正常发情周期并发情配种等方面判定药物对奶牛持久黄体的治疗效果。结果表明,无论是D-氯前列醇钠组还是氯前列醇钠对照组对于持久黄体奶牛的治疗都是有效的,在相同浓度和相同治疗条件下,D-氯前列醇钠对于患病奶牛的治疗效果优于氯前列醇钠,说明D-氯前列醇钠可以作为治疗奶牛持久黄体的治疗药物。

阴道彩超联合腹部超声对异位妊娠与妊娠黄体囊肿的鉴别诊断价值

目的:探究阴道彩超联合腹部超声对异位妊娠与妊娠黄体囊肿的鉴别诊断价值。方法:回顾性分析2019年1月—2023年1月厦门大学附属第一医院杏林分院收治的83例疑似异位妊娠或者妊娠黄体囊肿患者的相关资料。患者均接受阴道彩超及腹部超声检查,评估两种检查方式及其联合检测在异位妊娠与妊娠黄体囊肿鉴别诊断中的价值。结果:阴道彩超联合腹部超声诊断异位妊娠与妊娠黄体囊肿的敏感度、准确率、阴性预测值均显著高于腹部超声、阴道彩超单独诊断,差异有统计学意义(P<0.05)。异位妊娠组孕囊最大直径小于妊娠黄体囊肿组囊肿最大直径,孕囊回声高于内膜回声和卵巢实质回声、孕囊附近无小卵泡回声、有直肠凹积液、有心管搏动及胎芽等超声表现患者占比高于妊娠黄体囊肿组,差异有统计学意义(P<0.05);两组环壁厚度、盆腔积液患者占比比较,差异无统计学意义(P>0.05)。异位妊娠组以点状、条状血流信号为主,妊娠黄体囊肿组以环状、半环状血流信号为主,两组血流量特征比较,差异有统计学意义(P<0.05)。异位妊娠组脉搏指数(PI)及阻力指数(RI)高于妊娠黄体囊肿组,收缩期峰值流速(PSV)低于妊娠黄体囊肿组,差异有统计学意义(P<0.05)。异位妊娠组以极低阻型血流频谱为主,妊娠黄体囊肿组以高组型血流频谱为主,两组血流频谱特征比较,差异有统计学意义(P<0.05)。结论:阴道彩超联合腹部超声检测诊断异位妊娠与妊娠黄体囊肿的敏感度、准确率、阴性预测值较高,可以通过超声表现、超声血流情况有效提高两者诊断准确率。

阴式彩色多普勒超声对卵巢黄体破裂与宫外孕破裂的应用价值研究

目的分析阴式彩色多普勒超声对卵巢黄体破裂与宫外孕破裂中的应用价值。方法回顾性分析2020年1月—2022年12月期间济南市第五人民医院收治的49例卵巢黄体破裂患者与51例宫外孕破裂患者资料。两组患者均接受阴式彩色多普勒超声检查,比较两组患者阴式彩色多普勒超声检测下的卵巢体积、液性暗区深度、异常回音区直径,血流特征(环状或半环状、条状、点状)与血流动力学指标[收缩期峰值流速(peak systolic velocity,PSV)、阻力指数(resistance index,RI)、搏动指数(pulsatility index,PI)]。结果阴式彩色多普勒超声检测下,宫外孕破裂组的异常回音区直径、液性暗区深度、卵巢体积较卵巢黄体破裂组低,差异有统计学意义(P<0.05)。宫外孕破裂组阴式彩色多普勒超声血流特征主要表现为条状或点状,卵巢黄体破裂组血流特征主要表现为环状或半环状,差异有统计学意义(P<0.05)。宫外孕破裂组的PI(0.95±0.20)、RI(0.55±0.12)高于卵巢黄体破裂组的(0.66±0.19)、(0.33±0.08),差异有统计学意义(t=7.428、10.742,P<0.05),PSV(12.03±3.00)cm/s低于卵巢黄体破裂组的(15.45±4.02)cm/s,差异有统计学意义(t=4.834,P<0.05)。结论阴式彩色多普勒超声能够有效鉴别出卵巢黄体破裂与宫外孕破裂。

猪卵巢颗粒细胞和黄体细胞凋亡的调控机制研究进展

母猪卵巢皮质上存在大量卵泡,卵泡由原始卵泡向初级卵泡、次级卵泡逐步发育为排卵前的成熟卵泡时,伴随着卵泡闭锁的发生。目前认为颗粒细胞凋亡是导致卵泡闭锁的主要因素,并且已经证实。卵泡成熟后会破裂排卵,如果卵子未受精,则黄体会发生萎缩并退化,形成称作白体的结缔组织,最终被组织吸收。细胞凋亡受到多基因严格控制,随着分子生物学技术的发展,已经证明存在多个信号通路。本文以猪卵巢为模型,综述了卵泡闭锁期间颗粒细胞凋亡和黄体退化过程中黄体细胞凋亡的调控机制,以期为深入研究卵巢细胞凋亡提供理论基础。

超声诊断卵巢扭转合并黄体破裂1例

患者女,35岁,持续性下腹痛较剧烈5 h,无恶心、呕吐,无呕血、黑便,无尿频、尿急,无排便困难,无发热;既往月经较规则,末次月经来潮于18天前。妇科急诊超声显示右侧附件区混合型包块、腹腔积血(考虑黄体破裂,不除外异位妊娠);实验室检查发现血人绒毛膜促性腺激素<2 mIU/ml,考虑黄体破裂。入院后超声:子宫前位,形态正常,大小52 mm×40 mm×50 mm,内膜厚13 mm,肌层回声均匀;右侧卵巢明显增大,内见43 mm×40 mm和36 mm×34 mm囊性回声,其内呈絮状,CDFI未见明显血流信号(图1A);其下缘见36 mm×30 mm×27 mm中等回声(图1B),CDFI见星点状血流信号,脉冲多普勒探及低速高阻动脉频谱;右侧卵巢旁见75 mm×29 mm×59 mm絮状回声;子宫后方见23 mm深、肝肾隐窝见28 mm深液性暗区。超声提示:右侧卵巢明显增大伴黄体血肿,其旁中等回声考虑卵巢扭转;腹盆腔积血考虑黄体破裂所致。行腹腔镜下腹腔探查术,见右侧卵巢囊肿最大径约2 cm,表面1 cm破裂口有血块覆盖,右侧卵巢蒂部扭转360°;盆腔见游离血液及血块约800 ml。行腹腔镜下右侧卵巢囊肿剔除术+右侧卵巢成形术。术后病理:右侧卵巢囊肿,符合黄体囊肿破裂伴大片状出血坏死。

子宫动脉PI及妊娠黄体超声诊断输卵管妊娠价值及危险因素分析

目的:探究超声检测子宫动脉PI变化及妊娠黄体超声对输卵管妊娠的诊断价值及危险因素。方法:将2017年2月-2022年1月于本院诊断为输卵管妊娠的101例患者纳入为观察组,产前检查正常孕妇100例为对照组。比较两组超声检查子宫动脉阻力指数(RI)、搏动指数(PI)、收缩期峰值流速(PSV)、舒张末期流速(EDV),比较观察组妊娠黄体与输卵管同侧和不同侧、功能侧和非功能侧患者的PI,分析子宫动脉PI、妊娠黄体及输卵管PI变化值诊断输卵管妊娠价值,分析输卵管妊娠危险因素。结果:观察组RI和PI均低于对照组,PSV和EDV均高于对照组;同侧组子宫动脉PI水平(4.19±1.11)低于非同侧组(19.74±5.29),功能侧组子宫动脉PI水平(2.62±0.19)低于非功能侧组(2.77±0.25)(均)。ROC曲线分析,子宫动脉PI、妊娠黄体与输卵管PI变化值联合诊断可提高输卵管妊娠诊断效能,临界值子宫动脉PI≤2.22,妊娠黄体与输卵管PI变化值≥0.18;输卵管炎、孕产≥3次、放置宫内节育器均是输卵管妊娠危险因素。结论:超声检测子宫动脉PI变化及妊娠黄体超声对输卵管妊娠有较好的诊断价值,输卵管炎、孕产≥3次及放置宫内节育器者建议作为临床疑似异位妊娠的重点关注对象。

GnRH-a联合HCG双扳机对年轻患者IVF/ICSI妊娠结局的影响

目的探究GnRH拮抗剂促排卵方案中用GnRH激动剂(GnRH-a)联合HCG双扳机是否可以改善年轻患者的IVF/ICSI妊娠结局。方法本研究为回顾性队列研究,收集2020年1月至2021年12月期间在西北妇女儿童医院采用拮抗剂方案行IVF/ICSI助孕且年龄≤35岁的患者资料,根据HCG日应用扳机药物的不同分为单扳机组(HCG扳机,n=2070)及双扳机组(GnRH-a+HCG扳机,n=453),比较两组间的基本资料、促排卵情况以及新鲜周期移植后的临床妊娠结局,并对年龄、窦卵泡计数(AFC)、体质量指数(BMI)、不孕年限、移植胚胎个数以及扳机方式等影响妊娠结局的主要因素行Logistic多因素分析。结果两组患者间年龄、BMI、不孕年限、基础FSH水平、原发不孕占比、总Gn剂量、Gn天数、HCG日激素(E 2、P及LH)水平、ICSI周期MII卵数、受精方式、可用胚胎数、优质胚胎数,以及新鲜周期的移植胚胎个数、移植囊胚占比及临床妊娠率等比较均无统计学差异(P>0.05)。与单扳机组相比,双扳机组患者流产率(22.63%vs.16.89%)显著升高,活产率(40.40%vs.47.44%)显著降低(P<0.05)。在校正了年龄、AFC、BMI、不孕年限、移植胚胎个数等相关混杂因素后,双扳机会导致新鲜周期活产率低[OR=0.746,95%CI(0.605,0.920),P=0.006];另外年龄[OR=0.966,95%CI(0.939,0.994),P=0.018]及不孕年限[OR=0.961,95%CI(0.928,0.994),P=0.022]为活产率的独立影响因素,年龄小、不孕时间短者活产率更高(P<0.05)。结论扳机方式和年龄、不孕年限均为影响年轻患者IVF/ICSI妊娠结局的主要因素。首次行IVF助孕的年轻患者,扳机日经评估无明显OHSS风险且可新鲜周期移植时,用GnRH-a联合HCG双扳机并不能改善新鲜周期的妊娠结局。