Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment:A prospective study

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

hucMSC-derived exosomes protect ovarian reserve and restore ovarian function in cisplatin treated mice

Anti-cancer therapy often causes premature ovarian insufficiency and infertility as the ovarian follicle reserve is extremely sensitive to chemotherapy drugs,such as cisplatin.Various fertility preservation methods have been explored for women,especially prepubertal girls undergoing radiotherapy and chemotherapy due to cancer.In recent years,mesenchymal stem cell-derived exosomes(MSC-exos)have been reported to play an important role in tissue repair and the treatment of various diseases.In the current study,we observed that human umbilical cord-derived MSC-exos(hucMSC-exos)after short-term culture improved follicular survival and development while receiving cisplatin treatment.Moreover,intravenous injection of hucMSC-exos improved ovarian function and ameliorated inflammatory environment within the ovary.The underlying mechanism of hucMSC-exos on fertility preservation was associated with the down-regulation of p53-related apoptosis and their anti-inflammatory function.Based on these findings,we propose that hucMSC-exos may be a potential approach to improve fertility in women diagnosed with cancer.

Clinical observation of Kuntai capsule combined with Fenmotong in treatment of decline of ovarian reserve function

BACKGROUND Decreased ovarian reserve function is an ovarian hypofunction disease that occurs in women before 40 years of age,leading to a decline in fertility and perimeno-pausal symptoms,such as irregular menstruation,amenorrhea,infertility,de-creased libido,and autonomic nervous dysfunction.Fenmatong(FMT)is a com-pound mixture of estradiol tablets and estradiol didroxyprogesterone tablets,which can improve ovarian reserve function by supplementation of exogenous estrogen.However,this treatment has also been shown to cause breast pain,gastrointestinal discomfort,irregular vaginal bleeding,and changes in sexual desire.In severe cases,FMT can promote the development of breast cancer,endometrial cancer,and venous embolic disease.AIM To observe the effects of Kuntai capsules and FMT on endocrine indexes and uterine artery blood circulation in patients with decreased ovarian reserve func-tion.METHODS Patients(130)with decreased ovarian reserve function,who were treated in our hospital from May 2018 to May 2020,were divided into two groups:The FMT group,in which patients were treated with FMT,and the observation group,in which patients were treated with Kuntai capsules.Chinese medicine symptom scores,uterine artery blood flow parameters,ovarian ultrasound test indexes,pictorial blood loss assessment chart(PBAC)scores,and hormone levels were recorded,and total effective rates were calculated for both groups.RESULTS The total effective rate in the observation group was higher than that in the FMT group(P<0.05).After treatment,primary symptoms,including low menstrual volume,delayed menstruation,red color and thick consistency of menses,di-zziness,palpitation,weakness at the waist and knee,insomnia and excessive dreaming,irritability,and dryness and astringency of the pudendal canal in the observation group decreased,and scores for primary and secondary symptoms in the observation group were significantly lower than those in the FMT group(P<0.05).The systolic peak flow rate(PSV),end-diastolic flow rate(EDV),ovarian diameter,sinus follicle count,and resistance index(RI)of the uterine arteries in the observation group and FMT group increased after treatment.Notably,the PSV,EDV,ovarian diameter,and antral follicle count in the observation group were higher than those in the FMT group,whereas the RI in the observation group was lower than that in the FMT group(P<0.05).The PBAC scores in the observation and FMT groups increased after treatment,with that in the ob-servation group becoming significantly higher than that in the FMT group(P<0.05).After treatment,estradiol(E2)and anti-Mullerian hormone(AMH)levels increased,whereas follicle-stimulating hormone(FSH)levels decreased in the observation group and FMT group;E2 and AMH levels became significantly higher and FSH levels became significantly lower in the observation group than in the FMT group(P<0.05).CONCLUSION Compared with FMT,Kuntai capsules promoted uterine artery blood circulation,improved menstruation,relieved symptoms,regulated endocrine function,and improved curative effects.

Effect of Acupuncture and Jianpi Bushen Decoction on Ovarian Function and Metabolic Disorders in Patients with PCOS

Objective:To study the effects of acupuncture combined with Jianpi Bushen Decoction on ovarian function and metabolic disorders in patients with polycystic ovary syndrome(PCOS).Methods:A total of 100 PCOS patients admitted in our hospital from October 2018-January 2020 were selected,and the patients were divided into the Jianpi Bushen Decoction group and the combined group with 50 patients each according to a completely random method.The patients in the Jianpi Bushen Decoction group were given Jianpi Bushen Decoction;the combined group was given acupuncture on the basis of the Jianpi Bushen Decoction group.Detection of follicle stimulating hormone(FSH),testosterone(T),pituitary prolactin(PRL),estradiol(E2),fasting insulin(FIN),fasting blood glucose(FBG),insulin resistance index(HOMA-IR),triglyceride Ester(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),endometrial thickness,ovarian volume,number of ovarian sinus follicles,C-reactive protein(CRP),procalcitonin(PCT).Statistical treatment is effective.Results:After treatment,FSH,T,PRL,FIN,FBG,HOMA-IR,TG,TC and LDL-C were lower in Jianpi Bushen Decoction group,and E2 and HDL-C levels were higher than Jianpi Bushen Decoction group(P<0.05).The endometrial thickness of the combined group was higher than that of Jianpi Bushen Decoction group,and the ovarian volume and the number of ovarian sinus follicles were lower than that of Jianpi Bushen Decoction group(P<0.05).The levels of CRP and PCT in the combination group were lower than those in the Jianpi Bushen Decoction group(P<0.05).The total effective rate of patients in combination group was higher than that in Jianpi Bushen Decoction group(P<0.05).Conclusion:Acupuncture combined with Jianpi Bushen Decoction has significant therapeutic effects on patients with PCOS,effectively improves patients'ovarian function,improves endocrine and metabolic disorders,and reduces inflammatory reactions,which deserves clinical promotion.

Ovarian Endometrioid Adenocarcinoma with Functioning Stroma Accompanied with Endometrial Endometrioid Adenocarcinoma: Immunohistochemical Study and Literature Review

Background: The ovarian tumors with functioning stroma are defined by the morphological presence of endocrine active cells in stroma, and the clinical, biochemical or pathological evidence of endocrine function. Case Report: The ovarian endometrioid adenocarcinoma with functioning stroma accompanied with endometrial endometrioid adenocarcinoma was found in 64-year-old post-menopausal woman complaining abnormal genital bleeding and mammary distention. Her preoperative serum 17?-estradiol level was high (53.2 pg/ml) while human chorionic gonadotropin (hCG) level was within normal limit. Her right ovary with 8.8 × 5.3 cm in size and tan-yellow in color mostly consisted of solid tumor. Histologically, tumor was composed of estrogen receptor (ER)- and progesterone receptor (PgR)-positive, and androgen receptor (AR)-negative cancerous endometrial cells with aggregates of vacuolated foamy stromal cells resembling luteinized cells. These stromal cells contained lipid droplets, and was immunopositive for α-inhibin and 17?-estradiol. After surgery, serum 17?-estradiol level decreased and became normal (14.2 pg/ml). These findings indicate the production of steroid hormone (17?-estradiol) from the foamy stromal cells and may be correlated with the clinical symptoms. Furthermore, ER- and PgR-positive endometrial endometrioid adenocarcinoma developed synchronously. However, ovary and uterus were totally immunonegative for human chorionic gonadotropin (hCG). Four other cases from the literature including ours are reviewed. Conclusion: Cancer cells were positive for ER and PgR in both ovary and uterus responded to steroid hormone produced by foamy stromal cells, which played a role in proliferation and progression of ovarian and endometrial endometrioid adenocarcinoma, respectively.

人脐带间充质干细胞治疗多囊卵巢综合征模型小鼠卵巢组织中Rab27A的表达

背景:多囊卵巢综合征是导致育龄女性不孕的常见生殖内分泌疾病,目前尚无有效的治疗方法,人脐带间充质干细胞可能有助于修复卵巢功能,但其治疗多囊卵巢综合征方面的研究较少。目的:探讨人脐带间充质干细胞治疗多囊卵巢综合征的作用及机制。方法:3周龄雌性ICR小鼠随机分为3组(n=15):正常对照组不作处理,模型组连续21 d灌胃来曲唑诱导建立多囊卵巢综合征模型,治疗组连续21 d灌胃来曲唑+经尾静脉注射人脐带间充质干细胞悬液。治疗前和治疗后7,14 d称量小鼠体质量;治疗后连续10 d阴道涂片检测小鼠动情周期;治疗后14 d,ELISA检测小鼠外周血性激素水平,苏木精-伊红染色观察卵巢形态学改变,免疫荧光、免疫组化检测卵巢组织中Rab27A蛋白表达。结果与结论:①与正常对照组相比,模型组小鼠动情周期紊乱,体质量明显升高,卵泡刺激素水平降低,黄体生成素和睾酮水平均升高,卵巢可见较多囊状扩张的卵泡,Rab27A蛋白表达水平降低;②与模型组相比,治疗组小鼠体质量降低,卵泡刺激素水平升高,黄体生成素和睾酮水平均降低,多囊状扩张的卵泡减少,Rab27A蛋白表达水平升高;③结果表明,人脐带间充质干细胞可能通过上调Rab27A的表达改善多囊卵巢综合征小鼠血清性激素水平及卵巢功能。

基于国医大师夏桂成教授天癸新解促围绝经期女性再孕经验总结

围绝经期女性肾气渐衰,冲任虚衰,天癸渐竭,月经紊乱渐而闭止,生育能力明显衰退。国医大师夏桂成教授认为围绝经期女性诸多病症的发病核心在于心(脑)、肾,他在经验总结中重新解读了天癸的含义,认为天癸中“天”指心(脑)言,“癸”指肾言。其调周法亦从补肾调周到心肾合治,逐步调整为以调心为主。临床常以清心滋肾、宁心安神为基本治法,同时兼顾健脾疏肝。文章以“天癸新解”角度,从围绝经期女性生理变化,结合案例分析探讨,为围绝经期女性缓解临床症状、恢复月经周期、创造生育机会。

Oncological and Reproductive Outcomes of Fertility-sparing Surgery in Women with Early-stage Epithelial Ovarian Carcinoma:A Multicenter Retrospective Study

Summary:With delayed childbearing in women,preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma(EOC).Fertility-sparing surgery(FSS)can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life.In order to evaluate oncological safety,attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS,this multicenter retrospective study was conducted.Between January 2005 and December 2014,total of 87 young women with FIGO stage I EOC were included,with their clinicopathologic parameters in relation to disease-free survival(DFS)and overall survival(OS)assessed.Attitudes toward childbearing,ovarian function and fertility were studied in women undergoing FSS(n=36).As a result,in contrast to radical sur ery,FSS did not affect prognosis by Kaplan-Meier curves(log-rank test;DFS:P=0.484;OS:P=0.125).However,two of the three recurrence cases and both death cases were in FSS group stage IC.All women undergoing FSS resumed regular menstrual periods after chemotherapy.Only 16(44.44%)had tried to conceive,and 17 pregnancies occurred in 15(93.75%)women.Among 20 women who did not attempt conception,the most common reason was not being married(70%),followed by already having children(15%).In summary,FSS is considered safe in young women with stage IA EOC.Regular menstruation and good obstetric outcomes can be achieved.This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.

Cold exposure induces ovarian dysfunction through endoplasmic reticulum stress-mediated apoptosis

Background:Prior research has established that exposure to low temperatures adversely affects ovarian function,yet the precise mechanisms remain to be elucidated.Methods:Thirty experimental rats,each demonstrating two regular estrous cycles,were assorted randomly into three distinct groups:a control group,a cold exposure group,and a group treated with 4-phenylbutyric acid(4-PBA).To mimic the conditions of cold exposure,rats in the cold exposure and 4-PBA groups were subjected to immersion in ice water for 21 days.After 7 days of exposure to ice water,the 4-PBA group received intraperitoneal injections of a 20 mg/mL solution of 4-PBA at a dose of 100 mg/kg/day for 14 days.Estrous cycles were monitored via analysis of vaginal secretion smears.Serum hormone levels were measured using enzyme-linked immunosorbent assay(ELISA)kits.Ovarian morphology and the ultrastructure of granulosa cells(GCs)were evaluated using hematoxylin and eosin(HE)staining,and transmission electron microscopy(TEM),respectively.Apoptotic levels in GCs were quantified using a terminal deoxyribonucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)kit.Expression of apoptotic markers,endoplasmic reticulum stress(ERS)indicators,and molecules associated with relevant pathways were assessed through immunohistochemistry,western blot,and quantitative realtime polymerase chain reaction(qRT-PCR).Results:Dysregulation of the estrous cycle was notable in rats exposed to cold.The cold exposure group exhibited significantly reduced levels of estradiol(E2)and progesterone(P)compared to controls,alongside an increase in follicular atresia and a reduction in the count of developing follicles.After cold exposure,enhanced apoptosis and ERS were evident,with activation of the protein kinase RNA-like endoplasmic reticulum kinase(PERK)/eukaryotic translation initiation factor 2α(eIF2α)/activating transcription factor 4(ATF4)signaling pathway in ovarian.Notable changes were also observed in the ultrastructure of ovarian GCs,where both apoptosis and ERS levels were increased.Conversely,treatment with 4-PBA alleviated disturbances in the estrous cycle and hormonal imbalances,improved ovarian morphology,and alleviated apoptosis and ERS,effectively inhibiting the PERK/eIF2α/ATF4 pathway.Additionally,4-PBA treatment significantly improved the ultrastructure of GCs and alleviated apoptosis and ERS in these cells within the cold exposure group.Conclusion:These findings suggest that ERS plays a significant role in ovarian dysfunction induced by cold exposure,primarily through promoting apoptosis.

Endocrine and ovarian responses in water buffalo cows immunized against inhibin and subjected to the Ovsynch protocol

The aim of this study was to investigate the feasibility of stimulating ovarian fol icle development in order to improve fertility in water buffalo cows by immunization against inhibin. The experiment was carried out in early summer (May) and included 24 multi-parity crossbred Murrah-Swamp buffaloes that were divided into immunized (n=11) and control (n=13) groups. Each immunized cow was administered with a 2-mL immunogen of mineral oil adjuvant containing 2 mg of recombinant inhibinα-subunit fusion protein. The controls were treated with the adjuvant only. Al animals received Ovsynch protocol treatment, starting on the day of the antigen administration, and they were artiifcial y inseminated upon behavioral estrus. As a result, al of the immunized buffaloes generated antibodies against inhibin during the experimental period and had higher plasma concentrations of fol icle-stimulating hormone (FSH), activin, and estradiol (E2) related to estrous expression. A higher proportion of immunized animals expressed estrus behavior than did the controls (72%vs. 30%, P<0.05). On aver-age, inhibin-immunized buffaloes had signiifcantly more large fol icles (≥9 mm in diameter) than the controls (mean±SEM;1.2±0.1 vs. 0.84±0.1, respectively;P<0.05) and a slightly higher mean total number of fol icles (≥2 mm;11.4±0.7 vs. 9.0±1.1, respectively;P=0.09) and smal (2–4 mm) fol icles (8.81±0.6 vs. 6.84±1.0, respectively;P=0.12). A higher percentage of cows ovulated in the immunized group than in the control group (91%(10/11) vs. 54%(7/13), respectively;P<0.05). Moreover, inhibin-immunized cows had slightly larger corpus luteum (CL) than the controls 9 days after ovulation and signiifcantly higher (P<0.01) post-ovulation peak plasma progesterone (P4) concentrations. Immunization against inhibin also mar-ginal y increased the conception rate 42 days after insemination (45.8%vs. 15.4%;P>0.05). These results demonstrate that immunization against inhibin, coupled with the treatment with the Ovsynch protocol, can constitute a new technique to increase fertility in water buffalo cows.

Laparoscopic coring-type resection of noncommunicating broadly attached rudimentary horn with recurrent large ovarian endometriomas:A report of two cases

Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability.We report two cases involving women who presented with a broadly attached rudimentary horn and large ovarian endometriomas that were innovatively treated by laparoscopic coring-type dissection of the rudimentary horn of the uterus.This novel surgical approach ensured the integrity of the myometrium of the unicornuate uterus and avoided uterine rupture during pregnancy and ipsilateral ovarian function impairment.

Evaluation the effect of fertility-preserving surgery on young patients with malignant ovarian tumors

Objection： To evaluate the impact of fertility-preserving surgery and adjuvant chemotherapy on survival and fertility of young patients with ovarian malignant tumors. Methods： Retrospective analysis of 39 patients with ovarian malignant germ cell tumors, 23 patients with malignant epithelial tumors and 4 patients with sexual cord mesenchymal tumors receiving conservative treatments. Results： Two patients lost follow-up （we do not statistics them）. Fifty-nine among 64 patients were alive up to now （92.19%）. The overall survival rate for ovarian epithelial malignancies, malignant germ cell tumors and sexual cord mesenchymal tumors were 95.45%, 89.47% and 100% respectively. Fifteen patients received second operation and recurrence was found in 6 patients. Among the 59 surviving patients, 53 patients have normal menstruation. Thirteen patients among 20 patients who want to pregnant have 15 pregnancies and 9 successful deliveries. Conclusion： The management of fertility-preserving surgery on patients with ovarian malignant germ cell tumors, whatever the FIGO staging is, is a safe option. For patients with ovarian epithelial carcinomas, fertility-preserving surgery only confined to low-stage （stage Ⅰ）, low-grade （G1）, and patients who want keep fertility function seriously. Cisplatinum-based combination chemotherapy is necessary. Standardized chemotherapy has no affection on fertility function.

腹腔镜输卵管切除术对异位妊娠患者卵巢储备功能及血清神经肽Y、皮质醇的影响

目的 探究腹腔镜输卵管切除术对异位妊娠患者卵巢储备功能及血清神经肽Y(NPY)、皮质醇(Cor)的影响。方法 选2018年6月至2021年6月于安徽医科大学附属巢湖医院就诊的异位妊娠患者82例,随机分为两组,每组41例,对照组采用腹腔镜输卵管切开取胚缝合术,观察组采用腹腔镜输卵管切除术治疗。比较两组的手术时间、术中出血量、下床活动时间、出院时间、血清NPY及Cor、卵巢窦卵泡(AFC)个数、卵巢动脉血流速度峰值、阻力指数。术后跟踪随访2年,记录成功妊娠率及异位妊娠率。结果 观察组手术时间短于对照组(P <0.05)。术后即刻、术后1周,两组血清NPY差值、Cor差值比较,差异无统计学意义(P> 0.05)。术后1个月、术后6个月,观察组患侧卵巢血流速度峰值均低于对照组,阻力指数高于对照组(P <0.05);术后6个月,两组患者的卵巢血流速度峰值均升高,阻力指数均降低(P <0.05)。术后两组AFC及成功妊娠率比较,差异均无统计学意义(P> 0.05)。观察组异位妊娠率低于对照组(P <0.05)。结论 与腹腔镜输卵管切开取胚缝合术比较,腹腔镜输卵管切除术治疗异位妊娠患者,同样可保留术后卵巢AFC,且在降低术后再次异位妊娠风险上更具优势。

路径式护理对卵巢癌术后患者胃肠功能恢复及预后的影响

目的:探讨路径式护理对卵巢癌术后患者胃肠功能恢复及预后的影响。方法:选取126例卵巢癌手术患者为研究对象,按照护理干预方式不同分为观察组和对照组,每组各63例。对照组患者予以手术常规护理干预;观察组患者在对照组基础上予以路径式护理干预,干预时间均为3个月。比较两组患者术后(胃肠功能恢复时间及住院时间、肠鸣音恢复、首次排便时间)、疲乏症状[癌症疲乏量表(CFS)]、心理状态[焦虑自评量表(SAS)及抑郁自评量表(SDS)评分]、生活质量[癌症生命质量核心量表(QLQ-C30)及卵巢癌患者生活质量问卷评分(QLQ-OV28)]。结果:干预后,观察组患者术后胃肠功能恢复时间及住院时间短于对照组(P<0.05);CFS各项评分、SAS及SDS评分、QLQ-OV28中消化道症状、外在形象和治疗依从性评分均低于对照组(P<0.05);QLQ-C30总分高于对照组(P<0.05)。结论:路径式护理可改善卵巢癌患者术后胃肠功能及心理状况,缓解癌性疲乏,改善患者生活质量。

穴位埋线对两种肥胖类型PCOS患者生殖指标及炎症因子的影响

目的探究穴位埋线对两种肥胖类型PCOS患者炎性因子及生殖指标的影响。方法将2020年1月—2021年1月于山东中医药大学附属医院妇科门诊诊断为多囊卵巢综合征(肾虚痰湿证)肥胖患者63例作为研究对象。将患者按照不同肥胖类型分为均匀性肥胖组(A组,WC<80cm,n=33)和腹型肥胖组(B组,WC≥80,n=31)。两组均给予穴位埋线配合炔雌醇环丙孕酮治疗,对比3个月后两组的性激素(E_(2)、T、FSH、LH),炎症因子(TNF-α、hs-CRP、APN、IL-6),卵巢功能(卵巢体积、AMH、INHB),子宫内膜容受性(子宫内膜厚度、PI、RI),并统计治疗后患者的体质量、BMI、治疗后2个月排卵率、妊娠率。结果治疗后,均匀性肥胖组(A组)和腹型肥胖组(B)组T(0.74±0.07 VS 1.05±0.13)ng/mL,LH(10.43±1.07 VS 14.08±0.95)mIU/mL,IL-6(17.84±0.36 VS 21.06±1.34)ng/L,TNF-α(16.19±1.61 VS 19.95±0.95)ng/L,hs-CRP(4.75±0.35 VS 6.66±0.27)ng/L,卵巢体积(10.7±0.64 VS 11.31±0.62)cm^(3),PI(2.33±0.10 VS 2.55±0.13),RI(0.62±0.04 VS 0.74±0.03),体质量(63.83±2.87 VS 69.47±3.29)kg,BMI(24.23±1.46 VS 26.35±1.31)kg/m^(2)均显著降低(P<0.05),且均匀性肥胖组(A组)降低明显(P<0.05)。均匀性肥胖组(A组)和腹型肥胖组(B)组APN(57.15±3.6 VS 48.16±1.52)pg/L,FSH(7.24±0.86 VS 6.66±0.81)mIU/mL,E_(2)(98.75±4.63 VS 70.19±23.61)pg/mL,子宫内膜厚度(8.95±0.22 VS 8.29±0.29)cm,AMH(8.60±0.54 VS 7.56±0.55)ng/dL均显著提高(P<0.05),且A组(均匀性肥胖组)提高明显(P<0.05)。A组(均匀性肥胖组)的排卵率为80%,高于B组(腹型肥胖组)的40%(χ^(2)=10.00,P=0.000)。A组(腹型肥胖)的妊娠率60%,高于B组(腹型肥胖组)的33.3%(χ^(2)=4.29,P=0.04)。结论穴位埋线联合炔雌醇环丙孕酮能够改善PCOS(肾虚痰湿证)肥胖患者的性激素、卵巢功能、子宫内膜容受性,其机制可能与改善机体炎症状态相关。均匀性肥胖组改善更明显。提示,穴位埋线治疗均匀性肥胖PCOS效果更好,临床应针对腹型肥胖PCOS患者特点,采取更精准的治疗措施。

腹腔镜子宫肌瘤剔除术对子宫肌瘤患者盆底功能、卵巢功能的影响

目的探讨腹腔镜子宫肌瘤剔除术(LM)对子宫肌瘤患者盆底功能、卵巢功能的影响。方法纳入2021年1月至2022年10月濮阳市安阳地区医院收治的80例子宫肌瘤患者,按抽签法分两组。对照组40例行开腹子宫肌瘤剔除术(AM),研究组40例行LM,对比两组手术前后疼痛因子[心肌细胞P物质(SP)、前列腺素E_2(PGE_2)]、应激反应指标[去甲肾上腺素(NE)、皮质醇(COR)]、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、盆底功能指标[盆底障碍影响简易问卷7(PFIQ-7)]及卵巢功能指标[雌二醇(E_2)、促黄体生成素(LH)、促卵泡激素(FSH)]。结果术后1 d、术后3 d时,研究组血清SP、PGE_2、NE、COR水平低于对照组,差异有统计学意义(P<0.05)。术后1d时,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)功能指标与术前相比均有所降低,但研究组明显高于对照组,差异有统计学意义(P<0.05);而两组的CD8^(+)功能指标与术前相比有所升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术后1个月、术后3个月时,两组PFIQ-7评分均有所升高,但研究组明显低于对照组,差异有统计学意义(P<0.05)。术后3个月、术后6个月时,研究组血清E_2水平高于对照组,而血清LH、FSH水平低于对照组,差异有统计学意义(P<0.05)。结论对子宫肌瘤患者行LM可有效减轻机体疼痛程度、应激反应及对免疫、盆底和卵巢功能的负面影响,优势较为显著,具有进一步的使用价值。

坤泰胶囊结合电针周期疗法治疗卵巢储备功能低下效果观察

目的观察坤泰胶囊结合电针周期疗法治疗卵巢储备功能低下的效果。方法将医院2019年2月—2021年6月收治的109例卵巢储备功能低下患者以随机数字表法分为观察组(55例)与对照组(54例),对照组患者均予以激素周期疗法治疗,观察组患者采取激素周期疗法及坤泰胶囊结合电针周期疗法治疗。各组数据观察:临床疗效、治疗前后中医证候(月经推后或月经量少、闭经、性欲减退、神疲乏力等)积分变化、雌二醇(Estradiol,E2)及卵泡雌激素(Follicle-Stimulating Hormone,FSH)、黄体生成素(luteinizing Hormone,LH)等血清激素水平变化、卵巢间质血流动力学指标变化、卵泡发育情况以及不良反应、治疗后1年受孕率。结果对照组与观察组患者治疗总有效率比较(81.48%vs94.55%)(P<0.05);治疗前,各组患者中医证候(月经推后或月经量少、闭经、性欲减退、神疲乏力等)积分、E2、FSH及LH等血清激素水平、阻力指数(Regular Insulin,RI)及搏动指数(Pulsatility Index,PI)、收缩期最大血流速度(Peak Systolic Veloci⁃ty,PSV)、动脉血流收缩期峰值流速/舒张末期流速(systolic phase diastolic phase,S/D)等卵巢间质血流动力学指标、排卵日子宫内膜厚度、非排卵日子宫内膜厚度及初级卵泡数、优势卵泡数等卵泡发育情况指标比较,P>0.05,经治疗后各组患者中医证候(月经推后或月经量少、闭经、性欲减退、神疲乏力等)积分、E2、FSH及LH等血清激素水平、RI及PI、PSV、S/D等卵巢间质血流动力学指标、排卵日子宫内膜厚度、非排卵日子宫内膜厚度及初级卵泡数、优势卵泡数等卵泡发育情况指标均改善,观察组患者治疗后中医证候(月经推后或月经量少、闭经、性欲减退、神疲乏力等)积分、E2、FSH及LH等血清激素水平、RI及PI、PSV、S/D等卵巢间质血流动力学指标、排卵日子宫内膜厚度、非排卵日子宫内膜厚度及初级卵泡数、优势卵泡数等卵泡发育情况指标均优于对照组(P<0.05);观察组治疗不良反应率与对照组不良反应率均较低(P>0.05);观察组治疗1年后受孕率(47.27%,26/55)高于对照组患者(25.93%,14/54)(P<0.05)。结论坤泰胶囊结合电针周期疗法治疗卵巢储备功能低下的效果较为显著,患者症状恢复较好,且卵巢功能恢复好,患者未来1年受孕率高,且不良反应较少,安全可靠,值得进行应用。

补肾健脾方治疗卵巢储备功能减退相关不孕脾肾两虚证临床观察

目的:研究补肾健脾方治疗卵巢储备功能减退相关不孕脾肾两虚证的临床疗效。方法:纳入60例卵巢储备功能减退相关不孕脾肾两虚证患者,采用随机数字法分成治疗组和对照组,每组30例。治疗组患者给予补肾健脾方治疗,对照组患者给予芬吗通治疗,两组均连续治疗6个周期。检测性激素指标[基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)、血清雌二醇(E2)、抗米勒管激素(AMH)]、超声指标[卵巢体积、窦卵泡(AFC)数量],比较两组患者中医证候积分、总有效率、妊娠率、流产率,并监测安全性指标。结果:治疗组总有效率为79.31%(23/29),对照组总有效率为82.14%(23/28),差异无统计学意义(P>0.05)。经过6个月经周期治疗后,两组治疗后中医证候积分、bFSH均较治疗前下降(P<0.05),AMH较治疗前升高(P<0.05),且治疗组优于对照组(P<0.05)。治疗组治疗后bLH较治疗前下降(P<0.05);对照组治疗前后bLH比较,差异无统计学意义(P>0.05)。两组治疗后E2较治疗前有明显升高(P<0.05),两组患者治疗后E2比较,差异无统计学意义(P>0.05)。治疗组治疗后卵巢体积明显增大(P<0.05),窦卵数量明显增多(P<0.05),治疗组明显优于对照组(P<0.05)。治疗组妊娠率[34.48%(10/29)]高于对照组[21.43%(6/28)](P<0.05),治疗组流产率[10.00%(1/10)]低于对照组[33.30%(2/6)(P<0.05)]。两组患者治疗前后安全性指标未发现异常,未发生不良反应。结论:补肾健脾方能安全有效地治疗卵巢储备功能减退相关不孕脾肾两虚证,改善卵巢相关激素水平,提高妊娠率,降低流产率,缓解临床症状。

腹腔镜下卵巢囊肿剔除术对患者卵巢功能、炎症因子及T淋巴细胞亚群水平的影响

【目的】探讨腹腔镜下卵巢囊肿剔除术对患者卵巢功能、炎症因子及T淋巴细胞亚群水平的影响。【方法】选取2019年1月至2023年1月本院妇科收治的76例卵巢囊肿患者,根据手术方法不同分为对照组和观察组,每组38例。对照组行开腹卵巢囊肿剔除术治疗,观察组行腹腔镜下卵巢囊肿剔除术治疗,比较两组手术前后卵巢功能[雌二醇(E 2)、促卵泡激素(FSH)、黄体生成素(LH)]、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]及T淋巴细胞亚群水平(CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+))。【结果】两组术后3个月FSH、LH均升高,但观察组低于对照组(P<0.05);两组术后3个月E 2均降低,但观察组高于对照组(P<0.05)。观察组患者术后IL-6、TNF-α、CRP水平低于对照组,差异有统计学意义(P<0.05)。两组患者术前CD4^(+)、CD4^(+)/CD8^(+)比较,差异无统计学意义(P>0.05);术后1 d,两组患者血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均较术前明显降低,但观察组高于对照组,差异均有统计学意义(P<0.05);观察组患者术后3 d血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)恢复至术前水平。【结论】腹腔镜下卵巢囊肿剔除术可有效促进患者卵巢功能恢复,并减轻机体炎症反应,提高T淋巴细胞亚群水平,减轻对机体细胞免疫功能的抑制,有利于患者术后康复。

从生物钟对卵巢功能的影响探析调周法的科学内涵

国医大师夏桂成教授立足于中医学天人相应的观点,重视女性生殖节律中的阴阳消长转化,创立“调整月经周期节律法”。女性的特殊生理现象表现在周期节律上,生物钟是产生和调节生物体生理行为和规律的内在机制,生物钟基因广泛表达于卵巢颗粒细胞、卵泡膜细胞及黄体细胞中,并且参与类固醇激素的合成、卵泡体细胞的分化、卵泡发育以及排卵等多个生理过程,在女性生殖内分泌中发挥重要作用。昼夜节律紊乱可导致女性月经失调、卵巢功能障碍、内分泌代谢紊乱等生殖疾病。中医时间医学与生物钟节律系统有共通之处,充分认识生物钟对女性卵巢功能的影响,揭示其科学的内涵,明确其调控方法和机制,对抵御生殖障碍性疾病,优化生育具有积极的促进作用。