孤独症谱系障碍(ASD)起源于发育早期,通常为慢性终身性病程,可导致严重的疾病负担。本文以国内外发表的相关论文为基础,总结了ASD的病因学及流行状况研究进展,旨在为ASD的早期筛查和干预提供理论依据。结果发现主要的遗传因素包括单基因突变、拷贝数变异、多基因的相互作用和表观遗传学因素;主要的环境因素包括产前、围产期和产后危险因素环境暴露;流行趋势为:近年来患病率呈上升趋势,经济水平较高地区患病率更高,男性患病率高于女性。

目的 序贯检测可溶性血管内皮生长因子受体1(sFlt-1)/胎盘生长因子(PlGF)在子痫前期高危孕妇中随孕周变化趋势以确定最佳筛查时机及其对子痫前期(PE)的预测价值。方法 本研究为前瞻性研究,选取2022年7月—2023年7月于孕20周前在南京医科大学附属苏州医院暨苏州市立医院进行规律产检的具有PE高危因素的单胎孕妇577例,妊娠期内分为5个窗口期(妊娠≤20周、23～25周、28～30周、33～35周和≥36周)序贯检测sFlt-1/PlGF,比较最终发生PE孕妇(PE组,n=146)和未发生PE孕妇(未发生PE组,n=431)各窗口期的sFlt-1/PlGF比值。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),比较不同窗口期sFlt-1/PlGF比值对PE的预测价值。通过Kaplan-Meier生存曲线和COX比例风险回归分析sFlt-1/PlGF比值与PE发病时间的风险比例。结果 本研究中,高危人群中PE的发生率为25.3%(146/577),5个窗口期,PE组sFlt-1/PlGF均高于未发生PE组,除了20周前,其余4个窗口期两组间差异均存在统计学意义,且在28～30周时两组显示最大差异(z=-15.828)。将前四个孕周窗口期sflt-1/PlGF预测PE,除了孕20周前,其余三个窗口期的sFlt-1/PlGF对PE的发生均有预测能力(P均<0.05),其中28～30周时sFlt-1/PlGF的AUC(0.944)值最大;在28～30周时最佳截值为24.06,敏感度为82.9%,特异性为92.6%,PPV为43.9%,NPV为91.7%。生存曲线结果显示sFlt-1/PlGF四分位数各组的发病时间差异具有统计学意义,sFlt-1/PlGF越大,PE的中位发病时间越短;当sFlt-1/PlGF增加50%时,PE发病风险增加2.275倍。结论 在PE高危孕妇中sFlt-1/PlGF具有随孕周动态变化的趋势,对于PE及其发病时间均有良好的预测价值,28～30周为sFlt-1/PlGF的最佳筛查时间,当sFlt-1/PlGF≤24时可以排除90%以上的PE发生。

Objective The impact of obstructive sleep apnoea (OSA) on polycystic ovary syndrome (PCOS) has not been extensively investigated. This study aims to investigate the occurrence of OSA in patients with PCOS and to elucidate the effect of OSA on the clinical features of PCOS patients and patients with PCOS alone. Methods PCOS patients who received infertility treatment at Peking University Third Hospital from January 2019 to August 2022 were included. Multiple physiological parameters, including physical indicators, sex hormone levels, inflammation and coagulation indicators, liver and kidney function were measured according to routine clinical measurements. Portable sleep monitoring was performed using Apnealink Plus from ResMed Ltd., Australia, and OSA was classified as mild, moderate, and severe based on respiratory distress index, AHI and nighttime minimum oxygen saturation. Results A total of 687 patients with PCOS were included in this study. Among them, 47% of PCOS patients were complicated with OSA, and 28 patients had severe OSA, accounting for 4%. The body mass index, the proportion of patients with hyperandrogenism (HA) and the proportion of insulin resistance (IR) increased in PCOS & OSA group (P<0.05). In terms of sex hormone, concentration of testosterone and free testosterone index (FAI) in PCOS & OSA group were higher than those in PCOS group alone, while progesterone (P), anti Mullerian hormone (AMH), and sex hormone binding globulin (SHBG) were lower than those in PCOS group alone (P<0.05). In terms of glucose and lipid metabolism indicators,glycated hemoglobin (HbA1c), fasting blood glucose level (Glu0), blood glucose level 30 minutes after oral administration of 75 g glucose (Glu30), blood glucose level 6 minutes after oral administration of 75 g glucose (Glu60), blood glucose level 12 minutes after oral administration of 75 g glucose (Glu120), fasting insulin level (INS0), serum insulin level 30 minutes after oral administration of 75 g glucose (INS30), serum insulin level 60 minutes after oral administration of 75 g glucose (INS60), serum insulin level 120 minutes after oral administration of 75 g glucose (INS120), steady-state model evaluation of insulin resistance index (HOMA-IR), steady-state model insulin secretion index (HOMA - β), beta cell function index (MBCI), low density lipoprotein (LDL) and triglycerides (TG) of PCOS & OSA patients were higher than those of PCOS patients alone. HDL was lower than that of PCOS patients (P<0.05). The US-CRP and prothrombin activity in PCOS & OSA patients were higher than those in PCOS alone (P<0.05). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and cystatin C in PCOS & OSA patients were higher than those in PCOS patients alone (P<0.05). Logistic regression analysis showed that higher high body mass index (BMI) (OR=8.51) and elevated glycosylated hemoglobin (OR=21.76) were associated with high incidence rate of OSA (P<0.05). Conclusion OSA has a high prevalence in Chinese female PCOS patients, and has negative effects on various clinical manifestations of these patients, such as body mass index, sex hormone levels, glucose and lipid metabolism, inflammation, coagulation and biochemical indicators, which worsen with the severity of OSA. High serum HbA1c level was associated with the onset of OSA in Chinese female PCOS patients. In the diagnosis and treatment of PCOS patients in China, attention should be paid to OSA, and corresponding health management and intervention should be provided.

Objective To explore the serum molecular markers of different infiltration depth and tumor diameter of endometrial carcinoma Methods The clinicopathological data of 144 patients with endometrial cancer who underwent comprehensive staged surgery in the First Hospital of Shanxi Medical University from January 2018 to July 2023 were collected. The patient′s serum human epididymal protein E4 (HE4), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), Squamous cell carcinoma antigen (SCC), and alpha fetoprotein (AFP) levels at the time of admission were detected to analyze their relationships and the pathological parameters of EC. Logistic regression analysis was used to test the relationships and the endometrial cancer invasion depth ≥1/2 myometrial and the diameter of the tumor＞2 cm. The sensitivity, specificity and the receiver operating characteristics (ROC) curve were calculated in each index separately and combined to compare diagnostic efficiency. Results The expression level of HE4, CA125, CA199, and CEA in serum were statistically different between EC invasion depth＜1/2 myometrial and endometrial cancer invasion depth ≥1/2 myometrial (P＜0.05). CA125 and HE4 were statistically different in the diameter of tumor ≤ 2 cm and tumor diameter＞2 cm (P＜0.05). The sensitivity, specificity accuracy of CA125+CEA in the diagnosis of invasion depth ≥1/2, and accuracy of CA125+HE4 in the diagnosis of tumor diameter＞2 cm were relatively higher. The area under the ROC curve of CA125+HE4 in diagnosing depth ≥1/2 and the area under the ROC curve of CA125+CEA in diagnosing tumor diameter＞2 cm were larger than that of CA125 single diagnosis, CEA single diagnosis, and HE4 single diagnosis. Conclusion The combined detection of CA125 and CEA in serum supports diagnosing the invasion depth more than a half and the combined detection of CA125 and HE4 in serum supports diagnosing the tumor diameter greater than 2 cm and predicting high-risk factors of EC.

目的 评估Septin9甲基化检测在宫颈癌筛查中的应用价值。方法 选择2019年10月至2022年9月在青海红十字医院及本院全省医联体医院行宫颈癌筛查(高危HPV和TCT)的女性患者768例,其筛查结果符合转诊阴道镜活检指征并行Septin9甲基化检测与阴道镜活检组织病理学检测。以宫颈组织病理学结果作为金标准,将研究对象分为阴性组(组织病理学结果阴性及宫颈炎症)和阳性组(LSIL、HSIL、宫颈癌)。分别分析高危HPV检测、TCT、Septin9甲基化检测在各组织病理学检测结果中的检出率,以及Septin9甲基化检出率与宫颈病变程度之间是否存在关系;探讨与高危HPV检测、TCT、高危HPV检测联合TCT相比,Septin9甲基化检测对宫颈癌及癌前病变的诊断效能。结果 两组研究对象的基本特征比较,结果差异均无统计学意义(P均＞0.05),两组具有可比性;高危HPV检测、TCT在四组组织病理学检测结果中的检出率存在统计学差异(P均＜0.001);Septin9甲基化检测在各组织病理学检测结果中的检出率分别为:正常宫颈/宫颈炎为16.50%(68/412)、LSIL 为76.12%(153/201)、HSIL为96.35%(132/137)、宫颈癌为100%(18/18),四组阳性检出率存在统计学差异(P＜0.001),Septin9甲基化检出率与宫颈病变程度之间存在线性趋势(P＜0.05);与高危HPV检测相比,Septin9甲基化检测的特异度、阳性预测值、准确率及AUC较高(P均＜0.05),而灵敏度与阴性预测值无统计学差异(P均＞0.05);与TCT相比,Septin9基因甲基化检测的灵敏度、阴性预测值、准确率及AUC较高(P均＜0.05);而特异度与阳性预测值无统计学差异(P均＞0.05);与高危HPV联合TCT相比,Septin9基因甲基化检测的灵敏度、阴性预测值较高(P均＜0.05),而特异度、阳性预测值不及高危HPV联合TCT检测(P均＜0.05),其准确率与AUC与两者联合筛查对比差异无统计学意义(P均＞0.05)。结论 Septin9甲基化阳性检出率随着宫颈病变程度的增加逐渐升高,对HSIL与宫颈癌的阳性检出率较高。Septin9甲基化检测对高危HPV分流具有较高效能;高危HPV检测、TCT单独筛查时,Septin9甲基化检测较两者对宫颈癌及癌前病变的诊断效能更佳;两者联合筛查时,Septin9甲基化检测与两者联合筛查对宫颈癌及癌前病变的诊断效能相当。在转诊阴道镜活检之前先行Septin9甲基化检测能降低部分患者阴道镜活检转诊率。

产后出血(PPH)是导致全球孕产妇死亡的重要原因,尤其在发展中国家负担较重。尽管已明确多种风险因素,但目前临床缺乏有效的PPH预测工具。近年来,人工智能(AI)和机器学习(ML)技术在妇产科领域逐渐应用,但在PPH风险预测方面研究仍较少。与传统方法相比,ML能够处理复杂非线性关系和多维数据,可显著提高预测的准确性和灵敏度。然而,现有模型多存在外部验证不足、数据集特征复杂等问题。未来研究应聚焦于高质量大数据分析,开发可靠的PPH定量预测模型,并在不同人群中验证其通用性。

目的 了解高龄产妇母婴健康素养水平、影响因素及其健康教育需求,为进一步开展高龄产妇健康教育与健康促进工作提供科学依据。方法 采用整群抽样,选取2022年3月至2024年2月在山西省妇幼保健院住院分娩的高龄产妇为研究对象。由经过培训的调查员利用问卷星对产妇进行面对面问卷调查,调查问卷自行编制,内容包括一般人口学特征、母婴健康素养情况及健康教育需求,其中母婴健康素养情况包含基本知识和理念、生活方式与行为和基本技能三个方面。利用Logistic回归分析高龄产妇具备母婴健康素养的影响因素。结果 发放问卷2 211份,有效问卷2 130份,有效率为96.3%。调查对象平均年龄为(37.0±2.1)岁。母婴健康素养平均得分为(17.6±3.3)分。母婴健康素养水平为30.9%,三个方面水平由高到低依次为生活方式与行为(67.6%)、基本知识和理念(36.0%)以及基本技能(31.3%)。多因素Logistic回归分析结果显示,职业为个体经商(OR=2.80,95% CI:1.24~6.30)、1 000元≤家庭人均月收入＜2 000元(OR=3.69,95% CI:1.31～10.34)、2 000元≤家庭人均月收入4 000元(OR=2.90,95% CI:1.10～7.63)、4 000元≤家庭人均月收入＜8 000元(OR=3.77,95% CI:1.44～9.85)、8 000元以上(OR=3.18,95% CI:1.21～8.39)、参加健康教育活动(OR=1.75,95% CI:1.06～2.88)和参加孕妇学校(OR=2.4,95% CI:1.59～3.62)是高龄产妇具备母婴健康素养的促进因素。观看健康教育视频和网络媒体宣传是高龄产妇获取母婴保健知识的最重要方式,同时也是高龄产妇最希望获取母婴保健知识的方式。结论 高龄产妇健康素养水平需进一步提高,尤其基本知识和理念及基本技能。自由职业及无业、低收入、未参加健康教育活动、未参加孕妇学校的高龄产妇的健康素养水平更需要关注和干预,应根据不同高龄产妇的特点和健康教育需求开展针对性的健康教育活动。

孤独症谱系障碍(ASD)是一种神经发育障碍性疾病,对儿童的健康及成年后的生活质量构成严重威胁,是5岁以下儿童致残的主要原因之一。ASD目前尚缺乏有效治疗药物,主要治疗途径为康复训练,通过早期发现、早期诊断、早期干预可不同程度改善患儿症状和预后。大多数儿童在3～4岁被正式确诊,少数典型症状明显的儿童可在18～24个月确诊,大部分ASD患儿在确诊时已经错过了更理想的干预窗口。为早期发现ASD,国际和国内学者进行了多项儿童ASD早期预测的研究。现对ASD早期预测的国内外进展情况进行综述。

围产期抑郁是孕产妇常见的心理障碍之一,发生率高且危害大。本文对围产期抑郁预测因素和预测模型相关研究进展进行综述,以期为医护人员早期识别围产期抑郁高危人群,制定有效预防管理方案,提高孕产妇心理健康水平提供参考。

Objective To evaluate the accessibility and equity of free cervical cancer and breast cancer screening services for rural women of childbearing age in Sichuan Province, and to provide evidence for formulating prevention and treatment strategies for cervical cancer and breast cancer. Methods A questionnaire survey was conducted using a self-developed “Sichuan Province Cervical and Breast Cancer Prevention and Control Status and Service Capacity Survey Questionnaire.” The cervical cancer and breast cancer screening management centers in 21 cities (prefectures) and 183 counties (districts) of Sichuan Province were interviewed, and information including staffing and equipment status was collected. Demographic and land data were obtained from Seventh national census data and the Sichuan Statistical Yearbook (2022). Index including Health Resource Agglomeration (HRADi), Population Resource Agglomeration (PADi) and their ratios were used to evaluate the accessibility and equity of free cervical cancer and breast cancer screening services for rural women of childbearing age in Sichuan from both in macro- and micro- levels. Results The distribution of screening institutions in Sichuan Province shows a pattern of "Southern district>Western district>Eastern district>Northern district"; The distribution of screening personnel in Sichuan Province presented a pattern of "Eastern district>Chengdu>Western district>Southern district>Northern district". There were significant regional differences in the health resources of the cervical cancer and breast cancer screening services in Sichuan Province, with HRADi>1 in densely populated and average population areas, HRADi<1 in sparsely populated areas, HRADi/PADi>1 in average and sparse population areas, and HRADi/PADi<1 in densely populated areas. Conclusion The distribution of institutions and personnel for free cervical cancer and breast cancer screening service for rural women of childbearing age in Sichuan Province is uneven. The accessibility in densely populated areas and areas with average population is significantly better than that of areas with sparse population. On the contrary, the equity in average population and areas with sparse population is better than that of areas with dense population. It is recommended to enhace the accessibility and equity of screening services by increasing talent training, establishing additional screening service sites, constructing remote medical service platforms, building a unified cervical cancer and breast cancer screening information management system across the province, and establishing a regional counterpart assistance mechanism.

Objective To examine the association between maternal exposure to airborne particulate matter during pregnancy and neonatal physical development status indicators and to evaluate the lag effects of particulate exposure to identify sensitive time windows. Methods This study included 14,148 mother-infant pairs from the Pregnancy Nutrition Intervention Program conducted in Hebei Province. Monthly average PM concentrations with a 1 km×1 km resolution were obtained from the China High Air Pollutants(CHAP) database. Exposure levels during first, second, and third trimesters, as well as the entire pregnancy period, were estimated using maternal residential addresses and gestational weeks. Neonatal physical development indicators were standardized as Z-scores by gestational age and sex according to Chinese reference standards. Multiple linear regression models were used to examine the associations between PM exposure and neonatal physical development status. Distributed lag linear models were applied to assess the lag effects of exposure at different pregnancy stages and determine critical windows of susceptibility. Results For every 10 μg/m³ increase in PM_2.5, PM₁₀, and PM_2.5-10 exposure during the entire pregnancy, the birth weight Z-score decreased by 0.03(95% CI:-0.04, -0.02), 0.03(95% CI:-0.04, -0.02), and 0.101(95% CI:-0.12, -0.08), respectively. Similar negative associations were found for birth length and head circumference, with the most significant effects observed for PM_2.5-10. Results from distributed lag linear models showed that early pregnancy and late pregnancy were critical windows for birth weight and length, while the sensitive window for head circumference was mainly in early pregnancy. Conclusion Maternal exposure to particulate matter during pregnancy is significantly associated with reduced neonatal physical development status, and the effect of PM_2.5-10 was the most prominent. Early and late pregnancy are critical windows for neonatal physical development affected by PM exposure. These findings provide important evidence to inform air pollution control and maternal health interventions.

子宫内膜癌全球发病率呈快速上升趋势。2022年,我国子宫内膜癌新发病例约7.7万例,已成为女性生殖系统第二大常见恶性肿瘤。早期子宫内膜癌的5年生存率可达90%以上,而晚期仅为16%左右,开展子宫内膜癌早诊筛查具有重要意义。我国对于子宫内膜癌筛查的卫生经济学评价研究相对落后,尚缺乏系统性研究。国外对子宫内膜癌筛查的卫生经济学评价研究主要集中在筛查策略比较和技术评价方面。研究表明,对肥胖、林奇综合征、长期使用他莫昔芬者等高危人群开展筛查具有成本效益,使用分子检测等新技术比传统方法更具成本效益;评价指标主要包括成本指标如筛查、诊断、治疗成本等,健康指标如检出率、避免疾病数量等,以及综合指标如增量成本效益比(ICER)等;评价方法主要包括马尔可夫模型、决策树模型等;评价视角多采用卫生系统或社会视角。国际研究对我国的启示包括:建立基于风险分层的精准筛查策略;对新兴技术进行经济学评价;确定最佳筛查起始年龄和间隔时间;考虑区域差异,制定差异化策略;推进多癌种联合筛查,将子宫内膜癌筛查纳入“两癌筛查”形成“三癌筛查”;加强子宫内膜癌筛查卫生经济学评价的方法学研究,尽量采用社会视角,规范应用QALY或DALY等指标和使用贴现率,以提高研究质量和可比性等。

Objective To describe the results of breast cancer screening among rural women aged 35-64 in a northern county of China from 2019 to 2022, to provide reference for optimizing and promoting breast cancer screening projects. Methods This study based on a breast cancer screening project implemented in a northern county of China from 2019 to 2022. The screening targeted rural women aged 35-64 who voluntarily participated. We analyzed the abnormal rate of ultrasound, positive rate of mammography, and breast cancer detection rate. Chi-square tests or Fisher′s exact tests were used to compare the screening results among different demographic groups, and Cochran-Armitage trend tests were used for trend analysis. Results A total of 68 695 individuals were included in the analysis, with a cumulative ultrasound screening count of 90 402. The abnormal rate of ultrasound was 24.0% (21 732/90 402), the positive rate of mammography was 7.0% (44/626), the breast cancer detection rate was 69.9 per 100 000 (48/68 695), and the early diagnosis rate of breast cancer was 72.9% (35/48). The abnormal rate of ultrasound increased with age initially and then decreased (P<0.001), increased with higher education levels (P for trend<0.001), and increased with earlier age at menarche (P for trend<0.001). The abnormal rate of ultrasound was significantly lower in postmenopausal women compared to premenopausal women (P<0.001). The positive rate of mammography increased with age (P for trend=0.001), showed a decreasing trend with higher education levels but was not statistically significant and did not differ significantly by age at menarche. The positive rate of mammography was higher in postmenopausal women but was not statistically significant. The breast cancer detection rate generally increased with age (P for trend=0.016), showed a decreasing trend with higher education levels but was not statistically significant, increased with earlier age at menarche but was not statistically significant. The breast cancer detection rate was higher in postmenopausal women but was not statistically significant. Conclusion The breast cancer detection rate among rural women aged 35-64 in the northern county of China from 2019 to 2022 was nearly 70 per 100 000, and the early diagnosis rate was nearly 73%, indicating that the breast cancer screening situation in the area was relatively good. Younger women had a higher abnormal rate of ultrasound but a lower breast cancer detection rate compared to older women, and the breast cancer detection rate increased with age, suggesting the need to explore breast cancer screening strategies tailored to different age groups of women. Future efforts should focus on enhancing health education to improve women′s participation in breast cancer screening, thereby achieving early detection and effective management of breast cancer.

近年来,随着脂肪来源血管基质成分(SVF)相关研究的不断深入,其组织修复再生的潜力已被证实,大量的研究表明脂肪SVF具有良好的安全性和明显的治疗效果;现阶段最普遍的治疗应用方向是骨科与美容整形,其次是神经、心血管、消化系统等。在生殖健康领域,目前已有研究将脂肪SVF应用于卵巢早衰、不孕症、女性压力性尿失禁等临床常见疾病的治疗,均未见严重的不良反应。本文主要介绍脂肪SVF的组成及功能和临床应用——特别是生殖健康领域的研究进展,并对脂肪SVF用于治疗疾病的可行性进行分析。

目的 了解一胎、二胎孕妇的感知压力状况,并探讨其影响因素。方法 采用横断面研究方法,选取2020年5月至8月在山东省昌邑市妇幼保健院416名处于孕13周至38周的孕妇为研究对象,其中一胎孕妇189人,二胎孕妇227人,采用基本情况调查表、中文版感知压力量表和领悟社会支持量表对孕妇进行问卷调查。结果 一胎孕妇感知压力得分为(18.5±7.9)分,二胎孕妇感知压力得分为(17.8±7.8)分,两者在感知压力状况上的得分不存在显著差异(P>0.05)。家庭月收入低、睡眠情况差、领悟社会支持水平低是一胎孕妇感知压力的主要风险因素(P<0.05)。低领悟社会支持水平是二胎孕妇感知压力的主要风险因素(P<0.05)。结论 一胎、二胎孕妇的感知压力状况均较低,领悟社会支持是一胎、二胎孕妇感知压力的共同影响因素,提示应给予孕妇提供更多的社会支持和家庭支持,以减轻孕妇的孕期压力水平。

Objective To analyze the allocation of health human resources among national maternal and child health (MCH) institutions in China in 2022, evaluate the equity, and provide reference for the rational allocation of health human resources in MCH institutions. Methods Data were collected from the national MCH institution monitoring system in China, human resource allocation of MCH institutions in each province was described. Lorenz curve, Gini coefficient and Theil index were used to analyze the equity of human resource allocation in MCH institutions by population, geographical area and gross national product (GDP) dimensions. Results In 2022, there were a total of 526,200 health care professionals in national MCH institutions in China, practicing (assistant) physician (34.8%) and nurse (47.0%) share the highest proportions. The total number of health care professionals by province varied significantly. Results of the Lorenz curve and Gini coefficient revealed that the allocation of health technicians was relatively equitable in terms of population and GDP dimensions, while the allocation in the geographical area dimension was highly inequitable. In geographical area dimension, the contribution rate of the Theil index within the region was significantly higher than that between regions. The high contribution rate within the region was primarily attributable to the inequitable allocation of human resources in MCH institutions in the western region. Conclusion In 2022, the allocation of health human resources in national MCH institutions across China exhibited relatively good equity in the dimensions of population and GDP, however, equity was lowest in the dimension of geographical area. Particular attention should be paid to the western region, where geographical factors must be taken into account. Resource allocation should be rationally planned according to the actual conditions within each region, with the aim of continuously improving both the equity of health human resources in maternal and child health institutions and their capacity for delivering medical services.

随着国家计划生育政策的改革,从“二孩”的开放到“三孩”政策落地,高龄人群不孕不育问题增多,需求辅助生殖技术(ART)治疗的需求相应增多。高科技的现代医学技术在给千万家庭带去希望和幸福,同时也加剧了患者本身的心理问题,如恐惧、焦虑、自责、抑郁、自闭等。文章以参考文献为指引,以实际工作总结为基础,全面分析不孕(育)症患者不良心理的成因,从医务工作者的视角出发,探讨临床上有效可行性的心理干预及应对策略。

目的 分析妊娠期危险因素及出生后养育方式对早产儿校正24月龄内体重发育轨迹的影响,探讨影响体重追赶的关键因素。方法 采用回顾性病例对照研究,选取2021年5月至2022年4月在北京大学第三医院产科分娩的早产儿作为研究对象,共纳入符合研究标准的早产儿363例,分别在校正月龄的6、12、18、24个月进行随访评估。通过分析临床资料和开展问卷调查,收集妊娠期合并症及养育方式等数据,探讨各因素对早产儿体重发育的影响。结果 妊娠期贫血、子痫前期等合并症,高龄妊娠、剖宫产及窒息史等围产因素,以及不当喂养方式和不同照护者均会影响早产儿体重发育;12月龄时,高龄妊娠是早产儿体重等级提升的保护因素;12～24月龄时,剖宫产是早产儿高体重的持续性危险因素;混合喂养模式可显著优化体重发育轨迹(各月龄均最优);18～24月龄时,贫血及祖父母照顾组的高体重比例显著增高(vs父母照顾组,P=0.008),甲状腺功能和受孕方式对子代体重无影响。结论 加强妊娠期合并症管理,正确喂养和养育,均有利于改善早产儿体重发育。

Objective To screen the risk factors for preterm birth and construct a preterm birth prediction model based on general and clinical information which provide reference for preterm birth screening. Methods 10 524 pregnant women from Lanzhou birth cohort were selected as subjects, and the relevant data such as general characteristics, pregnancy history, newborn condition and maternal factors were selected. The research data set was randomly divided into a training set and a test set according to the ratio of 7∶3, and the risk factors of preterm birth were screened in the training set. The data of preterm and non-preterm birth in the training set were balanced, and three kinds of machine learning algorithms were used to build prediction models. The area under receiver operating characteristic curve (AUC), balance accuracy, sensitivity, specificity and geometric mean (G-mean) were selected for performance evaluation in the test set. Results 10 136 pregnant women were included in the study and 9 variables were included in the model training. The model using the data balancing method had better prediction performance, and the AUCs were 0.766(95%CI:0.736-0.796) and 0.759(95%CI:0.730-0.788), respectively. Conclusion This study initially screened out the risk factors of preterm birth, and improved the performance of the machine learning preterm birth prediction model with data balancing, which provided more references for the screening of preterm birth. In the future, it is necessary to conduct a multi-center study to further verify the model performance.

肠道菌群是宿主体内极为庞大和复杂的微生物群,是人体的第二基因库。近年随着16SrRNA基因测序和宏基因组测序的不断发展,各类生育相关疾病的肠道菌群多样性、细菌相对丰度、代谢物、细胞因子等存在特异性改变,拟杆菌、咪唑丙酸等特定菌属和代谢物还可作为生育相关疾病的生物标志物。也有研究证实抗生素引起肠道菌群多样性和丰富度降低,影响患者术后及预后。益生菌、粪菌移植、调节代谢物等干预手段对改善肠道菌群有一定的效果,其它抗炎、调节肠道菌群的药物治疗方法也在不断的探索。本文拟对肠道菌群与多囊卵巢综合征、子宫内膜异位症、复发性流产、子宫内膜炎关系的研究进展进行系统综述。

Objective To explore the risk of patients with perimenopausal stress urinary incontinence(SUI) and construct a risk recognition model. Methods A total of 82 perimenopausal patients with stress incontinence admitted to the hospital from December 2020 to April 2024 were selected as the observation group, and 82 perimenopausal patients without SUI were selected as the control group. The clinical data of the two groups were compared. Logistic regression analysis was used to identify the risk factors for SUI in perimenopause. The risk identification model of SUI was constructed according to the influencing factors. Receiver operating characteristic curve(ROC) and Hosmer-Lemeshow test were used to verify the differentiation and fit of the model. Results Age ≥50 years old, body mass index≥25 kg/m², vaginal delivery, atrophic vaginitis, constipation, pelvic organ prolapse and urinary tract infection in observation group were higher than those in control group(P<0.05). Logistic regression analysis showed that constipation, pelvic organ prolapse, urinary tract infection history, vaginal delivery and body mass index≥25 kg/m² were independent risk factors for SUI in perimenopausal patients(P<0.05). A nomogram model was constructed based on risk factors. The total score ranged from 125 to 350, corresponding to a risk range of 0.1 to 0.9 The higher the score, the higher the risk of SUI in perimenopausal patients. The ROC curve was drawn by the nomogram model. The results showed that the area under the curve(AUC) of the model for predicting SUI was 0.905(95%CI:0.854~0.942), the sensitivity sensitivity was 92.68%, the specificity was 83.22%, and the Yodon index was 0.759. Calibration curve showed that the calibration curve of the prediction model was close to the actual curve(Hosmer-Lemeshow χ²=0.931, P=0.267). Conclusion constipation, pelvic organ prolapse, urinary tract infection history, vaginal delivery, and body mass index≥25 kg/m² were associated with an increased risk of SUI in perimenopausal patients. The nomogram model built based on the above factors had good differentiation and accuracy.

目的 探讨多种炎症细胞因子及脂氧素与子宫内膜异位症发病及分期的关系,为内异症的非侵入性诊断及病情程度的界定提供一定的依据。方法 2022年4月—2023年3月河南省人民医院妇科行腹腔镜手术病理结果提示为内异症的患者30例为内异症组,非内异症的患者31例为对照组。利用ELISA方法检测内异症组及对照组的血清液中炎症细胞因子IL-37、IL-17A、IL-10、IL-6、IL-4、IL-2、LXA4等水平;利用Pearson相关分析及ROC曲线分析以上血清各项指标与内异症发病风险及病情严重程度的关系。结果 血清中IL-2、IL-17A、LXA4与内异症发病及病情严重程度均呈明显负相关,差异有统计学意义(P＜0.05);IL-10、IL-37与内异症发病呈明显正相关,差异有统计学意义(P＜0.05);且 IL-37与内异症病情程度呈明显正相关,差异有统计学意义(P＜0.05);ROC 曲线得出,血清IL-2 对内异症的敏感性为90%,特异性为93.3%;IL-17A对内异症的敏感性为90%,特异性为96.7%;其对内异症病情程度的敏感性为86.7%,特异性为 86.7%;IL-37对内异症的敏感性为95%,特异性为96.7%;其对内异症病情程度的敏感性为60%,特异性为86.7%(P＜0.05)。结论 通过血清中IL-37、IL-17A、IL-10、IL-2、LXA4等浓度的表达差异,为内异症无创性诊断及病情严重程度的界定提供了更多依据。

Objective To describe the characteristics of neuropsychological development of children aged 0-2 years and analyze the association between birth weight and neuropsychological development of children. Methods The study data were the assessment records of Gesell Developmental Schedule(GDS) and related birth and delivery information of children aged 0-2 years who received physical examination in Liuyang Maternal and Child Health Hospital from 2018 to 2024. The five dimensions of GDS include gross motor, fine motor, adaptability, language, personal-social behavior as well as a comprehensive assessment. The assessment results were expressed by developmental quotient(DQ), which were divided into normal, borderline and abnormal by DQ from high to low. The abnormal results were subdivided into mild, moderate, severe, and profound abnormalities. Generalized estimation equations(GEE) and quantile regression models were used to evaluate the association between birth weight and neuropsychological development of children after adjusting for potential confounders. In order to exclude the influence of autocorrelation of multiple assessment results about neuropsychological development characteristics of the same child, sensitivity analysis was conducted by randomly keeping only one of the results among children who received multiple assessments. Results A total of 29 053 assessments from 19 027 children were included in the study. The overall neuropsychological development was normal in 17 872(61.5%), borderline in 8 691(29.9%), mild abnormal in 2 180(7.5%), moderate abnormal in 228(0.8%), and severe or profound abnormal in 82(0.3%) assessments, respectively. The GEE showed that compared with normal birth weight children, low birth weight children had a significant increase in the risk of overall abnormal neuropsychological development(OR=3.47, 95% CI:2.98-4.04), and the risk of abnormal development was significantly increased in all 5 domains(OR range:2.55-4.01). Macrosomia was a protective factor for abnormal fine motor development(OR=0.69, 95% CI:0.51-0.92), but not significantly associated with the overall abnormal development(OR=0.77, 95% CI:0.55-1.07) or those of the other 4 domains(OR range:0.77-0.97). Quantile regression showed a positive association between birth weight and overall DQ, and birth weight had a greater effect on the lower percentile of overall DQ. With every 1 kg increase in birth weight, the 80th percentile of overall DQ increased by 1.7, while the 20th percentile of overall DQ increased by 3.2. There was also a similar association between birth weight and DQ of all 5 domains. The result of sensitivity analysis was basically consistent with that of the main analysis. Conclusion Birth weight is positively associated with neuropsychological development of children aged 0-2 years. Low birth weight is a risk factor for abnormal neuropsychological development, and the lower the development level the stronger the negative effect of low birth weight.

在我国鼓励生育二孩、三孩和提倡优生优育的政策背景下,孤独症家庭常常陷入再生育意愿的矛盾困境,对于是否进行再生育产生焦虑情绪。针对这一社会现象,文章检索了国内外相关文献,详细阐述了生育意愿和生育焦虑的概念、孤独症家庭再生育现状以及患儿父母年龄、不良生育经历、经济压力、家庭需求和生育观念对孤独症家庭再生育意愿的影响,旨在为其缓解再生育焦虑提供建议,也为有关部门制定孤独症再生育服务政策提供理论参考。

随着国家三孩政策的开放,生育需求随之上升,但复发性流产(RSA)发生率也逐年提高,严重威胁女性的生殖健康及人口增长,其致病机理复杂。随着研究深入,已发现胰岛素抵抗可能通过多种机制影响妊娠的维持以引发直接或间接RSA,如同型半胱氨酸水平、子宫动脉血流、性激素水平、血管内皮功能、子宫内膜内环境稳态、胰岛素样生长因子系统等因素,导致子宫内膜血流供应不足、血液高凝状态、促炎和促氧化应激、激素轴代谢紊乱、卵巢功能衰退、子宫内膜容受性降低等,诱导RSA发生。其中,胰岛素抵抗诱导RSA的环节可能与PI3K/AKT、MAPK、NF-κB、AMPK等信号通路相关。因此,研究这些机制将有助于开发新的预防和治疗方法,进一步对RSA患者进行胰岛素抵抗的筛查和诊断,并采取综合的个体化管理措施,将有助于降低RSA的发生率,提高妊娠成功率。

卵巢黄体破裂是妇科育龄期女性急腹症之一,若出血较少,破口可自行闭合;若出血多,可导致休克,危及生命。特发性血小板减少性紫癜患者存在凝血功能障碍,此类患者卵巢黄体破裂的风险高,后果较严重,且有复发性的特点,临床处理棘手。本文回顾性分析2022年甘肃省妇幼保健院收治的 1 例青春期复发性卵巢黄体破裂合并特发性血小板减少性紫癜患者两次治疗过程进行回顾、讨论。探讨手术及保守治疗指征及采用药物抑制排卵、减少复发的重要性。

Objective To evaluate the differences in preoperative serummarkers of inflammation, coagulation, tumor biomarkers and ultrasound characteristics between borderline ovarian tumors(BOT) and epithelial ovarian cancer(EOC), and to explore the diagnostic value of combining preoperative serum markers with ultrasound characteristics in the differential diagnosis of BOT and EOC. Methods A retrospective analysis was conducted among 224 patients who underwent surgery in the First Hospital of Shanxi Medical University from August 2018 to December 2023 and were pathologically confirmed(112 cases in BOT group, 112 cases in EOC group). The differences in preoperative serum markers and ultrasonic features between the two groups were compared. Binary logistic regression analysis was used to identify independent factors for differentiating BOT from EOC. Receiver operating characteristic(ROC) curves were plotted to assess the ability of preoperative serum markers and/or ultrasonic features to differentiate BOT from EOC. Results Multivariate logistic regression analysis revealed that the presence of papillary projections, septations, blood flow signals on ultrasonic features, and serum markers including platelets(Plt), lymphocytes(L), monocyte-to-lymphocyte ratio(MLR), systemic immune-inflammation index(SII), fibrinogen(Fib), and ROMA were independent factors for preoperative differentiation between BOT and EOC(P<0.05). The ROC curve analysis indicated that the combination of ROMA + SII + Fib + MLR + Plt + L had the highest area under the curve(AUC) and the highest specificity and positive predictive value(PPV) in the combined serum marker differentiation. The combination of all the above independent factors along with ultrasonic features yielded the highest AUC of 0.930 for the combined differentiation, with the highest sensitivity and negative predictive value(NPV), both exceeding 90%. The combination of ROMA + SII + Fib + MLR + Plt + L + presence of blood flow signals + presence of septations balanced sensitivity, specificity, PPV, and NPV well, all at 85.7%. Conclusion Significant differences in preoperative serum markers and ultrasonic features exist between BOT and EOC. The combination of preoperative serum markers ROMA, SII, Fib, MLR, Plt, L, and ultrasonic features such as the presence of papillary projections, septations, and blood flow signals can be used for the preoperative differentiation of BOT and EOC with good diagnostic efficacy, which may provide a reference for preoperative clinical diagnosis.

目的 分析青海省4个监测县(区)不同孕期孕妇血清维生素D、维生素B12、铁蛋白、叶酸水平,评价监测县(区)孕妇的营养状况,为本地区开展不同孕期孕妇健康促进提供科学依据。方法 采用分层随机抽样方法,2023年3月在青海省西宁市城北区、海东市互助县、循化县及海南州贵德县4个监测县(区)作为调查现场,遵循自愿原则,采用方便抽样法,选取176名孕妇进行问卷调查并收集其空腹静脉血液用于实验室检测,分析不同孕期血液指标的水平,计算指标异常的比例。采用非参数检验,对不同孕期孕妇血生化指标检测结果进行总体及两两比较。采用χ²检验对血生化指标异常值发生率进行比较。结果 孕妇中血清维生素D缺乏率73.9%,维生素B12缺乏率29.0%,铁蛋白缺乏率47.7%,叶酸缺乏率27.8%,孕妇中有165人(93.8%)至少一种营养素缺乏,有96人(54.5%)至少两种营养素缺乏。随着孕期增加,维生素B12水平逐渐下降(P＜0.05),孕晚期维生素B12缺乏率分别高于孕早期、孕中期(P均＜0.05);孕早期铁蛋白水平分别高于孕中期、孕晚期(P均＜0.001),中、晚期孕妇铁缺乏率均高于孕早期(P均＜0.05);随着孕期增加,叶酸水平逐渐下降(P＜0.05),孕晚期叶酸缺乏率高于孕早期、孕中期(P均＜0.05)。结论 随着孕妇孕期增加,维生素B12、铁蛋白、叶酸水平降低,孕晚期营养素缺乏比例较高,孕妇维生素D缺乏严重。重视不同孕期孕妇营养素水平监测,及时纠正营养素缺乏的情况对保障孕妇健康有重要意义。

Objective To explore the correlation and differential effects of paternal smoking, alcohol consumption in three months before pregnancy with spontaneous abortion, so as to provide evidence for pre-pregnancy health guidance. Methods A case-control study was conducted in the Anhui Province pilot site of abortion monitoring under the birth and birth defects surveillance sub-project of the comprehensive cancer prevention and application promotion project. All recorded cases of spontaneous abortion and controls (full-term normal live births) collected from January 2020 to December 2024 were included. A unified registration form specific to the project was used to record maternal information, paternal information, pregnancy history, current pregnancy details, as well as major diseases and environmental risk factors from three months prior to conception until pregnancy termination. All information was uniformly entered into the Key Regions Birth and Birth Defect Surveillance Management Module of the China Disease Control and Prevention Information System. Results A total of 1 411 participants were included (737 controls, 674 spontaneous abortion cases). Paternal smoking and alcohol consumption rates in three months before pregnancy were 15.6% and 24.8%, respectively. Multivariate logistic regression analysis, after adjusting for covariates such as maternal age, education level, gravidity, and parity, showed that compared with the group with neither paternal smoking nor alcohol consumption in three months before pregnancy, the risk of spontaneous abortion was significantly increased in the smoking only group (OR=4.97, 95%CI=1.70, 14.50), the alcohol consumption only group (OR=1.68, 95%CI=1.04, 2.72), and the group with both smoking and alcohol consumption (OR=5.34, 95%CI=3.12, 9.12). Compared with non-smokers, the OR values for smoking 1-9 cigarettes and ≥10 cigarettes per day were 3.05 and 9.96, respectively. Conclusion The findings suggest that paternal smoking and alcohol consumption before pregnancy can significantly increase the risk of spontaneous abortion in their spouses. Health education emphasizing smoking and alcohol cessation for both partners during the preconception period should be strengthened.

目的 探究微小RNA-205(miR-205)在卵巢子宫内膜异位症(OEMs)中作用及与体外受精-胚胎移植(IVF-ET)妊娠结局关系。方法 选取2021年11月—2022年6月石家庄市人民医院100例OEMs患者作为OEMs组,另选同期50例体检正常的育龄女性作为体检正常组。比较两组基础资料、血清miR-205、OEMs传统标志物[糖类抗原125(CA125)、血管内皮生长因子(VEGF)、抗子宫内膜抗体(EMAb)]水平,并比较OEMs组不同临床特征患者血清miR-205水平,分析OEMs组血清miR-205水平与OEMs传统标志物水平、临床特征的相关性;OEMs组均行IVF-ET,移植后第35天评估妊娠结局,比较成功妊娠与未成功妊娠患者入院时血清miR-205、OEMs传统标志物水平,分析入院时血清miR-205、OEMs传统标志物水平预测IVF-ET妊娠结局的价值,比较含与不含miR-205预测方案对IVF-ET妊娠结局的预测价值。结果 OEMs组血清miR-205水平低于体检正常组,血清CA125、VEGF、EMAb水平高于体检正常组(P＜0.05);OEMs组不同美国生育学会修正EM分期(r-AFS)患者血清miR-205水平比较差异有统计学意义,随着r-AFS增加,血清miR-205水平明显降低;OEMs组血清miR-205水平与血清CA125、VEGF、EMAb水平、r-AFS呈负相关(P＜0.05);OEMs组IVF-ET后第35天未成功妊娠患者入院时血清miR-205水平低于成功妊娠患者,血清CA125、VEGF、EMAb水平高于成功妊娠患者(P＜0.05);入院时血清miR-205、CA125、VEGF、EMAb预测OEMs患者IVF-ET妊娠结局为未成功妊娠的曲线下面积(AUC)分别为0.744、0.757、0.745、0.774;与不含miR-205预测方案(血清CA125、VEGF、EMAb联合预测)的AUC(0.822)比较,含miR-205预测方案(血清miR-205、CA125、VEGF、EMAb联合预测)的AUC(0.947)明显增大,NRI、IDI均＞0(P＜0.05)。结论 OEMs患者血清miR-205水平明显降低,且在预测IVF-ET妊娠结局方面具有一定价值。

Objective To explore the comprehensive effect of weight gain in early pregnancy on gestational diabetes mellitus (GDM), gestational hypertension (GHP), and GDM combined with GHP.Methods A retrospective cohort study was conducted on one of the largest maternal and child health hospital in Hubei Province from April 2021 to April 2022, including general personal information, weight information in early pregnancy, and pregnancy outcomes. A total of 3 046 eligible participants were obtained, including 2 013 in the control group, 781 in the GDM group, 182 in the GHP group, and 70 in the GDM combined GHP group. The effects of maternal general personal information and gestational weight gain on GDM, GHP, and GDM combined with GHP were analyzed using multinomial logistic regression analysis, and the risk of GDM combined with GHP was predicted using a nomogram. The receiver operating characteristic (ROC) curve was used to visualize the predictive outcome, and the area under the ROC curve (AUC) was employed to assess the model's predictive performance.Results Pre-pregnancy BMI was a common influencing factor for GDM, GHP, and GDM combined with GHP. The higher the pre-pregnancy BMI, the higher risks were observed among the diseases (P for trend <0.001). GDM was also related to gestational age, ABO blood type, and family history of diabetes; GHP was associated with multiparous and a family history of hypertension; GDM combined with GHP was associated with ABO blood type. In addition, ABO blood type, pre-pregnancy BMI, and weight gain in early pregnancy have a good predictive effect on the incidence of GDM combined with GHP (AUC=0.792).Conclusion The results of this study suggested that attention should be paid to weight management before and during early pregnancy to reduce the risk of GDM and GHP. In addition, the predictive effect of the three factors, including ABO blood type, pre-pregnancy BMI, and weight gain in early pregnancy on GDM combined with GHP is conducive to early clinical identification of high-risk groups, which could be helpful in timely clinical intervention to reduce adverse pregnancy outcomes.

Objective To examine the temporal trends and spatial distribution characteristics of fertility rate among women of childbearing age across 31 provincial-level administrative regions in China from 2008 to 2022. Methods Statistical data related to fertility rates in 31 provincial-level administrative regions (excluding Hong Kong, Macao and Taiwan regions of China) in China from 2008 to 2022 were collected. Descriptive analysis was conducted in both spatial and temporal dimensions, spatial autocorrelation analysis was used to explore the spatial aggregation characteristics and patterns of fertility rates by region. Results Fertility rate among women of childbearing age in China remained persistently low from 2008 to 2022, accompanied by a notable phenomenon of delayed childbearing among the childbearing age population. The spatial pattern exhibited a gradual decrease from the south to the north. There is a positive spatial autocorrelation of fertility rates with distinct clustering patterns across regions. Conclusion Fertility rate among women of childbearing age in China continues to be persistently low, and it is expected that the fertility will remain at an extremely low rate for a long time in the future. In order to promote the long-term balanced population development, region-specific personalized suggestions could be put forward according to the distinct spatial patterns, and international experience could be drawn to foster a fertility-friendly social environment.

多囊卵巢综合征(PCOS)是育龄妇女最常见的内分泌紊乱性疾病,其临床表现多样,对妇女的身心健康产生巨大负面影响,不同表型PCOS 患者的临床表现存在显著异质性,患者主诉及需求各异以及代谢紊乱程度不同,本文介绍了PCOS不同表型在蛋白质组学上的进展,将为PCOS的预防和诊治带来新的契机。

目的 分析河北省唐县、黄骅市、丰宁县、容城县四个试点研究单位新生儿先天性心脏病筛查数据,探讨基层医院先天性心脏病规范化筛查模式构建及标准化管理成效。方法 选取2021年1月至2022年12月河北省唐县、黄骅市、丰宁县、容城县四个试点研究单位,借助公益基金支持,采用超声心动图对22 569例新生儿进行免费筛查。针对前期基层医院新生儿先天性心脏病筛查率、转诊率低的情况,河北省儿童医院于2022年建立标准化管理体系,启用了规范的新生儿先天性心脏病筛查模式(初筛-转诊-随访-治疗),其中2021年规范化筛查模式启用前,新生儿先天性心脏病筛查11 259例;2022年规范化筛查模式启用后,筛查11 310例;比较规范化筛查模式启用前后新生儿的筛查率、筛查阳性率、转诊到位率、心脏超声检查率、阳性确诊率、先天性心脏病死亡率之间的差异。结果 河北省唐县、黄骅市、丰宁县、容城县四个试点研究单位2022年规范化筛查模式启用后筛查率、初筛阳性率、患者的转诊到位率、心脏超声检查率、阳性确诊率、先天性心脏病的发病率均高于2021年启用前,死亡率低于2021年,差异均有统计学意义。结论 新生儿先天性心脏病标准化管理体系下的规范化筛查模式可有效提高基层医院先天性心脏病患者的筛查率、筛查阳性率、转诊到位率、心脏超声检查率、阳性确诊率,有效降低先天性心脏病的死亡率,有效提升基层医院新生儿先天性心脏病筛查项目的管理成效。

目的 比较不同受孕方式下双胎妊娠的母婴围产期结局差异。方法 收集2022年7月1日至2023年6月30日在山西省儿童医院产科分娩的515例双胎妊娠产妇,其中自然受孕组163例,体外受精-胚胎移植组302例,促排卵组50例。对产妇的一般资料、妊娠结局指标、新生儿结局指标进行统计学分析。结果 在孕产妇一般资料方面,体外受精-胚胎移植组的产妇年龄(32.0±0.2)岁大于自然受孕组(29.9±0.4)岁和促排卵组(29.4±0.4)岁;均P<0.001。体外受精-胚胎移植组的剖宫产率(94.4%)高于自然受孕组(86.5%);P=0.003。自然受孕组单绒双羊双胎的比例(42.3%)显著高于体外受精-胚胎移植组(6.0%)与促排卵组(4.0%);均P<0.001。在产妇妊娠结局指标方面,调整孕妇年龄等混杂因素后,体外受精-胚胎移植组产妇的妊娠期肝内胆汁淤积症(OR=4.13,95%CI:1.05~16.88)与胎盘不良结局(OR=2.07,95%CI:1.15~3.72)的发生率显著高于自然受孕组。在新生儿结局方面,调整胎龄、绒毛膜性等混杂因素后,体外受精-胚胎移植(OR=3.31,95%CI:1.64~5.65)与促排卵(OR=2.93,95%CI:1.27~6.73)新生儿贫血的危险因素。体外受精-胚胎移植(OR=1.79,95%CI:1.12~2.90)是胎儿宫内生长受限危险因素。结论 与自然受孕相比,辅助生殖技术包括体外受精-胚胎移植技术和促排卵技术助孕后的双胎妊娠是出现某些妊娠期并发症及新生儿早期疾病的危险因素。在临床工作中,经辅助生殖技术助孕后的双胎妊娠一旦确诊,必须按时进行产前检查,以便及早诊断和处理并发症,改善其母婴围产期结局。

目的 调查西藏拉萨地区妊娠期糖尿病(GDM)情况为科学防治提供参考。方法 收集2023年5月—2024年5月在拉萨市人民医院妇产科门诊就诊的孕24~28⁺⁶周孕妇的OGTT检查结果,选择50例GDM患者作为GDM组,同期分娩的50例无产科并发症的孕妇作为对照组,收集两组孕妇妊娠结局相关信息。结果 GDM在西藏地区检出率偏低,为6.4%。随年龄增长,GDM的检出率呈上升趋势。两组的年龄及产前BMI对GMD检出率差异有统计学意义(P＜0.05);两组在分娩方式选择上差异有统计学意义(P＜0.05);GDM组和对照组在分娩孕周、产后出血量、新生儿体重、新生儿Apgar评分(1、5、10 min)差异无统计学意义(P＞0.05)。结论 西藏高原地区GDM检出率低,仍需加强孕产妇体重管理。

回顾性分析1例Mohr-Tranebjaerg综合征合并X连锁无丙种球蛋白血症患儿的临床资料,并复习相关文献。Mohr-Tranebjaerg综合征是线粒体疾病,属于罕见病,主要表现为肌张力障碍、早发性耳聋和各种神经系统症状的罕见疾病,目前暂无有效治疗手段。X连锁无丙种球蛋白血症是原发性体液免疫缺陷,B细胞谱系固有的且局限于该系细胞的遗传缺陷。主要表现为重度低丙种球蛋白血症、抗体缺乏和感染易感性增加,目前有效的治疗方法为免疫球蛋白替代,避免感染,干细胞移植。两者均可基因检测有助确诊及产前诊断。

目的 分析影响多囊卵巢综合征(PCOS)患者妊娠结局的独立因素,并据此构建列线图模型。方法 回顾性分析河南中医药大学第一附属医院生殖医学科于2020年1月至2023年9月进入体外受精/卵胞质内单精子注射(IVF/ICSI)周期行卵泡期长方案新鲜胚胎移植251例PCOS患者的临床资料。根据妊娠结果,将患者分为临床妊娠成功组(n=134例)和临床妊娠失败组(n=117例)。收集患者一般资料、实验室检查、既往病史。正态分布的计量资料组间比较采用t检验;非正态分布的计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ²检验。通过多因素Logistic回归分析筛选出独立风险因子,基于此建立列线图,采用ROC曲线评估该列线图模型的区分度、校准曲线评价其有效性。结果 两组患者不孕年限、妊娠次数、流产次数、促卵泡激素(FSH)、雌二醇(E2)、孕酮(P)、睾酮(T)、催乳素(PRL)、抗缪勒管激素(AMH)、促性腺激素(Gn)启动剂量、促性腺激素(Gn)总用量、促性腺激素(Gn)用药天数、获卵率、成熟卵母细胞率(MII卵率)、移植日子宫内膜厚度、移植胚胎个数,差异无统计学意义;两组患者在年龄、体质指数(BMI)、扳机日促黄体生成素(扳机日LH)、扳机日雌二醇(扳机日E2)、扳机日孕酮(扳机日P)、优胚个数、优胚率、LH、人绒毛膜促性腺激素(hCG)注射日双侧卵巢内直径≥14 mm卵泡的个数方面之间差异均有统计学意义;经Logistic回归分析可知,年龄、BMI、扳机日P、hCG扳机日双侧卵巢内直径≥14 mm卵泡的个数均为影响PCOS患者妊娠丢失的危险因素(P<0.05);优胚率为PCOS患者临床妊娠的保护因素(P<0.05);ROC曲线分析结果显示该列线图预测PCOS患者临床妊娠的曲线下面积(AUC)为0.773(95% CI:0.716～0.831)。校准曲线显示发生临床妊娠的观测值和预测值拟合度好。结论 年龄、BMI、扳机日P、优胚率、hCG扳机日双侧卵巢内直径≥14 mm卵泡的个数均影响妊娠的独立因素,在此基础上构建列线图模型能够更直观、有效预测PCOS患者早期妊娠丢失的风险,具有良好的预测效能。

Objective Based on the “Balance Between Yin and Yang” theory, this study investigated the effects and mechanisms of circadian rhythm disruption on hormone levels and ovarian morphology in a rat model of Polycystic Ovary Syndrome(PCOS). Methods SD rats were used to establish a polycystic ovary syndrome(PCOS) model through the injection of dehydroepiandrosterone(DHEA). The general condition and body weight of the rats were observed, and vaginal smears were taken from day 12 of modeling to observe the estrous cycle. After modeling, ELISA was performed to measure serum levels of luteinizing hormone(LH), follicle-stimulating hormone(FSH), estradiol(E2), and total testosterone(T). A total of 30 PCOS model rats were successfully prepared and randomly divided into three groups:PCOS model group, PCOS+ prolonged light exposure group, and PCOS+continuous light exposure group, with ten rats in each group. Additionally, a control group of ten rats with normal sleep schedules were also set. After light treatment, blood samples were collected by decapitation for analysis, and ovarian tissues were collected to measure relative ovarian mass. HE staining was used to observe the morphology of ovarian tissue and the number of antral follicles and cystic follicles. Transmission electron microscopy was used to observe ultrastructural changes in ovarian tissue. Western blotting detected changes in bone morphogenetic protein(BMP), Smad4, Smad1/5/9 protein expression levels. Results The PCOS model in rats exhibited irregular estrous cycles, indicating successful preparation of the PCOS rat model. Compared to the PCOS group, the rats in the PCOS+PL group and PCOS+cCL group showed reduced body weight and ovarian coefficient, aggravated ovarian tissue morphology with increased numbers of antral follicles and cystic follicles, significantly increased levels of LH, E2, and T hormones in serum. In contrast, FSH hormone level was significantly decreased. Additionally, protein expression of BMP6, Smad4, and Smad1/5/9 was downregulated. The longer the light exposure, the more severe of PCOS symptoms. Conclusion Disruption of circadian rhythm exacerbates abnormal hormone levels and ovarian cystic changes in PCOS model rats, accelerating the occurrence and development of PCOS by downregulating the BMP/Smad signaling pathway.

目的 对三甲医院新生儿科医务人员关于捐赠人乳的知识、态度和行为现状进行调查,并分析其影响因素。方法 通过新生儿科医师分会营养专委会,向全国45家三甲医院450名新生儿科医务人员发放捐赠人乳电子问卷,最后共回收430 份问卷,回收率为95.6%。所有新生儿科医务人员均填写捐赠人乳一般情况调查问卷,仅设有捐赠人乳库的25家医院中新生儿科医务人员填写捐赠人乳知信行问卷,回收捐赠人乳知信行调查问卷184份,有效率100%。结果 45家三甲医院中,372名(86.5%)新生儿科医务人员听说过捐赠人乳。25家(55.6%)设有捐赠人乳库,184名医务人员填写捐赠人乳的知信行调查问卷,包括医生31(16.8%)名,护士153(83.2%)名。有关捐赠人乳的知识部分得分为10.0 (8.0,11.0)分,各条目正确率12.0%至99.5%,得分率63.8%,处于中等水平。态度部分得分为 94.0 (60.0,100.0)分。各条目选择 “十分同意”占比均在60.0%~70.1%。捐赠人乳行为得分为 94.0 (60.0,100.0)分,各条目选择 “总是”占比为42.9%至63.0%。其中,“主动向产妇宣传捐赠人乳的好处,鼓励乳汁富余的母亲捐赠人乳”占42.9%。培训次数是捐赠人乳相关行为得分的影响因素。结论 医护对于捐赠人乳的相关知识的掌握程度有待提高,对捐赠人乳持态度积极,捐赠人乳实践行为还需进一步加强,护理管理者应重视护士对捐赠人乳相关知识的培训,从而提高护士开展捐赠人乳相关工作的实践水平。