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。

为了探究和比较不同类型脐动脉舒张末期血流消失胎儿的围产期结果,本研究采用系统回顾和荟萃分析的方法,检索了1990年1月—2022年9月在PubMed、Web of Science、Cochrane Library和Embase发表的相关研究,采用DerSimonian-Laird随机效应模型进行荟萃分析,采用Meta回归和多因素线性回归进行混杂因素调整,研究方案已在PROSPERO(CRD42022358537)注册。本研究共纳入了25项研究共3 413名血流消失胎儿,结果显示,脐动脉舒张末期血流消失胎儿与血流正常胎儿相比不良结果率更高,包括新生儿死亡(13.8％与2.5％),死产或胎死宫内(8.7％与2.4％),胎儿窘迫(51.7％与26.3％)和胎儿生长受限(68.4％与31.5％)等。持续血流消失胎儿与间断血流消失胎儿相比,分娩孕周更早,出生体重更低。因此,脐动脉舒张末期血流消失是脐动脉多普勒筛查不良预后的重要预测因子,而持续血流消失与更差的围产期结局相关。

Objective To investigate the pregnancy stress status of low-risk pregnant women in early pregnancy and explore its related factors. Methods In this study, we enrolled 416 pregnant women, aged 19-45 years, with gestational age <14 weeks, who attended the obstetrics outpatient clinic of Peking University Third Hospital during April 2022-December 2023 and were evaluated to be in the low-risk category by their doctors. The Pregnancy Stress Rating Scale(PSRS) was used to assess the pregnancy stress status of the pregnant women. The socio-demographic information, basic health condition and pregnancy status of the pregnant women were extracted from a self-administered questionnaire and medical records. Results The quartile distribution of total pregnancy stress in early pregnancy among low-risk pregnant women was 36.0(20.0, 57.0), and the dimension with the highest mean scores being "pressure to seek maternal and child safety services"; the number of births and a history of adverse maternal outcomes were influencing factors of the pregnancy stress status in early pregnancy. Conclusion Low-risk pregnant women have mild pregnancy stress in early period. Maternal adverse maternal history and number of deliveries were associated with maternal stress.

Objective To investigate the effect of transfer of low-grade single blastocyst transfer on Day 5 and high-grade single blastocyst on Day 6 on clinical pregnancy and perinatal outcomes in the freeze-thaw embryo transfer(FET) cycle. Methods A retrospective analysis was conducted among patients who underwent single blastocyst transplantation during the FET cycle(n=1991) at the Reproductive Medicine Department of Gulou Hospital Affiliated to Nanjing University School of Medicine from January 1, 2017 to June 30, 2022. Two groups are divided according to the embryo transfer period, low-grade single blastocyst transplantation group(Day 5, n=1083) and high-grade single blastocyst transplantation group(Day 6, n=908). The rate of clinical pregnancy, miscarriage, live birth, preterm birth, sex ratio and birth weight were compared, and subgroup analysis by age was conducted. Results There were no statistically significant differences in the clinical pregnancy rate(49.0% vs. 51.1%, P>0.05), miscarriage rate(20.3% vs. 24.4%, P>0.05), live birth rate(39.1% vs. 38.7%, P>0.05), preterm birth rate(10.6% vs. 14.5%, P>0.05), and birth weight(3381.1 ± 505.6 vs. 3502.1 ± 1845.0, P >0.05) between the low-grade single blastocyst transplantation group(Day 5) and high-grade single blastocyst transplantation group(Day 6), There was a statistical difference in the sex ratio of newborns(1.1 vs. 1.5, P<0.05), with a significantly higher proportion of male newborns born in the high-grade single blastocyst transplantation group(Day 6) compared to the low-grade single blastocyst transplantation group(Day 5). Meanwhile, after age stratification, it was found that for patients under 35 years old, the abortion rate in the low-grade single blastocyst transplantation group(Day 5) was significantly lower than that in the high-grade single blastocyst transplantation group(Day 6)(18.5% vs. 24.7%, P<0.05), and there was no statistically significant difference in the rate of clinical pregnancy and live birth. For patients aged ≥ 35 years old, there was no statistically significant difference in the rate of clinical pregnancy, abortion, and live birth between the two groups. Conclusion There is no statistically significant difference in clinical outcomes between the low-grade single blastocyst transplantation(Day 5) and high-grade single blastocyst transplantation(Day 6) in the FET cycle. However, high-grade single blastocyst transplantation in Day 6 may pose a risk of sex imbalance in newborns, and for younger patients, transplanting blastocysts in Day 6 may lead to an increase in miscarriage rates.

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.

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。

Objective To investigate the impact of gestational diabetes mellitus(GDM) on social behavior in rat offspring. Methods Female Sprague-Dawley rats at 4 weeks of age were randomly divided into a control group(CON) and a gestational diabetes group(GDM) based on body weight. The GDM group was induced with a high-fat diet(HFD) and a low-dose injection of streptozotocin(STZ, 30 mg/kg·bw) to establish the disease model. After natural delivery, the offspring were subjected to open field test(OFT), elevated plus maze test(EPM), novel object recognition test(NOR), and three-chamber social test(3-CST) at three time points:postnatal day 21(PND 21, weaning), PND 56(sexual maturation), and PND 98(adulthood) to evaluate their social behavior. The concentrations of interleukin-1β(IL-1β), IL-4, IL-6 and IL-10 in offspring hippocampal tissues were measured at each time point. Results Compared to the CON group, female offspring in the GDM group showed a significant decrease in spontaneous activity scores in the OFT at PND 98(P<0.05). Male offspring in the GDM group exhibited a significant decrease in the percentage of time spent in the open arms in the EPM at PND 98(P<0.05). In the NOR, female offspring in the GDM group showed a significant decrease in the novelty preference index at PND 21(P<0.05). In the 3-CST, female offspring in the GDM group had a significant decrease in the social preference index at PND 21, and male offspring in the GDM group had a significant decrease in the social preference index at PND 98(P<0.05). The social novelty preference index was also significantly decreased in both male and female offspring in the GDM group at PND 98(P<0.05). In the hippocampus, compared to the CON group, among female offspring in the GDM group, the relative expression of p-ERK and p-CREB increased significantly while the relative expression of BDNF protein decreased significantly at PND 21(P<0.05), and the relative expression of p-TrkB decreased significantly at PND 56(P<0.05), and the relative expression of p-ERK and BDNF decreased significantly at PND 98(P<0.05). Compared to the CON group, among male offspring in the GDM group, the relative expression of p-ERK increased significantly while the relative expression of p-CREB decreased significantly at PND 21(P<0.05), the relative expression of p-TrkB decreased significantly at PND 56(P<0.05), and the relative expression of p-ERK decreased significantly at PND 98(P<0.05). Compared to the CON group, female offspring in the GDM group showed a significant decrease on the concentration of hippocampal IL-1β, IL-4 and IL-6 at PND 21(P<0.05), and their hippocampal IL-6 concentration had significantly increased at PND 56(P<0.05), and the IL-4 concentration decreased significantly, while the IL-10 concentration increased significantly at PND 98(P<0.05). Male offspring in the GDM group showed a significant decrease on the concentration of hippocampal IL-4, IL-6 and IL-10 at PND 21(P<0.05), and a significant increase on concentration of hippocampal IL-1β and IL-10 at PND 56(P<0.05), and their IL-4 concentration decreased significantly, while the IL-6 concentration increased significantly at PND 98(P<0.05). Conclusion The social behavior of GDM offspring does not show significant changes in early life but exhibits noticeable social impairments in adulthood, without significant gender specificity.

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。

产前超声是孕期最重要的检查,受孕周、声强、检查者经验等因素的影响,超声图像质量并不稳定。精准医疗是时下的一个热点,如何将人工智能与产前超声相结合,数据模型的建立是目前研究的热点和难点。文献复习结果表明,面临着数据来源各异、数量庞大、处理技术壁垒等问题,深度学习(DL)与产前超声相结合,可帮助优化图像质量,缩短检查时间,减轻临床负担,为产前超声自动化识别与测量方面提供便利。

Objective To compare the blood lipid concentrations between full-term newborns and late preterm newborns, and to explore related influencing factors. Methods A retrospective case-control study was conducted among pregnant women who underwent prenatal check ups and gave birth at Peking University People's Hospital from January to December 2020, as well as newborns admitted to the pediatric department. The study participants were divided into two groups based on the gestational age at delivery:full-term delivery group(gestational age ≥ 37 weeks) and late preterm delivery group(34 weeks ≤ gestational age<37 weeks). Newborns were also categorized into two groups based on their birth gestational age:full-term newborns(gestational age ≥ 37) and late preterm newborns(34 weeks ≤ gestation age<37). General basic characteristics information and lipid profiles of newborns and pregnant mothers were collected. Spearman rank correlation analysis and logistic regression models were used to analyze the correlation between maternal lipid concentrations and preterm delivery. Results 99 cases were included in the full-term newborn group, and 92 cases were included in the late preterm newborn group. The rate of cesarean section, the proportion of mothers with comorbid hyperuricemia and diabetes in the late preterm newborn group were higher than those in the full-term newborn group. After birth, serum total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), and low-density lipoprotein cholesterol(LDL-C) concentrations in the late preterm newborn group were higher than those in the full-term newborn group, while triglyceride(TG) concentrations were lower. Maternal TC and LDL-C in the early and late stages of pregnancy, as well as TC, TG, HDL-C, and LDL-C in the late stage of pregnancy in the late preterm newborn group, were lower than those in the full-term newborn group. Overall, newborn TG was positively correlated with gestational age and birth weight, while TC, HDL-C, and LDL-C were negatively correlated with gestational age and weight. Newborn TC was positively correlated with maternal TC in early pregnancy, newborn TG was positively correlated with maternal TG in late pregnancy, and newborn HDL was positively correlated with maternal HDL-C in each stage of pregnancy. No correlation was found between newborn LDL-C and maternal LDL-C during pregnancy. For mothers, a total of 185 cases were included in the late preterm delivery group and 2 330 cases in the full-term delivery group. With the changes in maternal mid-pregnancy TC, LDL-C, and late-pregnancy TC, TG, HDL-C, and LDL-C concentrations, there was a correlation with late preterm delivery. Conclusion There is a correlation between the blood lipid levels of newborns and their gestational age, birth weight, and maternal blood lipid levels. Abnormal blood lipids during pregnancy are associated with the risk of premature birth in pregnant women. Accurate management of maternal and neonatal blood lipid levels is of great significance for the short-term and long-term health of the mother and offspring.

双相情感障碍综合征是一种以情绪波动为主要特征的精神类疾病,以躁狂和抑郁反复发作和交替发作为特征,患者常常经历抑郁、躁狂、焦虑等情绪波动,可导致患者发生性功能障碍、不育,影响社交、工作、学习、劳动等能力,甚至给他人造成危险或不良后果等。对于患有这种疾病的已婚男性来说,如何生育子代同样也是一个重要、敏感且复杂的问题。本文将通过回顾1例患有双相情感障碍的已婚男性提出供精辅助生殖技术助孕的需求后,经过本院生殖医学伦理委员会讨论后准予实施的病例来引发该类疾病所涉及的伦理问题的思考,以供临床参考

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。

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。

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.

Objective To explore the impact of worries about infection on pregnant and postpartum women's mental health and protective behaviors after releasing the Covid-19 pandemic control measures in China. Methods A total of 206 pregnant and postpartum women across the country were invited to complete the survey including Patient Health Questionnaire(PHQ-9), Generalized Anxiety Disorder scale(GAD-7), and Positive and Negative Affect Scale(PANAS). Results Worries about infection was positively correlated with uncertainty(r=0.452, P<0.01) and participation in protective behaviors(r=0.288, P<0.01), and was positively correlated with anxiety(r=0.383, P<0.01) and depression(r=0.179, P<0.01). Negative affect was positively correlated with anxiety(r=0.594, P<0.01) and depression(r=0.565, P<0.01). Uncertainty moderated the effect of worries about infection on protective behaviors. Negative affect partially mediated the impact of worries about infection on anxiety [0.504, 1.273], and depression [0.577, 1.394]. Conclusion Worries about infection predicted the participation of pregnant and postpartum women in protective behaviors, and this predictive effect was moderated by uncertainty. Worries about infection predicted anxiety and depression in pregnant and postpartum women by influencing negative affect.

子痫前期(preeclampsia,PE)是妊娠期高血压疾病中发病率最高的一种,可对母婴妊娠结局造成较大影响。随着技术的进步,基因位点的单核苷酸多态性(single-nucleotide polymorphism,SNP)已经成为公认的第三代遗传标记,被广泛应用于分子诊断和遗传疾病等领域,大量PE易感基因及易感 SNP 位点被相继报道.基于PE的复杂性,进行多位点的SNP分析,对认识PE的发病机制并从遗传学角度预测PE的易感性具有重要的科学意义,本文就近年来所发现的PE相关基因SNP研究进行总结分析。

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.

为了总结妊娠期女性亲密伴侣暴力管理的最佳证据,本文根据6S金字塔模型自上而下进行检索,系统查询国内外数据库和网站包括临床决策、指南、证据总结、系统评价和专家意见,检索时限为建库至2023年12月31日。最终纳入16篇文献,包括2篇临床决策、4篇指南、1篇证据总结、7篇系统评价和2篇专家意见。从筛查、评估、应对与预防4个维度总结了19条最佳证据,可为临床医护人员实践提供参考。实践过程中应根据具体临床情况结合专业判断、孕妇需求,以确保亲密伴侣暴力管理的有效性和安全性,从而降低亲密伴侣暴力带来的不良影响。

Objective To describe phthalate(PAEs) concentrations in hair samples and explore the association between life behaviors and living conditions with hair concentrations of PAEs among participants with gestational hypertension(GH) in Beijing, China. Methods This study was based on the pregnancy cohort established by Beijing Haidian District Maternal and Child Health Hospital and the Institute of Reproductive and Child Health at Peking University. 2,731 pregnant women were recruited and completed follow-up from October 2017 to October 2018. According to the specific inclusion and exclusion standardization, a total of 206 GH women were included as participants in this study. We collected hair samples and baseline data on general characteristics, life behaviors and living conditions through questionnaires; we obtained follow-up data through the hospital's electronic medical record system. 12 components of PAEs in hair samples were detected by gas chromatography-coupled triple quadrupole mass spectrometry(GC-MS/MS). The median and quartiles were applied to characterize the distribution of PAEs concentrations, and logistic regression model was applied to explore the association between life behaviors and living conditions with PAEs levels. Results The detection rates of 12 PAEs in hair samples were more than 70%. The highest hair concentration was found in bis(2-ethylhexyl) phthalate(DEHP), with a median hair concentration of 7 770.2 ng/g. Cooking in the kitchen more than once a week in the last month was significantly associated with a higher level of diallyl phthalate(DAP) in hair among GH women(adjusted OR=2.52, 95%CI:1.17-5.44); not using cosmetics was significantly associated with a lower level of bis(2-methoxyethyl)phthalate(DMEP) in hair(adjusted OR=0.28, 95%CI:0.09-0.87); and home decoration in the last 1 year was significantly associated with a higher level of DMEP in hair(OR=3.09, 95%CI:1.24-7.68). Conclusion PAEs were commonly detected in the hair of GH women in Beijing, of which DEHP showed the highest concentration of 12 components. We found significant associations between various life behaviors and living conditions and specific PAEs exposures. Cooking in the kitchen and home decoration might be risk factors for exposure to DAP and DMEP, respectively. Not using cosmetics might be a protective factor to reduce exposure to DMEP.

目的 探讨健康体检女性检出真菌性阴道炎的临床特征及易感因素影响研究。方法 选取空军军医大学第一附属医院综合诊疗体检二部2023年3月—2024年3月1 200例进行健康体检的女性为观察对象,其中96例经全自动微生物分析仪确诊为真菌性阴道炎为感染组,同时以1∶1比例随机纳入未检出阴道炎的体检人群为未感染组,两组均行阴道分泌物病原学检查。收集两组临床资料,利用logistic回归模型分析易感因素,经受试者工作特征曲线(ROC)评估预测变量准确性。结果 96例真菌感染患者中,共检出112株真菌,其中84株为白念珠菌,占比为75.0%;多因素logistic回归显示:人工流产史(OR =3.17,95% CI:1.13~8.84)、安全套使用(OR=3.58,95% CI:1.21~10.58)、生育史(OR =5.30,95% CI:1.56~17.99)、内裤混洗(OR =5.91,95% CI:2.03~17.14)、月经情况(OR=5.65,95% CI:1.71~18.67)、穿紧身裤频率(OR =3.71,95% CI:1.35~10.17)、久坐不动(OR=3.92,95% CI:1.33~11.62)、IFN-γ(OR=1.39,95% CI:1.16~1.68)、IL-2(OR=1.04,95% CI:1.03~1.06)是女性阴道真菌感染的易感因素(P＜0.05);ROC分析显示:人工流产史、安全套使用、内裤混洗、穿紧身裤频率、久坐不动、IFN-γ、IL-2及联合预测对女性阴道真菌感染均具有统计学意义(P＜0.05);其中联合预测评估女性阴道真菌感染的曲线下面积(AUC)=0.942,95%CI为0.911~0.973,灵敏度为0.969,特异度为0.781。结论 人工流产史、生育史、月经情况、安全套使用、内裤混洗、穿紧身裤频率、久坐不动、IFN-γ、IL-2是女性阴道真菌感染的易感因素,临床上应注意其相关因素评估,以降低真菌性阴道炎发病率。

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。

多囊卵巢综合征是一种育龄期女性常见的生殖内分泌疾病,以胰岛素抵抗、高雄激素血症、肥胖、稀发或无排卵和卵巢多囊样改变为特征。临床上根据患者的BMI常将多囊卵巢综合征患者分为肥胖型和非肥胖型。目前多囊卵巢综合征的具体病因尚不明确,认为是基因遗传、mRNA非正常转录表达、肠道菌群失调、氧化应激及炎症和血清循环物质改变等多种致病因素共同作用的结果。中医理论常将多囊卵巢综合征归到“不孕症”,“月经后期”和“月经前后不定期”的范畴。现代研究表明肥胖型和非肥胖型多囊卵巢综合征妇女在具体病因方面有显著差异。中医理论认为“瘦人多火”是非肥胖型多囊卵巢综合征的主要病因。深入研究非肥胖型多囊卵巢综合征的病因有利于早期诊断和精准治疗。

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.

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 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.

目的 分析妊娠期糖尿病(GDM)孕妇以及单纯胰岛素释放异常孕妇的妊娠结局。方法 回顾性收集2022年8月—2023年1月山西医科大学第一医院收治的612例孕妇作为研究对象,根据孕24~28周OGTT试验和胰岛素释放试验结果,分为GDM组271例、胰岛素释放异常组263例以及对照组78例,比较三组孕妇一般情况以及不良妊娠结局。结果 与对照组比较,GDM组和胰岛素释放异常组甲状腺功能减退、胎膜早破以及高脂血症发生率显著升高(P＜0.05),GDM组剖宫产、子痫前期、高尿酸血症、新生儿高胆红素血症、早产及转儿科发生率显著升高(P＜0.05)。与胰岛素释放异常组比较,GDM组剖宫产、子痫前期、高脂血症、早产发生率显著升高(P＜0.05)。多因素Logistic回归分析结果显示,孕前BMI(OR＝1.16,95%CI为1.10~1.22),糖尿病家族史(OR＝2.62,95%CI为1.29~5.32)均是GDM发生的独立危险因素(P＜0.05)。结论 妊娠期糖尿病和单纯胰岛素释放异常孕妇不良妊娠结局发生率均高,加强对妊娠期糖尿病孕妇及单纯胰岛素释放异常孕妇的管理,可改善母婴结局。

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。

目的 圆柱瘤基因(CYLD)介导DVL蛋白(DVL)调控Wnt/β-连环蛋白(Wnt/β-catenin)通路对输卵管炎性上皮细胞纤毛运动机制研究,从纤毛运动角度探讨治疗新思路。方法 取健康大鼠输卵管上皮细胞,LPS建立炎症细胞模型,细胞转染后先设立免疫共沉淀组IP(si-NC组,si-CYLD组)、阳性对照组input(si-NC组,si-CYLD组)检测DVL与氨基酸泛素肽(UB)灰度;之后设立:oe-NC组、oe-CYLD组、oe-CYLD+oe-NC组与oe-CYLD+oe-DVL组;检测各组CYLD、DVL、Wnt3a、β-catenin、actin(内部参考基因)表达量及纤毛跳动频率情况。结果 DVL为CYLD的下游因子;CYLD通过去泛素化抑制DVL的降解,调控其表达;CYLD负调控Wnt3a、β-catenin蛋白量,提高纤毛运动频率,DVL则作用相反。各组实验均有统计学意义(P＜0.01)。结论 CYLD介导DVL去泛素化负调控Wnt/β-catenin通路的激活,增加输卵管炎性上皮细胞纤毛运动频次,改善输卵管炎性不孕。

目的 报道1例CHD7基因杂合变异导致CHARGE综合征病例。方法 回顾分析1例CHARGE综合征患儿的临床资料,并检索相关文献,总结其基因型及临床特点。结果 患儿女,15岁3月,无乳房发育、无月经初潮就诊。基因分析显示患儿CHD7基因有一个c.1919delA杂合突变,导致氨基酸发生移码突变(p.K642Rfs*69)。结论 CHARGE综合征临床表现复杂多样,基因分析发现致病突变仍然是确诊该病的重要手段。

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。

目的 检测成纤维细胞生长因子19(FGF19)、FGF21及其共受体KLB在妊娠期肝内胆汁淤积症(ICP)患者血清中的水平,并探讨其与ICP临床及实验指标的相关性。方法 选取2020年1月—2021年12月在成都医学院第一附属医院就诊的43例ICP孕妇作为研究对象,其中轻度22例、重度21例,选取同期健康孕妇67例作为对照组,采用酶联免疫吸附试验法检测两组孕妇产前空腹肘静脉血清FGF19、FGF21及其共受体KLB水平,分析与临床及实验室结果的相关性,探讨三者在ICP发病机制中的作用。结果 正常妊娠组、轻度 ICP 组、重度 ICP 组血清中FGF19水平分别为(8.6±4.3)pg/mL,(7.5±3.5)pg/mL,(14.6±12.4)pg/mL,差异无统计学意义(P=0.26),三组共受体 KLB 蛋白表达水平结果分别为(13.9±4.1)ng/mL,(15.0±6.0)ng/mL,(18.0±8)ng/mL,经统计学比较无显著性差异(P=0.470),而FGF21 水平分别为(84.4±36.2)pg/mL,(102.1±38.1)pg/mL,(124.9±42.5)pg/mL,ICP组高于健康对照组,差异具有统计学意义(P≤0.001),且重度ICP组高于轻度ICP组,差异具有统计学意义(P<0.05)。多元线性回归分析血清FGF21水平与AST(r=0.3,P<0.01)、ALT(r=0.3,P<0.01)及TBA(r=0.4,P<0.01)呈正相关。血清FGF21蛋白表达水平与分娩孕周(r=0.23,P＜0.05)具有负相关性,FGF21与TBA互为独立影响因素。结论 ICP孕妇血清FGF19和KLB表达水平与正常妊娠组比较无统计学差异,而FGF21 表达水平显著升高,与胆汁酸水平存在显著的相关性,可能在ICP发病机制中发挥了重要作用。

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.

目的 了解河北省2021—2022年人类辅助生殖技术服务机构(以下简称辅助生殖机构)卫生质量现状,分析存在问题,为辅助生殖机构监督管理政策制定提供参考依据。方法 通过现场调研及查阅资料获取河北省30家辅助生殖机构2021—2022年现场评审信息,并对国家级专家提出的问题进行汇总分类分析。结果 30家辅助生殖机构在伦理建设、制度管理、临床建设、实验室管理、规范执业方面均达到合格要求,但仍发现需要进一步整改的问题:主要集中在伦理管理、实验室管理等方面。结论 河北省30家辅助生殖机构均符合人类辅助生殖技术相关法律法规的基本要求,能够依法依规开展相关诊疗活动,同时应进一步重视伦理与制度管理体系建设,加强实验室质控以提高医疗卫生质量。

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 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.