复发性妊娠丢失病因复杂,目前仍有相当一部分原因不明。免疫、微生物等因素是不明原因复发性妊娠丢失的潜在病因之一。NK细胞是女性生殖道中的重要免疫细胞,参与妊娠抗感染免疫、滋养层侵袭和子宫螺旋动脉重塑,维持正常妊娠。在感染、内分泌异常、生殖道菌群失调等病理状态下,NK细胞可能通过破坏母胎界面免疫稳态和影响滋养层侵袭与子宫螺旋动脉重塑介导妊娠丢失发生。本文综述了人体NK细胞亚群及其作用,提出了NK细胞在复发性妊娠丢失发病中的可能参与机制,以期为复发性妊娠丢失的病因诊断和治疗提供参考。

目的 分析2015—2022年间北京市青少年中艾滋病病毒感染者和艾滋病病人(HIV/AIDS)的疫情特征,为科学防控艾滋病提供依据。方法 从“中国疾病监测信息报告管理系统”中选择2015—2022年期间年龄在13~22岁,疾病诊断为HIV/AIDS的报告病例,对校内和校外青少年中的流行情况进行趋势分析。结果 共报告HIV/AIDS病例2 417例,13~22岁青少年的HIV/AIDS报告发病率从2015年的21.4/10万下降到2022年的9.5/10万(P_趋势=0.007)。其中校内青少年的HIV/AIDS报告发病率从2015年的14.2/10万下降到2022年的2.8/10万(P_趋势=0.008);校外青少年的HIV/AIDS报告发病率在24.0/10万~50.0/10万之间波动,无明显趋势性变化(P_趋势=0.8);男性HIV/AIDS报告发病率远高于女性;中学、大学阶段,校外青少年的HIV/AIDS报告发病率分别是校内青少年的4.1倍、1.6倍;传播途径以同性传播为主,占86.9%(2 100/2 417)。结论 近年来北京市青少年中艾滋病报告发病率呈下降趋势,校内青少年中报告发病率下降明显,校外青少年无明显趋势性变化,应重点针对校外青少年中男男性行为者开展干预工作。

目的 基于生物信息学分析铜死亡相关基因在子宫内膜癌中的预后价值。方法 从癌症基因组图谱数据集官网和UCSC Xena数据库下载子宫内膜癌患者的RNA-seq表达数据及相应的临床数据,筛选出肿瘤组织与正常组织之间差异表达的铜死亡相关基因。用LASSO回归构建风险评分,分析风险评分与子宫内膜癌患者临床病理参数和预后的关系,利用风险评分和其他临床特征构建预后模型。通过DAVID网站对铜死亡相关基因进行GO注释和KEGG分析。结果 构建了由3个铜死亡相关基因形成的风险评分,该评分可较准确区分高、低风险病人,是子宫内膜癌患者总生存率的独立不良预后因素。GO和KEGG富集显示,铜死亡相关基因主要参与柠檬酸循环、丙酮酸代谢、糖酵解等信号通路,风险评分和其他临床特征构建的预测模型列线图可较准确预测子宫内膜癌患者1年、3年、5年生存率。结论 本文研究构建了铜死亡相关基因预后模型,可为子宫内膜癌患者预后的评估提供临床指导。

Objective To explore and analyze the differences in clinical features, outcomes and perinatal outcomes between delayed and timely treatment of pregnant women with tuberculosis, so as to provide empirical ideas for improving the prognosis of pregnant women with tuberculosis. Methods The medical records of pregnant women with tuberculosis admitted to the Tuberculosis Institute of the Eighth Medical Center of the PLA General Hospital from January 2017 to January 2022 were retrospectively analyzed. They were divided into the delayed treatment group and the timely treatment group. The clinical symptoms, tuberculosis outcomes and perinatal outcomes of the two groups were analyzed. Results In the delayed treatment group,7 patients (16.2%)with consciousness disorder were significantly more than 1 patient (5.5%) in the timely treatment group, the difference was statistically significant (P<0.05),but there was no statistically significant difference in the symptoms of headache, chest tightness and choking, cough and sputum and weight loss(P>0.05).In the delayed and timely treatment groups, 38 cases (82.6%) and 5 cases(27.7%) of patients with hematogenous disseminated tuberculosis/tuberculous meningitis,27 cases (58.6%) and 3 cases (16.6%) of patients with severe disease (neurological sequelae, coma),3 cases (6.5%) and 0 cases (0.0%) of patients died,and 6 cases (13) of patients with stable disease. 0%) and 10 cases (55.5%), there were statistical differences in the above indexes between the two groups (P<0.05). In perinatal outcomes, there were no significant differences in age, pre-pregnancy weight, method of termination of pregnancy, tuberculosis type, neonatal weight and live birth rate between the delayed and timely treatment groups (P>0.05).The weeks of diagnosis(22.2±6.5 vs 15.4±7.3) and termination of pregnancy(28.6±9.3 vs 23.7±14.6)in the delayed treatment group were larger than those in the timely treatment group,the difference was statistically significant (P<0.05). Conclusion Pregnancy with tuberculosis is prone to delay diagnosis and treatment; It is necessary to strengthen the education and awareness of pregnant women with tuberculosis and improve doctors′ awareness of pregnancy complicated with tuberculosis.Early treatment, diagnosis and treatment are helpful to improve the prognosis and perinatal outcome of pregnant women with tuberculosis.

Objective To explore the influence of fetal heart monitoring pattern, delivery mode and perinatal prognosis in women with excessive umbilical cord torsion. Methods A retrospective case-control study was used in this study. The observation group was used to select a total of 122 women with a single fetus during delivery in a third class Hospital Obstetrics Department from January 2012 to December 2021 with excessive umbilical cord torsion. In the same period, 136 of the puerperae without excessive torsion of the umbilical cord were selected as the control group. The general condition, mode of delivery, perinatal outcomes, and the influences of fetal heart monitoring characteristics with different umbilical coiling index on fetal and neonatal outcomes were retrospectively analyzed between two groups. Results Compared with the control group, there was statistically significant differences in mean gestational age in the observation group (P<0.05). Also statistically significant differences in delivery mode (cesarean section or natural delivery), newborn birth weight, body length, umbilical cord length and fetal distress incidence rate (P<0.05). The type Ⅱ and type Ⅲ fetal heart monitoring in the observation group were significantly higher than that in the control group (P<0.05). Compared with the UCL-H and UCL-L, there were statistical significance in fetal distress, type Ⅱ monitoring and type Ⅲ monitoring (P<0.05) Conclusion Excessive torsion of umbilical cord have certain risk factors during pregnancy, which increase the chance of cesarean section and vaginal midwifery, and increase the incidence of fetal distress. In fetal heart monitoring, the patterns of type Ⅱ and tpye Ⅲ are significantly increased.

Objective To investigate the current situation and possible risk factors of caregiver burden of children with autism spectrum disorder (ASD) in China, and provide reference for relevant departments to formulate intervention measures. Methods A cross-sectional study was carried out in the parent communities and rehabilitation centers for ASD children from December 16th, 2022 to February 20th, 2023. A total of 141 caregivers were surveyed, and 114 valid questionnaires were collected. The Chinese version of the Zarit Burden Interview (ZBI) was used to evaluate the caregiver burden among children with ASD. They were divided into no or very light burden (0~20 points), mild burden (21~39 points), moderate burden (40~59 points) and severe burden (60 points and above) according to the total scale score. Multiple linear regression was used to analyze the risk factors with stepwise method. Results The ZBI total score of caregiver burden among children with ASD was (52.8±12.0). 15 cases (13.2%) were of mild burden, 64 cases (56.1%) were of moderate burden, and 35 cases (30.7%) were of severe burden. Family structure, parents′ social support level, delaying work and whether receiving disability subsidies are the influencing factors of the caregiver burden (R²=0.373,F=4.957). Conclusion Caregiver burden generally exists in the families of children with ASD, and most families face moderate to severe care burden. Our findings highlight the importance of improving the accessibility and availability of treatment and rehabilitation services, and providing psychological, social and economic support for caregivers of children with ASD.

Objective To understand the prevalence of suspected development delay of left-behind children under 3 years old in rural areas and the impact of home environment. Methods Five national poverty-stricken counties were selected to conduct the cross-sectional study in 2018. The modified Infant-Toddler Home Observation for Measurement of the Environment inventory (IT-HOME) was used to assess the home environment of left-behind family. Ages and Stages Questionnaires-Chinese, Third Edition (ASQ-3) were used to detect the suspected development delay of left-behind children. The chi-square test was used to compare the differences in the rates of suspected development delay among left-behind children with different characteristics, and multivariate logistic regression was applied to analyze the effects of home environment on the early development of rural left-behind children aged 0-3 years. Results A total of 878 pairs of left-behind children under the age of 3 and their caregivers were included. The overall suspected development delay rate for left-behind children aged 0-3 years was 31.8%. After controlling for children′s gender, age, low birth weight, left-behind type and caregivers′ gender, age, ethnicity, education level, depression and the number of vehicles and appliances owned by the family, lack of a stimulating home environment was a risk factor for the communication, gross motor, fine motor, problem solving, and personal-social competence zones, as well as for overall suspected developmental delay, with ORs of 2.53 (95% CI: 1.51-4.24), 2.00 (95% CI: 1.12-3.57), 2.17 (95% CI: 1.31-3.61), 3.94 (95% CI: 2.42-6.42), 2.52 (95% CI: 1.47 -4.32), and 2.97 (95% CI: 1.95-4.51), respectively. Conclusion The early development status of left-behind children aged 0-3 years in the survey areas is not optimistic, and the lack of a stimulating home environment increases the risk of suspected early development delays in left-behind children.

Objective To analyze and forecast the incidence, prevalence and years lived with disability of depressive disorders in child-bearing women in China and provide evidence for women′s health care in the future. Methods Based on the data of Global Burden of Disease Study 2019, the differences in the distribution of depressive disorders in Chinese women of child-bearing age (15-49 years) from 1990 to 2015 were analyzed, and the severity of depressive disorders in 2025 and 2030 were forecasted with GM (1, 1). Results The influences of dysthymia were relatively increasing in recent years in women of child-bearing age in China. The loss of health due to depressive disorders in child-bearing women might decrease in 2025, and the incidence and prevalence of depressive disorders in women aged 40~49 year might be higher than the average level of women of the child-bearing age. Conclusion The health services on depressive disorders in child-bearing women should be designed according to the age and categories of diseases, and more attention should be paid to the mental health care in perimenopausal women and the prevention and cure of dysthymia.

目的 了解河北省新生儿中小于胎龄儿(SGA)的发生率,并分析其危险因素,为制定妇幼健康工作政策和规划提供可靠依据。方法 采用回顾性分析方法,分析2017—2021年河北省21所危重孕产妇监测医院中出院且妊娠满28周的所有单胎活产儿的孕产妇及新生儿相关数据,分析SGA发生率及其危险因素。结果 本研究共纳入单胎活产儿205 707例,SGA发生率为15.93%。多因素Logistic 回归分析显示:产妇年龄＜20岁或≥40岁、产妇受教育程度高中及中专、前置胎盘、胎盘早剥、子痫前期、早产是SGA发生的危险因素;经产妇、妊娠期糖尿病、产前贫血是新生儿发生SGA的保护因素。结论 建议适龄怀孕,对于受教育程度低及高危因素的人群,进行早期规范管理,切实降低SGA的发生率。

目的 了解新疆地区高危型人乳头瘤病毒(HR-HPV)感染现状,分析其与宫颈病变的关系。方法 回顾性收集2020年1月至2021年12月在新疆维吾尔自治区人民医院行HPV分型检测的2 447例患者资料,其中705例HR-HPV感染且行阴道镜下宫颈活检、宫颈锥切术或子宫切除术的宫颈病变患者符合纳入标准入选本研究。依据病理诊断分为宫颈炎组、宫颈低级别上皮内瘤变(LSIL)组、宫颈高级别上皮内瘤变(HSIL)组和宫颈癌组。分析不同宫颈病变患者HR-HPV亚型与各宫颈病变的关系。结果 HPV总的阳性感染率为54.84%(1 342/2 447)。本研究纳入的705例患者中,单一感染率为70.92%(500/705),多重感染率为29.08%(205/705)。不同年龄段宫颈病变患者HR-HPV多重感染率存在显著差异(P＜0.05),25<～≤35岁年龄组多重感染率最高(36.55%)。HPV16、39、56、59、66型检出率在不同宫颈病变患者中的差异有统计学意义(P＜0.05)。随着宫颈病变逐渐加重,HR-HPV多重感染率呈降低趋势(P_趋势<0.05)。结论 新疆地区HPV阳性率较高,本地区不同宫颈病变患者HR-HPV感染率前五的亚型分别是:HPV16、52、58、39、51/53型。随着宫颈病变程度增高,HR-HPV多重感染率逐渐降低。

Objective To investigate the correlation between sperm DNA fragmentation index(DFI), serum 25-hydroxy-vitamin D[25(OH)VD] and semen routine parameters in male infertility patients. Methods The examination data of 627 male infertility patients in the Reproductive Medicine Center of the First Affiliated Hospital of Air Force Military Medical University from November 2021 to July 2022 were retrospectively analyzed. The routine parameters of semen were analyzed by computer assisted sperm analysis system, the percentage of sperm with normal morphology was detected by manual method, the sperm DFI was analyzed by flow cytometry, and the total amount of 25(OH)VD in serum was detected by liquid chromatography-tandem mass spectrometry detection system. SPSS 25.0 software was used to analyze the correlation between sperm DFI and total sperm count, sperm concentration, percentage of forward motile sperm (PR), total sperm motility and percentage of normal morphology sperm, as well as the correlation between total amount of serum 25(OH)VD and total sperm count, concentration, PR, total sperm motility, percentage of normal morphology sperm and sperm DFI. Results Sperm DFI was negatively correlated with total sperm count and concentration (r=-0.082, -0.094, P<0.05), but r<0.1, with limited clinical value. Sperm DFI was negatively correlated with PR, total sperm motility and percentage of normal morphology sperm (r =-0.519, -0.534, -0.327, P<0.001). Serum 25(OH)VD was not correlated with total sperm count, concentration, PR and total sperm motility (r =-0.009, -0.020, 0.059, 0.054, P>0.05), but was positively correlated with the percentage of normal morphology sperm (r =0.147, P<0.001), and was negatively correlated with sperm DFI (r =-0.294, P<0.001). Conclusion Sperm DFI was negatively correlated with the PR, total sperm motility and percentage of normal morphology sperm, which could reflect sperm quality to a certain extent. Sperm DFI detection and semen routine parameters could complement each other, providing effective information for a comprehensive and objective assessment of male fertility. The total amount of serum 25(OH)VD was positively correlated with the percentage of normal morphology sperm and negatively correlated with sperm DFI, which could be used as a reference index to evaluate male fertility.

Objective This study aims to determine the prevalence of intimate partner violence (IPV) against pregnant women and the risk of adverse birth outcomes (ABO) in pregnant women in Wuhan, China. Methods The survey was conducted among 806 pregnant women at Tongji Hospital, Qiaokou District Maternity and child care hospital and Dongxihu District People′s Hospital in Wuhan from April 2013 to March 2014. Face-to-face standardized interviews were performed prior to woman′s antenatal care. IPV and depressive symptoms were assessed through the Abuse Assessment Screen (AAS) and the Center for Epidemiologic Studies-Depression scale (CES-D). Birth outcomes were collected after delivery. Chi-square test was applied to compare the differences of prevalence rate of various ABO between IPV and non-IPV groups, Path analysis was used to determine the risk for ABO in women experienced IPV during pregnancy. Results 18.3% of 797 participants reported experiencing IPV during pregnancy. Husband′s personality, pregnancy complications, depression and IPV had direct effects on ABO, the influence coefficient were 0.107, 0.084, 0.095, and 0.099, respectively. Conclusion The findings revealed IPV and depression in the antenatal significantly predicted adverse birth outcomes, and assist prenatal care providers in prioritizing and screening for IPV and depression during pregnancy that are associated with ABO.

Objective To detect the expression levels of serum histone deacetylase 4 (HDAC4) and histone deacetylase 6 (HDAC6) in patients with preeclampsia, and analyze the correlation between the two and the severity of the disease. Methods Eighty preeclampsia patients (study group) hospitalized in Northwest Women and Children′s Hospital from January 2020 to June 2021 were selected, the patients were grouped into mild group (n=48) and severe group (n=32) according to the severity of their illness, in addition, 80 healthy pregnant women who gave birth in hospital during the same period were regarded as the control group. The general data of the study group and the control group were compared; Pearson correlation analysis was applied to analyze the correlation between serum HDAC4 level, HDAC6 level and the severity of preeclampsia, and the correlation between serum HDAC4 level and serum HDAC6 level; multivariate Logistic regression analysis was applied to analyze the factors influencing the occurrence of preeclampsia in pregnant women; the evaluation value of serum HDAC4 and HDAC6 levels on the occurrence of preeclampsia was analyzed by receiver operating characteristic (ROC) curve. Results Systolic blood pressure, diastolic blood pressure, 24h urine protein content, total cholesterol, triglyceride, HDAC4, and HDAC6 in preeclampsia patients were obviously higher than those in the control group (P<0.05); the expression levels of HDAC4 and HDAC6 in severe group were obviously higher than those in mild group (P<0.05). Correlation analysis showed that serum HDAC4 and HDAC6 were obviously positively correlated with the severity of the disease (r=0.536, 0.614, P<0.001); there was a obvious positive correlation between serum HDAC4 level and HDAC6 level in patients with preeclampsia (r=0.412, P<0.001). Multivariate Logistic regression analysis showed that serum HDAC4, HDAC6, systolic blood pressure, diastolic blood pressure, 24h urine protein content, total cholesterol, and triglyceride, were the influencing factors of preeclampsia (P<0.05). The AUC of combined prediction of serum HDAC4 and HDAC6 for the occurrence of preeclampsia was 0.886, the sensitivity was 87.50%, and the specificity was 78.75%, which was superior to their respective independent prediction (Z_{combined detection-HDAC4}=2.564, Z_{combined detection-HDAC6}=4.083, P<0.05). Conclusion The serum HDAC4 and HDAC6 levels in patients with preeclampsia are closely related to the occurrence and severity of the disease, and the combination of the two has a good reference value for pregnant women with preeclampsia.

目的 分析产科发生非计划再次手术的原因,提高对相关危险因素的识别,探讨减少和防范非计划再次手术的临床对策。方法 回顾性分析2011年1月—2021年12月北京市通州区妇幼保健院产科收治的非计划二次手术的11例患者的临床资料。结果 非计划再次手术的发生率为0.011%(11/101 833)。11例患者中9例首次手术为剖宫产术,2例为产后出血行宫腔球囊置入术。首次剖宫产指征:中央型前置胎盘2例,多胎妊娠2例,瘢痕子宫1例,巨大儿2例,绒毛膜羊膜炎1例,引产失败1例,其中择期手术8例,急诊手术1例。二次手术指征均为宫缩乏力导致产后出血,其中3例可疑羊水栓塞,1例合并巨大子宫肌瘤。二次手术方式:3例行双侧子宫动脉上行支结扎术+子宫压迫缝合术;8例行宫腔填纱术,其中2例同时行双侧子宫动脉上行支结扎术,1例同时行子宫肌瘤剔除术。10例患者于本院治愈出院,1例患者因术中心脏骤停,术后转至上级医院,经追访其治愈后出院。结论 产科发生非计划二次手术的主要原因是子宫收缩乏力导致的严重产后出血。术后加强监测,及时诊断并采取相应治疗措施,是减少再次手术并挽救孕产妇生命的重要手段。

目的 检测乳腺癌患者外周血中调节性T细胞(CD4^＋CD25^＋ CD127^lowTreg)和T淋巴细胞亚群(CD3⁺、CD4⁺、CD4⁺／CD8⁺)及NK细胞表达情况,分析乳腺癌患者细胞免疫功能状况及其临床价值。方法 收集2019.5—2021.11南京市妇幼保健院收治的120例乳腺癌患者作为乳腺癌组,选择46例健康女性作为对照组,采用流式细胞技术检测两组受试者外周血中调节性T细胞和T淋巴细胞亚群以及NK细胞表达情况水平,同时检测了 Luminal A ,Luminal B ,HER2 过表达,三阴型四组分子分型的T淋巴细胞亚群水平。结果 与对照组相比,乳腺癌组患者除Treg,CD8⁺＋细胞水平显著升高外,CD3^+＋、CD4⁺、CD4⁺／CD8⁺以及NK细胞指标均显著降低,差异有统计学意义(P＜0.05);不同临床分期乳腺癌患者细胞免疫功能差异有统计学意义(P<0.05),随着临床分期的升高,除了CD8⁺细胞和 Treg 细胞水平逐渐升高,其余指标细胞水平逐渐降低(P<0.05);有淋巴结转移乳腺癌患者CD3⁺(58.3±4.2)、CD4⁺(26.9±4.3)、CD4⁺／CD8⁺(1.1±0.2)以及NK(12.6±2.3)细胞水平比较无淋巴结转移(62.2±5.2、32.6±4.3、1.3±0.2、16.7±2.7)患者显著降低(P＜0.05),而CD8⁺细胞百分比(31.6±3.0)水平较无淋巴结转移患者(27.9±3.6)显著升高(P＜0.05);三阴型组CD3⁺和CD4⁺指标高于其余三组,CD8⁺和CD4⁺ /CD8+指标明显低于其余三组,差异具有统计学意义(P＜0.05)。结论 乳腺癌患者存在广泛的免疫功能低下或免疫失调,且患者免疫功能的变化与肿瘤进展、淋巴结转移有关,监测患者外周血淋巴细胞亚群水平,可为临床应用免疫治疗配合手术与分子靶向治疗提供一定参考。Treg 细胞(CD4^＋CD25^＋ CD127^lowTreg)与肿瘤免疫抑制相关,其比例可能随乳腺癌病情分期进展而升高,并对评估乳腺癌的预后具有一定重要性意义。同时,研究不同分子分型的原发性乳腺癌体内T淋巴细胞的表达状况,对评估患者临床的病情、治疗预后有着一定的参考价值。

目的 分析卵巢低反应(poor ovarian response,POR)人群按波塞冬(POSEIDON)分型后各组的临床结局。方法 回顾性分析2020年1 月至2021 年12月在本院生殖医学中心行辅助生殖治疗的POR患者3 702例,基于POSEIDON标准将患者分成4组:A组1 887例,年龄＜35岁,AMH≥1.2 ng/mL; B组696例,年龄≥35岁,AMH≥1.2 ng/mL; C组623例,年龄＜35岁,AMH＜1.2 ng/mL; D组496例,年龄≥35岁,AMH＜1.2 ng/mL,比较四组患者的基本资料及临床结局,同时将A、B组进行亚组分类分析,获卵数小于4为A₁组和B₁组,获卵数4~9枚为A₂组和B₂组。结果 在具有相同卵巢储备的患者中,低龄组POR人群有更好的临床结局,差异有统计学意义,即在预期外POR人群中,A组优于B组,临床妊娠率A组与B 组分别为66.8%和53.8%(P＜0.05);活产率A组与B 组分别为56.4%和41.1% (P＜0.05);在预期内POR人群中,C组优于D组,临床妊娠率C组与 D 组分别为64.8%和46.7%(P＜0.05);活产率C组与 D 组分别为55.6%和32.5%(P＜0.05)。在获卵数为4~9枚的群体中,以上指标依然是低龄组更具优势,且差异有统计学意义,临床妊娠率A₂组与B₂ 组分别为67.4% 和 55.2%(P＜0.05),活产率A₂组与B₂ 组分别为56.9%和42.6%(P＜0.05);而在获卵数小于4枚的群体中,低龄组与高龄组差异无统计学意义。如果按相同年龄组再行比较,即B组和D组比,A组和C组比,发现卵巢储备较好的POR人群比卵巢储备差的群体有更好的临床结局趋势,但差异无统计学意义。结论 患者年龄是预测POR群体临床结局的关键参数。

目的 探讨宫内刨削系统(IBS)对育龄期子宫内膜息肉患者治疗效果及术后复发情况,探讨其影响因素。方法 回顾性分析2020年1月—2021年12月本科室治疗的106例育龄期子宫内膜息肉患者的临床信息,根据术式不同分为电切组和IBS组,比较两组患者的手术疗效、并发症发生率、妊娠率及复发率,并分析复发相关因素。结果 IBS组的病理平滑肌组织报告率4.9%低于电切组患者的27.7%(P=0.003);IBS组较电切组手术时间、膨宫液用量相对更少,但差异无统计学意义;两组患者术后复潮时间和卵泡后期内膜厚度之间差异无统计学意义;IBS组术后妊娠率较电切组高,复发率较电切组低(P均<0.05);术后联合药物辅助治疗组与未用药组复发率存在统计学差异。多因素Logistics回归分析显示:体质指数、术后内膜厚度、多发息肉、剖宫产史、PCOS史均是患者术后复发的危险因素(P均＜0.05)。结论 宫内刨削系统能提高妊娠率,更安全有效地治疗育龄期妇女子宫内膜息肉。联合术后药物辅助疗法可降低复发率。在术后随访管理中,建议肥胖、有剖宫产史、PCOS史、多发息肉、术后内膜较厚的患者加强随诊,降低复发风险。

褪黑素是一种吲哚类的神经内分泌激素,在调节机体昼夜节律和女性生殖内分泌中起着重要作用。目前越来越多的研究发现,褪黑素受体在生殖器、子宫、乳腺、卵巢及胎盘中均有表达,它具有抗氧化、抗衰老、抗雄激素、抑制细胞凋亡、改善卵母细胞质量的作用,这些作用在女性生殖内分泌调节系统中扮演着重要的角色。本文就褪黑素在女性生殖内分泌疾病中的研究进行综述。

目的 探讨剖宫产产妇唾液、血浆中催产素水平与产后抑郁的关系。方法 选取2020年5月至2021年10月在本院327名剖宫产产妇为研究对象。根据术后42 d爱丁堡产后抑郁量表(EPDS)评分分为抑郁组(EPDS评分≥13分)、非抑郁组(EPDS评分<13分),比较两组临床资料及产前1 d的唾液、血浆催产素水平;分析唾液、血浆催产素水平对产后抑郁的影响及其预测价值。结果 最终随访到322名产妇,其中43例(13.3%)发生产后抑郁,产后抑郁产妇EPDS评分13~23分,平均(16.3±2.6)分。Logistic回归显示:唾液催产素(OR=0.768,95% CI=0.687~0.859)、血浆催产素(OR=0.984,95% CI=0.976~0.992)是剖宫产产妇产后抑郁的保护因素(P<0.05)。ROC曲线显示:唾液水平预测产后抑郁的AUC为0.745(95%CI=0.666~0.825)、敏感度74.4%、特异度65.9%;血浆催产素水平预测产后抑郁的AUC为0.764(95%CI=0.694~0.833),敏感度为72.1%,特异度为73.8%。Pearson相关性显示:产后抑郁产妇唾液、血浆催产素水平与EPDS评分均呈负相关(r=-0.550、r=-0.518,P<0.05)。结论 产前唾液、血浆催产素水平与剖宫产产妇产后抑郁EPDS评分相关,是产后抑郁的保护因素,且对产后抑郁具有预测价值。

目的 通过分析内蒙古地区出生缺陷和发育异常患儿的染色体异常分布情况,探讨染色体核型分析及染色体微阵列分析(CMA)技术在出生缺陷和发育异常患儿中的应用价值,为临床诊断及遗传咨询提供参考。方法 选取2013年10月—2021年10月在内蒙古妇幼保健院就诊的出生缺陷和发育异常患儿,对其外周血染色体核型分析及CMA分析结果进行回顾性分析。结果 448例外周血染色体核型分析检出异常核型163例,占36.4%;其中染色体数目异常和结构异常的占比分别为74.8%、15.3%。数目异常主要为21-三体及45,X;结构异常包括衍生染色体、易位、倒位、缺失、重复、环状染色体以及等臂X染色体;其他异常有性反转12例、染色体多态4例。71例CMA检出23例异常,占32.4%,包括致病性14例、疑似致病3例及意义未明6例。19例进行外周血染色体核型分析及CMA联合检测,检出10例异常,占52.6%。两种方法联合检测异常检出率高于单一方法检出率。结论 对出生缺陷和发育异常的患儿进行染色体检测,可以明确病因,而且外周血染色体核型分析联合CMA检测可以提高染色体异常的检出率,为本地区患者进行遗传咨询、家庭再发风险评估、提供理论基础。

目的 一种子宫造影管及造影操作装置,探讨其临床应用效果及评价。方法 采用便利抽样法,选取2021年7月—12月北京中医药大学东直门医院门诊收治的60例患者作为试验组,2022年1月—6月收治的60例患者作为对照组。试验组采用新型子宫造影管及造影操作装置进行造影操作,对照组采用普通子宫造影管,手工推注。依据两组4D超声下输卵管通畅性分组进行置管依从性的比对。结果 试验组4D超声下输卵管通畅率:输卵管通畅20例,输卵管通而不畅组27例,输卵管阻塞13例。对照组4D超声下输卵管通畅率:输卵管通畅19例,输卵管通而不畅组25例,输卵管阻塞16例。输卵管阻塞患者中试验组与对照组的依从性得分无统计学差异;输卵管通畅患者和输卵管通而不畅患者中试验组与对照组的依从性得分有统计学差异,试验组均高于对照组。结论 一种子宫造影管及造影操作装置的设计及应用能够提高患者的依从性,减轻患者痛苦。

目的 探讨孕早期血清产前筛查指标妊娠相关血浆蛋白A(PAPP-A)、游离β人绒毛膜促性腺激素(F-βhCG)的中位数倍数(MoM)值变化与不良妊娠结局的相关性。方法 回顾性分析2021年1月4日—2022年12月20日在湖南省人民医院生殖医学中心进行早孕期产前筛查1 447例孕妇,排除双胎、拒绝随访及有家族病史或孕前体检有异常的孕妇,最终将在孕9~13⁺⁶周进行产前筛查的871例孕妇选为研究对象,比较不同妊娠结局孕妇的PAPP-A、F-βhCG的MoM值差异;并将PAPP-A、F-βhCG的MoM值的正常异常范围分组,正常范围为PAPP-A MoM≥0.5,0.25≤F-βhCG MoM≤2,异常范围为PAPP-A MoM＜0.5,F-βhCG MoM＜0.25,F-βhCG MoM＞2,比较不同组间不良妊娠结局的发生情况。结果 流产、早产、先兆子痫、妊娠期高血压的PAPP-A MoM值低于正常妊娠孕妇(P<0.05);流产、甲状腺功能减退症的F-βhCG MoM值低于正常妊娠孕妇(P<0.05),产后出血的F-βhCG MoM值高于正常妊娠孕妇(P<0.05);PAPP-A MoM<0.5组不良妊娠结局的发生率明显高于PAPP-A MoM≥0.5组(P<0.05),F-βhCG MoM<0.25组不良妊娠结局的发生率明显高于0.25≤F-βhCG MoM≤2组(P<0.05);PAPP-A MoM值与分娩孕周呈正相关(r=0.07,P=0.045)。结论 孕早期血清产前筛查指标PAPP-A MoM值变化在预测流产、早产、先兆子痫、妊娠期高血压及分娩孕周方面有一定意义;F-βhCG MoM值变化在预测流产、产后出血和甲状腺功能减退症方面有一定的意义。

Objective To analyze the association between dietary garlic intake and risk of preterm birth. Methods A birth cohort study was conducted in 2010-2012 at Gansu Provincial Maternity & Child Care Hospital in Lanzhou, China. A total of 9,710 pregnant women were enrolled. The general demography characteristics, garlic intake in the perinatal period and the information of fetal delivery were investigated. A multivariate logistic regression models was used to analyze the relationship between dietary garlic intake and preterm birth. Results Raw garlic intake reduced the risk of preterm birth with a dose-response relationship (overall:OR=0.81, 95%CI:0.69-0.96; before pregnancy:OR=0.81, 95%CI:0.68-0.95; ＜2 times/week:OR=0.81, 95%CI:0.69-0.97, ≥2 times/week:OR=0.79, 95%CI:0.64-0.97; P_trend=0.03; during pregnancy:OR=0.82, 95%CI:0.70-0.96; ＜2 times/week:OR=0.83, 95%CI:0.71-0.98, ≥2 times/week:OR=0.79, 95%CI:0.65-0.97; P_trend=0.03).Especially there was a significant negative correlation with spontaneous preterm without premature rupture of membranes (overall:OR=0.67,95%CI:053-0.85;before pregnancy:OR=0.69, 95%CI:0.55-0.88; during pregnancy:OR=0.68, 95%CI:0.55-0.85). However, there was no significant association with iatrogenic preterm birth and premature rupture of membranes. Conclusion Dietary raw garlic intake can reduce the risk of preterm birth with dose-response relationship, especially spontaneous preterm without premature rupture of membranes.

Objective To study the therapeutic effect of dandelion extract (Shawkea T-1) on ovarian hypofunction and its mechanism. Methods Menopausal transition mice were the intervention group for ovarian hypofunction, and healthy young female mice were the control group. The number of ovarian antral follicles in menopausal transition mice fed with dandelion extract for 30 days was observed. At the same time, human granulosa cell line (KGN) was cultured. The apoptosis of KGN cells was compared after incubation with dandelion extract using flow cytometry,TUNEL and apoptosis PCR array. Results The number of ovarian antral follicles in postmenopausal mice fed with dandelion extract was significantly higher than that in the control group (P<0.01). The apoptosis rate of KGN cells of dandelion extract culture group was significantly lower than that in control group (P<0.05). 20 up-regulated genes and 4 down regulated genes were screened by apoptosis PCR chip (P<0.05). Conclusion In the animal model, dandelion extract can effectively treat the ovarian hypofunction of female mice. The underlying mechanism may be due to the decreasing apoptosis rate of granulosa cells.

为扭转处于低迷状态的生育水平,中国政府积极调整人口生育政策,但逐渐宽松的生育政策并未取得理想的效果,长期的低出生率对中国的人口结构产生了较大的影响。社会的低生育率是个体低生育水平的结果,最根本的原因是“成本-价值”的不平衡对生育决策造成的负向影响。生育成本的提高和生育价值观的改变是育龄人群生育意愿改变的直接动力和深层动因,当前中国育龄人群的低生育意愿和低生育水平正是高看生育成本,低看生育价值的结果。

妊娠期高血压疾病(HDP)是孕产妇发病和死亡的重要原因,HDP在中国的发病率约为4.74%。与产前子痫前期相比,产后子痫前期/子痫可能与更高的孕产妇并发症相关。产后子痫前期的重要性长期以来一直未被充分认识,早期识别产后子痫前期的危险因素、病因,早期诊断及早期处理产后子痫前期对于降低产后孕产妇并发症和死亡率至关重要。本文将从危险因素、病因、临床表现、处理及预后角度对目前产后子痫前期的相关研究进行综述,以期能提高临床医师对产后子痫前期的认识,降低相关并发症及死亡率。

中央性前置胎盘是指妊娠28周以后胎盘组织完全覆盖宫颈内口,与围产期母儿并发症及死亡关系密切,这类患者首选的分娩方式是择期剖宫产。前置胎盘伴植入又加重了产科出血的风险,因此,产前、产后应当采取措施积极预防出血的发生。当患者在产后存在抗凝指征需要抗凝治疗时,抗凝药物的使用与产后出血的预防又存在着潜在的矛盾。本文将报告1例来自广州中医药大学第一附属医院产科分娩的病例,患者为中央性前置胎盘伴植入,剖宫产术前曾行腹主动脉球囊阻断术,在剖宫产术后形成了较大面积的肺栓塞,通过回顾、分析本病例产后肺栓塞发生的相关因素及抗凝治疗措施,旨在提高对产后栓塞性疾病的预防和管理。

HtrA系丝氨酸蛋白酶家族,参与许多生理病理过程。HtrA4相对局限表达于胎盘组织,大量研究证明HtrA4在子痫前期(PE)的胎盘或是血液循环中都存在差异,近年通过生物信息学分析出的PE与正常妊娠之间的差异基因也涉及到HtrA4。PE严重影响母儿安全,早期发现和及时治疗至关重要,HtrA4参与PE生理病理的全部机制仍有待研究,深入探讨其与子痫前期的关系有可能为子痫前期的治疗与诊断提供依据。随着国内外对HtrA4参与子痫前期的深入研究,近年的研究结果发现其通过多种机制参与PE,包括抑制血管生成、破坏血管内皮屏障、影响滋养细胞合胞浸润等。本文就HtrA4的结构功能及与子痫前期发病的关系综述。

Objective To investigate the effects of lactation diet in rats with pre-pregnancy obesity and excessive gestational weight gain on inflammatory and iron-related indicators in the offspring. Methods A total of 24 SPF-rated Wistar female rats were randomly divided into pre-pregnancy obesity group (Pre-obe) and excessive gestational weight gain group (GWG) in a 1:1 ratio, and further divided equally into Pre-obe high-fat diet group (n=6), Pre-obe standard diet group (n=6), GWG high-fat diet group (n=6), and GWG standard diet group (n=6) according to lactation diet. A total of 48 offspring rats were included in the study with 12 rats in each group; they were weaned on the 21st day after birth, and all were fed a standard diet after weaning. Body weights were measured on the days 0, 7, 14, 21, 28, 35 and 42 after birth. Interleukin-6 (IL-6), hepcidin, ferritin, hemoglobin (Hgb), mean corpuscular hemoglobin (Mch), and mean corpuscular volume (Mcv) in the serum/whole blood were measured on the days 28, 35 and 42 after birth. Results Compared with a high-fat diet during lactation, the standard diet significantly reduced the body weight. Compared with a high-fat diet during lactation, the standard diet significantly reduced the level of IL-6 (152.97 pg/mL vs. 105.24 pg/mL on day 28;155.15 pg/mL vs. 110.53 pg/mL on day 35; 155.4 pg/mL vs. 139.02 pg/mL on day 42, P<0.017) and Hepcidin (119.99 ng/mL vs. 99.67 ng/mL, P<0.05), and increased the level of Mch (22.43 pg vs. 23.32 pg, P<0.05) and Mcv (72.71 fL vs. 75.71 fL, P<0.05) of the offspring in Pre-obe. Compared with a high-fat diet during lactation, the standard diet significantly reduced the level of IL-6 (140.21 pg/mL vs. 127.57 pg/mL on day 35, P<0.017), and increased the level of Hgb (107.25 g/L vs. 112.92 g/L on day 35, P<0.017) and Mcv (72.90 fL vs. 74.34 fL, P<0.05) of the offspring in GWG. In addition, the standard diet during lactation significantly reduced the level of Ferritin (50.60 ng/mL vs. 42.06 ng/mL, P<0.05) and Hgb (110.53 g/L vs. 106.28 g/L, P<0.05) of the offspring in Pre-obe. After adjusting for inflammatory indicators (IL-6 and Hepcidin), the effect of lactation diet on multiple iron-related indicators of the offspring in Pre-obe and GWG was no longer statistically significant. Conclusion Our results suggest that the standard diet during lactation in rats with pre-pregnancy obesity and excessive weight gain during pregnancy reduces the inflammatory response and increases the levels of iron-related indicators in the offspring, and the inflammatory response may play a mechanistic role in the association between maternal diet during lactation and iron-related indicators in the offspring.

Objective To analyze the influence of postpartum weight on postpartum stress urinary incontinence (SUI) after childbirth. Methods Data were collected from January to December 2018 from 6,500 postpartum women undergoing postpartum examinations at Nanjing Maternity and Child Health Care Hospital. Among them, 6,338 women (97.5%) returned valid response questionnaires after being randomly selected for questionnaire surveys and pelvic surface electromyography testing. The 6,338 postpartum women were divided into the postpartum SUI group (540 cases) and the control group (5,798 cases). According to the classification criteria of adult weight determination in the People′s Republic of China Health Industry Standard—Classification of Adult Weight (WS/T 428-2013), participants were classified into underweight (BMI <18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI <24 kg/m²), overweight (24 kg/m² ≤ BMI <28 kg/m²), and obese (BMI ≥28 kg/m²) groups. The relationship between postpartum weight and postpartum SUI was analyzed, and the severity and impact of SUI on life in different postpartum weight groups were assessed. The pelvic floor electromyography values of the SUI and normal groups with different postpartum weights were compared. Results The incidence of postpartum SUI was 8.5%. The incidence rates of postpartum SUI in the underweight, normal weight, overweight, and obese groups were 6.1%, 8.0%, 9.7%, and 11.0%, respectively. The incidence rate increased gradually with increasing postpartum BMI (P=0.037). Multivariate logistic regression analysis showed that the occurrence of SUI in the postpartum overweight group and postpartum obese group was 1.36 times (95%CI:1.09-1.68) and 1.67 times (95%CI:1.11-2.53) higher, respectively, than that in the postpartum normal weight group. Conclusion Postpartum overweight and obesity are high-risk factors for postpartum SUI. Early management of postpartum weight is beneficial for reducing the risk of postpartum SUI occurrence.

Objective To investigate the regulation of the methyltransferase inhibitor 5-aza-2-deoxycytidine (5-AZA-DC) on trophoblast apoptosis, proliferation, invasion, and migration in preeclampsia. Methods Placental tissue samples were collected from 40 normal pregnancies (normal pregnancy group) and 40 preeclampsia (PE group) patients. Hematoxylin-eosin (HE) staining was performed on the placental tissues after delivery, and whole-genome bisulfite sequencing (WGBS) was conducted on the placental tissues. Trophoblast cell lines HTR8/Svneo, JEG-3, JAR, and BeWo were cultured in vitro and divided into blank control group (Control group), STAT3 silencing group (shSTAT3 group), and STAT3 overexpression group (STAT3OE group). Cells were treated with 5-AZA-DC, and cell apoptosis, proliferation, invasion, and migration were assessed using CCK8, flow cytometry, Transwell invasion assays, and scratch assays. Statistical analysis was performed using t-tests and one-way ANOVA. Results (1) In placental tissue, compared to the normal pregnancy group, the PE group showed reduced vascular lumens, vascular occlusion, blood flow, fibrin deposition in the intervillous stroma, and visible infarction and hyaline degeneration in the villi. WGBS revealed a significant increase in methylation levels in the PE group, with statistically significant differences in the methylation of genes such as STAT3 [(17.25±1.05 vs 30.36±1.33),P＜0.01],PTEN[(13.33±0.71 vs 23.05±1.17),P＜0.02],TSC2[(15.28±1.43 vs 26.53±1.15),P＜0.02]. (2) In the cell lines, compared to the Control group, 5-AZA-DC intervention significantly reduced trophoblast apoptosis while increasing cell proliferation, invasion, and migration. These differences were statistically significant (P＜0.05). Conclusion STAT3 is a key gene in the pathogenesis of preeclampsia.The intervention with 5-AZA-DC intervention has significant effects on trophoblast apoptosis, proliferation, invasion, and migration in preeclampsia. 5-AZA-DC may be a potential epigenetic therapeutic agent for preeclampsia.

Objective To analyze the data of congenital abnormal deaths among children under 5 years old, explore the trend of congenital abnormal deaths from 2016 to 2022. Methods We collect data of child mortality from 2016 to 2022, and analyze the congenital abnormal deaths rate、proportion 、age and regional distribution. Results (1)From 2016(62.3/10⁵)to 2022(34.8/10⁵),the mortality rate of congenital malformations among children under 5 years old in Beijing was significantly decreased —a decrease of 44.1 percent(P＜0.01). The mortality rates of congenital heart disease, neural tube defects, and other congenital malformation were significantly decreased(P＜0.05), while the mortality rate of Down′s synfrome was not decreased(P＞0.05). The proportion of congenital malformations death among children under 5 years old in Beijing was significantly decreased from 23.4%(2016)to 18.1%(2022)(P＜0.05). (2)There are differences in mortality rates among different diseases between urban and suburban areas.The mortality rate of congenital heart disease was significantly decreased in both urban and rural areas(P＜0.01), while the mortality rate of neural tube defects was only decreased in rural area(P＜0.05), the mortality rate of other congenital malformations was only decreased in urban area(P＜0.05). (3)The proportion of deaths caused by congenital abnormalities in the neonatal period continues to decrease, and there are differences in the age distribution characteristics of deaths among different congenital abnormalities. Conclusion The three-level prevention of birth defects in Beijing has achieved significant results, but there are still differences between urban and suburban areas. More targeted measures can be taken in different periods (such as before pregnancy, during pregnancy, and after birth) and regions based on the causes of different congenital abnormalities, differences in suburban areas, and characteristics of age of death, in order to further reduce the mortality rate of congenital abnormalities in children.

目的 探讨X染色体非整倍体嵌合对接受体外受精胚胎移植(IVF/ICSI)助孕患者妊娠结局的影响。方法 采用回顾性研究方法,收集83 对女方存在X染色体非整倍体嵌合的夫妇资料,根据异常核型嵌合比例不同分为＜10%组(71例)和＞10%组(12例),以1∶2匹配166对染色体正常的夫妇,统计嵌合比例＜10%组和嵌合比例＞10%两组病例在体外受精胚胎移植患者(IVF-ET)中的年龄、身高、BMI、不孕原因、不孕年限、基础内分泌值、双侧窦卵泡数、 IVF用药方案、当周期移植率、周期取消率、当周临床妊娠率、持续妊娠率和流产率。结果 两个嵌合组与正常对照组的临床妊娠率没有显著性差异,而X染色体非整倍体嵌合的女性,嵌合比例＜10%的低比例嵌合组其流产率显著高于对照组,活婴分娩率显著低于对照组。结论 X染色体非整倍体嵌合比例＜10%的低比例嵌合的女性在妊娠过程中增加了流产的风险。

目的 观察乳酸菌联合氟康唑治疗外阴阴道假丝酵母菌病(VVC)的临床疗效及对阴道免疫状况的影响,为临床治疗提供参考依据。方法 选取2022年1月—6月育龄期VVC患者84例,随机分为观察组及对照组,每组各42例,对照组采用氟康唑治疗,观察组在对照组基础上联合乳酸菌治疗,比较两组症状消失时间、用药安全性、炎性因子、T淋巴细胞亚群和阴道清洁度。结果 (1)观察组患者用药期间阴道瘙痒、疼痛、异常阴道分泌物、黏膜充血、黏膜水肿症状消失时间均低于对照组(P<0.05);两组用药期间恶心呕吐、皮肤过敏、头晕头痛发生率差异均无统计学意义;治疗后6个月观察组复发率均低于对照组(P<0.05);(2)观察组治疗14 d后炎性因子(IL-2、IL-13、TNF-α)水平低于对照组(P<0.05);炎性因子(IL-8、INF-γ)水平高于对照组(P<0.05);(3)观察组用药4周后CD3+T细胞、CD4+T细胞及CD4+T细胞/CD8+T细胞水平高于对照组(P<0.05);CD8+T细胞水平低于对照组(P<0.05);(4)观察组用药14 d后阴道清洁度Ⅰ度、Ⅱ度病例数多于对照组(P<0.05);Ⅲ度、Ⅳ度病例数少于对照组(P<0.01)。结论 乳酸菌联合氟康唑治疗VVC患者能缩短症状消失时间,快速改善患者症状,治疗后6个月VVC的复发率明显降低。该治疗方法能降低炎性因子水平,提升T淋巴细胞水平,提高阴道清洁度,增加阴道局部免疫力。

Objective To investigate the use patterns of antenatal corticosteroids among pregnant women at risk of late preterm birth, and to evaluate the likelihood and influencing factors of administering the treatment at the optimal time (delivery within 2-7 days after the first dose of dexamethasone). Methods A retrospective study was conducted among 155 pregnant women (aged 23-54 years) who gave birth at our hospital between January 2017 and December 2022, who received antenatal corticosteroids during gestational weeks 34-36. 119 pregnant women received antenatal corticosteroids therapy during weeks 34-36 and delivered before 37 weeks, while another 36 pregnant women received antenatal corticosteroids during weeks 34-36 but delivered at term. Based on the indications for antenatal corticosteroid administration, the participants were divided into spontaneous preterm birth risk group (98 pregnant women) and iatrogenic preterm birth risk group (57 pregnant women). The average age of pregnant women in the spontaneous preterm birth risk group were (31.8±4.3) years, and that of the iatrogenic preterm birth risk group was (32.2±3.9) years. The timing of antenatal corticosteroid administration and maternal characteristics were compared between the two groups. Multivariable logistic regression was conducted to adjust for confounding factors and assess the factors associated with optimal timing of antenatal corticosteroid administration. Results The prevalence of optimal timing of antenatal corticosteroid administration was 29.7%. The proportion of women receiving corticosteroids at the optimal time in the iatrogenic preterm birth group was significantly higher than in the spontaneous preterm birth (P＜0.05). Compared to the iatrogenic preterm birth, women in the spontaneous preterm birth were more likely to have a delivery interval > 7 days after the administration of antenatal corticosteroids (P＜0.05) and had a higher probability of delivering at full term (P＜0.05). Logistic regression analysis revealed that women in the iatrogenic preterm birth group were 8.68 times more likely to receive antenatal corticosteroids at the optimal time than those in spontaneous preterm birth (95% CI:2.69-28.02). Additionally, women with premature rupture of membranes were 4.09 times more likely to receive antenatal corticosteroids at the optimal time than those without premature rupture of membranes (95% CI:1.24-13.45). Conclusion Regardless of the indication for late preterm antenatal corticosteroid administration, the likelihood of pregnant women at risk of late preterm birth receiving optimal timing of antenatal corticosteroid administration was low. However, women with risk of iatrogenic preterm birth were more likely to receive antenatal corticosteroid at the optimal time of administration. In addition, premature rupture of membranes is also a factor influencing the timing of optimal antenatal corticosteroid administration.

目的 探讨胎盘植入性疾病(PAS)产前漏诊病例的临床特征、高危因素和围产结局。方法 收集2015年1月至2021年12月本院收治的319例PAS孕妇的临床资料,其中产前漏诊60例,产前诊断259例,比较两组患者的临床特征、胎盘植入高危因素和围产结局。结果 与产前诊断组相比,产前漏诊组前置胎盘发生率低,胎盘植入程度轻,IVF-ET术和宫腔镜手术史是产前漏诊PAS的独立危险因素(P均＜0.05)。产前漏诊组产时/术中出血、严重产后出血率、血液制品用量、子宫切除率、转入ICU、新生儿早产率均低于产前诊断组(P均＜0.05),但两组二次手术率、大量输血率、手术并发症无差异。结论 不伴有前置胎盘的PAS产前漏诊率高,IVF-ET术和宫腔镜手术史是产前漏诊PAS的独立危险因素,可发生严重的围产期并发症。

目的 研究不明原因复发性流产(RPL)患者和正常生育人群人类白细胞抗原(HLA)抗体的状态;检测淋巴细胞免疫治疗(LIT)后HLA抗体的转阳率;对比不明原因RPL患者淋巴细胞免疫治疗后HLA抗体与妊娠结局,评估HLA抗体是否可作为LIT预测妊娠结局的有效指标。方法 选取2014年12月3日至2015年6月10日在北京大学第三医院生殖中心门诊就诊的不明原因RPL患者24例作为RPL组,同期于北京大学第三医院体检中心体检的健康未孕女性30例作为对照组,两组年龄均在20～40岁。应用酶联免疫吸附法和流式细胞仪-微珠法,分别测定不明原因RPL患者LIT前后和健康生育者外周血的HLA特异性IgG抗体,根据HLA抗体状态分为4类,包括HLA-I类阳性、HLA-II类阳性、双阳性(HLA-Ⅰ类、Ⅱ类均阳性)和双阴性(HLA-Ⅰ类、Ⅱ类均阴性),比较两组人群HLA抗体状态,分析LIT后RPL患者HLA抗体的转阳率,及HLA抗体状态与妊娠结局的关系。结果 RPL患者HLA抗体状态与健康生育者比较,差异无统计学意义;LIT促进HLA抗体转阳,LIT后不同HLA状态的活产率比较,差异无统计学意义。结论 不明原因PRL患者,LIT前HLA特异性IgG抗体与正常生育者差异无统计学意义,LIT可以促进HLA抗体转阳,免疫治疗后PRL患者HLA特异性IgG抗体与妊娠结局无关,HLA特异性IgG抗体不能作为LIT预测妊娠结局的唯一参考指标,尚需要结合其他免疫指标综合分析。