原发不育症子宫内膜花生凝集素受体的研究

本文以PNA(花生凝集素)为探针,应用ABC亲和组化技术,对69例原发不育症患者的子宫内膜PNA受体进行了检测.结果表明,原发不育症子宫内膜的增生期、分泌期PNA受体的阳性率均显著低于年龄相似、有生育史的对照组子宫内膜的阳性率.不育症子宫内膜分泌欠佳的PNA受体阳性率显著低于不育症分泌期不同时期子宫内膜的阳性率.提示,这种差异可能与雌孕激素对两组子宫内膜作用水平的不同引起.     

不孕症患者的子宫自然杀伤细胞、浆细胞与子宫内膜异位症的相关性

摘要 目的：探究不孕症患者的子宫自然杀伤细胞、浆细胞与子宫内膜异位症的相关性。方法：选择80例患有子宫内膜异位症的不孕症患者做为本研究的不孕症组和80例正常生育的健康女性做为本研究的健康组,对比分析两组患者人口学基本资料、子宫自然杀伤细胞（uNKs）、浆细胞（PC）水平、血清性激素水平、子宫内膜中血管内皮生长因子（VEGF）表达情况、免疫细胞水平。通过Person法分析不孕症患者的子宫自然杀伤细胞、浆细胞与子宫内膜异位症的相关性。结果：两组的BMI指数、流产史、吸烟史、饮酒史比较,差异有统计学意义（P<0.05）;不孕症组患者uNKs、抗苗勒氏管激素（AMH）和黄体生成素（LH）水平均显著高于健康组;PC、卵泡刺激素（FSH）、雌激素（Estrogen）和性激素结合球蛋白（SHBG）、VEGF阳性表达水平、CD4⁺、CD8⁺和CD4⁺/CD8⁺水平均显著低于健康组,差异有统计学意义（P<0.05）。另外,不孕症患者的uNKs与子宫内膜异位症存在显著的正相关关系（r=1.555,P<0.001）;PC与子宫内膜异位症存在显著的负相关关系（r=-3.778,P<0.001）。结论：不孕症患者的uNKs、PC参与不孕症的发生和发展过程,对女性子宫内膜异位症的诊断具有重要的参考意义。     

宫腔镜下电切术与刮宫术治疗子宫内膜息肉合并不孕症的疗效比较及术后妊娠的影响因素分析

摘要 目的：比较宫腔镜下电切术与宫腔镜下刮宫术治疗子宫内膜息肉合并不孕症的疗效,并分析术后妊娠的影响因素。方法：选取2018年10月～2020年9月我院收治的318例子宫内膜息肉合并不孕症患者,其中接受宫腔镜下电切术治疗的159例归为电切术组,接受宫腔镜下刮宫术治疗的159例归为刮宫术组,术后均随访12个月,比较两组手术相关指标、子宫内膜厚度、月经量和围术期并发症、息肉复发率、临床妊娠率,多因素Logistic回归分析术后妊娠的影响因素。结果：电切术组术中出血量低于刮宫术组（P＜0.05）,两组患者手术时间、住院时间比较无差异（P＞0.05）。两组患者术后12个月子宫内膜厚度较术前降低,且电切术组术后子宫内膜厚度低于刮宫术组（P＜0.05）。两组患者术后1个月、术后3个月月经量较术前逐渐减少,且电切术组较刮宫术组变化更明显（P＜0.05）。电切术组息肉复发率低于刮宫术组,而临床妊娠率高于刮宫术组（P＜0.05）,两组患者围术期并发症总发生率比较差异无统计学意义（P＞0.05）。多因素Logistic回归分析结果显示,年龄≥35岁、多发息肉、息肉直径≥1 cm、宫角息肉、术后子宫内膜厚度≥13 mm、术后息肉复发是影响子宫内膜息肉合并不孕症患者术后妊娠的危险因素（P＜0.05）。结论：宫腔镜下电切术治疗子宫内膜息肉合并不孕症患者疗效较宫腔镜下刮宫术更为显著,其术后妊娠率受年龄、息肉类型、息肉直径、息肉部位、术后子宫内膜厚度、术后息肉复发等因素影响。     

不育男性患者和健康男性血液与精浆中微量元素含量的对比分析

目的:研究不育患者精浆和血液中微量元素的含量,为男性不育的诊断和治疗提供理论依据。方法:对73例正常生育组男性和265例男性不育患者的精浆和血液中的锌、铁、铜、钙、镁、镉进行检测分析,分析两组血液和精浆微量元素的差异。结果:不育组患者精浆和血液中锌的含量明显低于正常对照组,铜、镉离子含量明显高于正常对照组,与正常对照组比较均有显著性差异(P<0.01);而两组中的钙、铁、镁的含量接近,差异无统计学意义(P>0.05)。不育组患者精浆中的锌元素水平明显高于血液锌含量,而血液中的镉含量明显高于精浆中的镉含量,差异有明显的统计学意义(P<0.05)。结论:精浆和血液中锌、铜、镉的变化与男性不育密切相关。     

腹腔镜术后联合GnRH-a治疗卵巢型内异症并不孕的疗效观察

目的:研究腹腔镜保守术后联合短期促性腺激素释放激素激动剂(GnRH-a)对卵巢型子宫内膜异位症合并不孕患者的治疗效果。方法:回顾性分析2008年5月-2011年5月在我院治疗内异症合并不孕的126例患者的临床资料,比较腹腔镜手术后联合GnRH-a治疗(用药组)和术后期待处理(对照组)的症状缓解率和妊娠情况。结果:用药组患者症状缓解率比对照组高,且差异有统计学意义(P0.05);用药组总妊娠率较对照组高,差异无统计学意义(P0.05),流产率比较无统计学差异(P0.05);治疗后患者1年内妊娠率最高,两组比较无统计学差异(P0.05),随访期间累积妊娠率比较,用药组高于对照组,无统计学意义(P0.05);用药组及对照组中Ⅰ-Ⅱ期及Ⅲ-Ⅳ期患者妊娠率均在50%以上,两组比较均无统计学差异(P0.05)。结论:此研究进一步明确腹腔镜术联合GnRH-a治疗卵巢子宫内膜异位症合并不孕患者能较好提高其症状缓解率和妊娠率,但妊娠率提高与期待治疗无差别。经手术或联合GnRH-a治疗后患者首次妊娠多发生在治疗后1年内,如果1年以上仍未妊娠,可根据实际情况选择其他助孕方法如辅助生育技术,以增加受孕机会。     

A change in the steroid metabolic pathway in human testes showing deteriorated spermatogenesis

During androgen biosynthesis, the human testes normally produce only small quantities of Δ⁴-C₂₁ steroids as these are products of the Δ⁴-pathway and healthy human testes preferentially use the Δ⁵-pathway. However, the Δ⁴-C₂₁ steroid progesterone accumulates in the thickened lamina propria of the seminiferous tubules in testes with deteriorated spermatogenesis. The objectives of this study were to analyse the pregnenolone metabolites in testes with deteriorated spermatogenesis and to establish whether the androgen biosynthesis pathway changes in this condition. Biopsied or orchiectomised testicular samples were obtained from patients with varicocele, non-obstructive azoospermia, obstructive azoospermia, testicular cancer, and cryptorchidism. The samples were segregated into spermatogenesis related Johnsen’s score groups: Low-JS (< 5.0) and High-JS (> 7.8). Higher levels of progesterone and 17α-hydroxyprogesterone were metabolised under in vitro conversion in the Low-JS testes than the High-JS testes when cell-free homogenates from each group were separately incubated with ¹⁴C-labelled pregnenolone. Nevertheless, the serum hormone levels did not differ between groups. Two novel pregnenolone metabolites 5β-pregnan-3β-ol-20-one and 5α-pregnan-3α, 21diol-20-one were identified from in vitro conversion in Low-JS testes and by recrystallisation. Immunohistochemistry revealed the higher βHSD expression in the Low-JS than the High-JS testes. However, the CYP17A1 expression levels did not differ between groups. Infertile testes increase the relative βHSD levels in their Leydig cells and synthesised testosterone from pregnenolone via the Δ⁴- rather than the Δ⁵-pathway. A new insight into a change of metabolites in Low-JS testes will be relevant to understand the mechanism of the deteriorated spermatogenesis under the normal range of testosterone level.     

Effect of sodium molybdate on cadmium-related testicular damage in adult male Wistar rats

BackgroundMolybdenum, as a trace element, has various pharmacological effects, including antioxidant, antiviral, anti-allergic, anti-osteoporosis, anti-tumor, anti-inflammatory, anti-diabetic, anti-obesity, and free radical-scavenging activities. This study aimed at investigating the sodium molybdate impacts on cadmium chloride (CdCl₂)-induced testicular toxicity in adult Wistar rats.MethodsThe impacts of oral administration of sodium molybdate (0.05, 0.1, 0.2, and 0.4 mg/kg) was evaluated in healthy and infertile animals. Animals were randomly assigned to nine groups, including healthy control, sodium molybdate alone, infertile control (3 mg/kg of CdCl₂), and sodium molybdate plus CdCl₂. Following 30 days of administration, animals were sacrificed for biochemical and histopathological assays.ResultsThe results indicated that administration of sodium molybdate to infertile rats significantly mitigated the cadmium impacts on sperm appearance, concentration, and motility parameters. Also, sodium molybdate reduced the production of malondialdehyde (MDA) and enhanced antioxidant enzymes activities in the testicular homogenates in rats; these findings were supported by histopathological examinations. Treatment with sodium molybdate significantly increased aquaporin-9 (AQP9) expression in the testicular tissues of infertile rats.ConclusionsThe current findings suggested that sodium molybdate performs as a strong protective agent from CdCl₂-related testicular toxicity in rats.