游离睾酮指数联合血清GnSAF、SHBG对多囊卵巢综合征不孕患者IVF-ET治疗妊娠结局的预测价值

摘要 目的：探讨游离睾酮指数（FAI）联合血清促性腺激素平抑因子（GnSAF）、性激素结合球蛋白（SHBG）对多囊卵巢综合征（PCOS）不孕患者体外受精-胚胎移植（IVF-ET）治疗妊娠结局的预测价值。方法：选取2020年1月～2022年6月湖南省妇幼保健院生殖医学中心收治的197例PCOS不孕患者为PCOS组,根据IVF-ET治疗妊娠结局分为妊娠失败组和妊娠成功组,另选取同期68名体检健康妇女为对照组。收集PCOS不孕患者临床资料,计算FAI并检测血清GnSAF、SHBG水平。采用单因素和多因素Logistic回归分析PCOS不孕患者IVF-ET治疗妊娠结局的影响因素,采用受试者工作特征（ROC）曲线分析FAI和血清GnSAF、SHBG对PCOS不孕患者IVF-ET治疗妊娠结局的预测价值。结果：PCOS组FAI和血清GnSAF水平高于对照组,SHBG水平低于对照组（P＜0.05）。197例PCOS不孕患者IVF-ET治疗妊娠成功率为51.27%（101/197）。单因素分析显示,妊娠失败组体质指数、黄体生成素（LH）、LH/促卵泡生成素（FSH）、睾酮、抗苗勒管激素（AMH）、FAI、GnSAF高于妊娠成功组,FSH、受精率、优胚率、SHBG低于妊娠成功组（P＜0.05）。多因素Logistic回归分析显示,体质指数增加和LH、LH/FSH、AMH、FAI、GnSAF升高为PCOS不孕患者IVF-ET治疗妊娠失败的独立危险因素,SHBG升高为其独立保护因素（P＜0.05）。ROC曲线分析显示,FAI和血清GnSAF、SHBG联合预测PCOS不孕患者IVF-ET治疗妊娠结局的曲线下面积大于FAI、GnSAF、SHBG单独预测。结论：FAI和血清GnSAF、SHBG水平联合预测PCOS不孕患者IVF-ET治疗妊娠结局的价值较高。     

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.     

实时三维超声输卵管造影与X线造影诊断不孕症患者输卵管病变的价值比较

目的:比较实时三维超声输卵管造影与X线造影检查诊断女性不孕症患者输卵管病变的临床应用价值。方法:选择2014年3月至2016年12月我院诊治的不孕症患者60例作为研究对象,所有患者都于月经干净后3-7 d同时随机实施实时三维超声输卵管造影与X线造影检查,观察并记录造影图像质量与诊断结果,比较两种方法的诊断效果。结果:实时三维超声输卵管造影与X线造影的图像质量优良率分别为98.3%和86.7%,实时三维超声输卵管造影的图像质量明显高于X线造影(P0.05)。实时三维超声输卵管造影与X线造影诊断不孕症患者输卵管不通畅率分别为56.7%和46.7%,实时三维超声输卵管造影组显著高于X线造影组(P0.05)。输卵管通畅性评价金标准腹腔镜下通液术诊断发现输卵管不通畅35例,在此基础上实时三维超声输卵管造影与X线造影检查不孕症的敏感性分别为97.1%和80.0%,特异性均为100.0%,超声诊断的敏感性明显高于X线(P0.05)。结论:相对于X线造影,实时三维超声输卵管造影检查不孕症患者输卵管病变的图像质量更好,有利于疾病的判断,对输卵管通畅度判断更精确,利于后期治疗及疾病预防,还可提高诊断敏感性。     

血清瘦素、鸢尾素、SHBG、AQP8与PCOS不孕症接受IVF-ET患者激素水平和妊娠结局的关系研究

摘要 目的：研究血清瘦素、鸢尾素、性激素结合球蛋白（SHBG）、水通道蛋白8（AQP8）与多囊卵巢综合征（PCOS）不孕症接受体外受精-胚胎移植（IVF-ET）患者性激素水平和妊娠结局的关系。方法：选取2020年1月～2022年1月我院收治的293例接受IVF-ET的PCOS不孕症患者,根据是否临床妊娠成功将其分为临床妊娠失败组（n=118）和临床妊娠成功组（n=175）。收集患者临床资料,检测血清瘦素、鸢尾素、SHBG、AQP8水平。Pearson相关系数分析PCOS患者不孕症血清瘦素、鸢尾素、SHBG、AQP8水平与性激素水平的相关性,多因素Logistic回归分析PCOS不孕症接受IVF-ET患者妊娠结局影响因素,受试者工作特征（ROC）曲线分析血清瘦素、鸢尾素、SHBG、AQP8水平单独及联合预测PCOS不孕症接受IVF-ET患者临床妊娠失败的价值。结果：与临床妊娠成功组比较,临床妊娠失败组促卵泡生成素（FSH）、促性腺激素（Gn）用量、获卵数、受精率、优胚率、SHBG水平降低,黄体生成素（LH）、LH/FSH、睾酮（T）、胰岛素抵抗指数（HOMA-IR）、瘦素、鸢尾素、AQP8水平升高。Pearson相关系数显示,PCOS不孕症患者血清瘦素、鸢尾素、AQP8与FSH水平呈负相关,与LH、LH/FSH、T水平呈正相关（P均＜0.05）;SHBG与FSH水平呈正相关,与LH、LH/FSH、T水平呈负相关（P均＜0.05）。多因素Logistic回归分析显示,LH/FSH、T、HOMA-IR、瘦素、鸢尾素、AQP8为PCOS不孕症接受IVF-ET患者临床妊娠失败的危险因素,优胚率、SHBG为保护因素（P均＜0.05）。ROC曲线显示,血清瘦素、鸢尾素、SHBG、AQP8水平联合预测PCOS不孕症接受IVF-ET患者临床妊娠失败的曲线下面积（AUC）大于各指标单独预测。结论：血清瘦素、鸢尾素、SHBG、AQP8水平与PCOS不孕症接受IVF-ET患者FSH、LH、LH/FSH、T水平和临床妊娠失败相关,有助于预测PCOS不孕症患者妊娠结局。     

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.     

达英-35治疗多囊卵巢综合征合并不孕症的疗效及对患者血清FSH、LH、TOS、TAS水平的影响

摘要 目的：研究达英-35治疗多囊卵巢综合征合并不孕症的疗效及对患者血清卵泡刺激素(FSH)、促黄体生成素(LH)、总氧化态(TOS)、抗氧化态(TAS)水平的影响。方法：选取2015年8月至2016年7月我院收治的76例多囊卵巢综合征合并不孕症患者,根据随机数字法分为观察组和对照组,38例每组。对照组使用克罗米芬,观察组在此基础上加以达英-35。比较两组患者临床疗效,治疗前后血清FSH、LH、TOS、TAS水平、卵泡数、卵巢体积、体重指数的变化及不良反应的发生情况。结果：治疗后,观察组临床总有效率显著高于对照组[89.47%(34/38) vs. 60.53%(23/38)](P<0.05);两组患者的血清FSH、LH、TOS水平、卵泡数、卵巢体积、体重指数明显减少较治疗前均显著降低(P<0.05),而血清TAS水平较治疗前显著上升(P<0.05),且观察组的血清FSH、LH、水平明显低于对照组(P<0.05),而血清TAS水平显著高于对照组(P<0.05)。观察组和对照组的不良反应的发生率比较无明显差异(P>0.05)。结论：达英-35治疗多囊卵巢综合征合并不孕症患者能有效提高患者的临床疗效和改善其临床症状,且安全性高,这可能与其有效改善患者血清FSH、LH、TOS、TAS水平有关。     

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.