目的:探讨不同时机宫腔镜检查对反复胚胎移植未孕患者后续体外受精-胚胎移植(IVF-ET)临床妊娠结局的影响。方法:回顾性分析2025年1月至2025年10月于东莞康华医院生殖医学科就诊的206例行IVF-ET助孕研究对象的临床资料。根据宫腔镜检查时机分为三组:A组(胚胎移植前检查,n=82)、B组(胚胎移植1次失败后检查,n=70)、C组(胚胎移植2次失败后检查,n=54)。比较三组研究对象后续IVF-ET周期的临床妊娠率。结果:三组研究对象基线年龄、不孕年限、BMI、AMH等指标差异无统计学意义(P>0.05)。总人群临床妊娠率为53.59%(97/206),其中A组妊娠率为72.0%(59/82),B组为35.7%(25/70),C组为24.1%(13/54),组间差异有统计学意义(P<0.001)。免疫双染阳性研究对象占86.27%(176/206),其在组间分布均衡,未改变主要结论。结论:对于IVF-ET助孕研究对象,胚胎移植前进行宫腔镜检查并处理异常,可能与后续临床妊娠率升高相关;延迟至1次或2次胚胎移植失败后再检查,妊娠获益可能大幅降低。提示胚胎移植前常规行宫腔镜评估的必要性。
Objective: To investigate the impact of different timing of hysteroscopy on the subsequent clinical pregnancy outcomes of patients with recurrent embryo transfer failure undergoing in vitro fertilization - embryo transfer (IVF-ET). Methods: The clinical data of 206 patients who underwent IVF-ET assisted pregnancy treatment at the Reproductive Medicine Department of Dongguan Kanghua Hospital from January 2025 to October 2025 were retrospectively analyzed. The patients were divided into three groups based on the timing of hysteroscopy: Group A (examined before embryo transfer, n = 82), Group B (examined after one failed embryo transfer, n = 70), and Group C (examined after two failed embryo transfers, n = 54). The clinical pregnancy rates of the subsequent IVF-ET cycles of the three groups were compared. Results: There were no statistically significant differences in baseline age, duration of infertility, BMI, AMH, etc. among the three groups (P > 0.05). The overall clinical pregnancy rate of the population was 53.59% (97/206), with the pregnancy rates in Group A being 72.0% (59/82), in Group B 35.7% (25/70), and in Group C 24.1% (13/54). The differences among the groups were statistically significant (P < 0.001). Immunobright staining positive study subjects accounted for 86.27% (176/206), and their distribution among the groups was balanced, without changing the main conclusion. Conclusion: For patients undergoing IVF-ET assisted pregnancy treatment, performing hysteroscopy and treating abnormalities before embryo transfer may be associated with an increased subsequent clinical pregnancy rate; delaying the examination until one or two failed embryo transfers may significantly reduce the pregnancy benefit. It suggests the necessity of routine hysteroscopy assessment before embryo transfer.
目的 探讨经阴道超声多参数联合血清孕酮在先兆流产妊娠结局中的临床意义,以期为临床制定相应干预方案提供参考。 方法 回顾性选取我院2022年8月~2024年8月就诊的152例早期先兆流产(孕5~8周)患者作为研究对象,均随访至孕12周,根据妊娠结局分为继续妊娠组(n=64)、难免流产组(n=88),比较两组临床资料及入院时经阴道超声多参数[收缩期峰值流速(S)/舒张末期流速(D)、阻力指数(RI)、搏动指数(PI)、孕囊大小]、血清孕酮水平,Logistic回归方程分析入院时经阴道超声多参数及血清孕酮水平对先兆流产患者妊娠结局的影响,受试者工作特征(ROC)曲线分析其对先兆流产患者难免流产的预测价值。 结果 两组年龄、流产史、S/D、RI、PI、孕囊大小、血清孕酮水平比较,差异具有统计学意义(P<0.05);经Logistic回归方程分析结果显示,在校正年龄、流产史潜在混杂因素后,S/D、RI、PI、孕囊大小、血清孕酮水平仍与先兆流产患者妊娠结局显著相关,均为其独立影响因素(P<0.05);绘制ROC曲线结果显示,S/D、RI、PI、孕囊大小、血清孕酮对于先兆流产患者难免流产的预测AUC分别为0.749、0.764、0.743、0.774、0.793,具有一定预测价值;基于S/D、RI、PI、孕囊大小、血清孕酮水平建立Logistic回归方程模型,经Hosmer-Lemeshow拟合优度检验显示,构建的模型χ2=2.249,P=0.117,说明该模型构建的预测结果与实际结果一致;绘制ROC分析该模型对先兆流产患者难免流产的预测价值,结果显示AUC为0.894(95%CI:0.834~0.938),敏感度为81.82%,特异度为87.50%。结论 经阴道超声多参数联合血清孕酮对于先兆流产患者妊娠结局具有较高预测价值,临床可通过早期联合检测评估患者难免流产发生风险,以针对性制定相应干预方案。
目的 探讨不同剂量左甲状腺素钠联合二甲双胍治疗妊娠期糖尿病(GDM)并发甲状腺功能减退症(简称“甲减”)患者的临床疗效,并分析其对甲状腺激素水平、妊娠结局的影响。方法 选取2023年1月~2025年1月于本院诊治的92例GDM并发甲减患者为研究对象,依据治疗方案不同将其分为2组,对照组采用左甲状腺素钠、二甲双胍治疗,观察组采用维生素D联合左甲状腺素钠、二甲双胍治疗。比较2组临床疗效及治疗前后甲状腺激素[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)]、糖脂代谢指标[空腹血糖、胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)]、血管内皮功能[一氧化氮(NO)、内皮素-1(ET-1)、一氧化氮合酶(NOS)、非对称性二甲基精氨酸(ADMA)]、病情进展相关指标[成纤维细胞生长因子-21(FGF-21)、视黄醇结合蛋白4(RBP4)、脂蛋白相关磷脂酶A2(Lp-PLA2)]。比较2组妊娠结局。结果 观察组总有效率高于对照组(P<0.05);观察组治疗后TSH水平低于对照组,FT3、FT4水平高于对照组(P<0.05);观察组治疗后空腹血糖水平、TC、TG、LDL-C水平及HOMA-IR低于对照组(P<0.05);观察组治疗后NO、NOS水平高于对照组,ET-1、ADMA水平低于对照组(P<0.05);观察组治疗后血清FGF-21、RBP4、Lp-PLA2水平低于对照组(P<0.05);2组流产、胎盘早剥、新生儿窒息发生率比较无明显差异(P>0.05),观察组早产发生率低于对照组(P<0.05)。结论 维生素D联合左甲状腺素钠、二甲双胍治疗GDM并发甲减患者的效果显著,可更好地维持甲状腺功能正常,纠正糖脂代谢,改善血管内皮功能,控制疾病进展,并可在一定程度上改善妊娠结局。
目的 探讨精子DNA碎片指数(DFI)对体外受精-胚胎移植(IVF-ET)胚胎发育及妊娠结局的影响,为优化男性生育力评估及辅助生殖治疗策略提供依据。方法 回顾性分析2023年1月—2024年1月于徐州市妇幼保健院接受IVF-ET治疗的126对不孕夫妇,根据男方DFI检测结果分为低碎片组(DFI≤15%,n=42)、临界组(15%<DFI<30%,n=45)和高碎片组(DFI≥30%,n=39)。比较三组患者受精相关指标、胚胎发育指标及妊娠结局指标的差异,并分析DFI与各指标的相关性。结果 低碎片组双原核率(2PN)率、优质胚胎率及囊胚形成率均高于临界组和高碎片组(P<0.001),低碎片组1PN率、多PN率均低于临界组和高碎片组(P<0.001);三组种植率、临床妊娠率、早期流产率比较差异无统计学意义(P>0.05),但高碎片组活产率低于低碎片组(P<0.05)。相关性分析结果表明,DFI与优质胚胎率(r=-0.412,P<0.001)、囊胚形成率(r=-0.387,P<0.001)、活产率(r=-0.287,P=0.012)呈负相关,与早期流产率(r=0.206,P=0.059)、种植率(r=-0.215,P=0.058)、临床妊娠率(r=-0.203,P=0.072)无显著相关性。结论 精子DNA碎片指数是影响IVF-ET胚胎发育及妊娠结局的重要因素,高DFI主要通过降低胚胎发育潜能及增加流产风险导致活产率下降,临床需对高DFI患者进行干预以改善治疗结局。
Objective To investigate the impact of sperm DNA fragmentation index(DFI)on embryo development and pregnancy outcomes of in vitro fertilization-embryo transfer(IVF-ET),and to provide a basis for optimizing male fertility assessment and assisted reproductive treatment strategies.Methods A retrospective analysis was performed on 126 infertile couples undergoing IVF-ET treatment at the Reproductive Medicine Center of Xuzhou Maternal and Child Health Hospital from January 2023 to January 2024.According to the male DFI test results,they were divided into three groups:low fragmentation group(DFI≤15%,n=42),critical group(15% < DFI < 30%,n=45),and high fragmentation group(DFI≥30%,n=39).Differences in fertilization-related indicators,embryo development indicators,and pregnancy outcome indicators were compared among the three groups,and the correlation between DFI and each indicator was analyzed.Results The 2 pronuclei rate(PN)rate,high-quality embryo rate,and blastocyst formation rate in the low fragmentation group were significantly higher than those in the critical and high fragmentation groups(P<0.001).The 1PN rate and multi-PN rate in the low fragmentation group were significantly lower than those in the critical and high fragmentation groups(P<0.001).There was no significant difference in the three groups of implantation rate,clinical pregnancy rate and early abortion rate(P>0.05),but the live birth rate of high fragment group was significantly lower than that of low fragment group(P<0.05).The results of correlation analysis showed that DFI was significantly negatively correlated with the rate of high quality embryos(r=-0.412,P<0.001),blastocyst formation rate(r=-0.387,P<0.001)and live birth rate(r=-0.287,P=0.012),but not with the rate of early abortion(r=0.206,P=0.059),implantation rate(r=-0.215,P=0.058)and clinical pregnancy rate(r=-0.203,P=0.072).Conclusions Sperm DFI is an important factor affecting embryo development and pregnancy maintenance in IVF-ET.High DFI leads to a decrease in live birth rate mainly by reducing embryo developmental potential and increasing the risk of early abortion.Clinically,early intervention is needed for patients with high DFI to improve treatment outcomes.
目的 探讨妊娠期糖尿病(GDM)患者孕24~28周的75 g 口服葡萄糖耐量试验(OGTT)血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组(92例),2项异常为GDMⅡ组(48例),3项异常为GDMⅢ组(27例),比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数(BMI)及妊娠晚期的糖化血红蛋白(HbA1c)间比较差异均有统计学意义(P<0.05)。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义(P<0.05);75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义(P<0.05);③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义(P<0.05)。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义(P<0.05)。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA1c水平。
Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test(OGTT)at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus(GDM)patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects.The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group(92 cases),with 2 abnormal items were GDMⅡ group(48 cases),and with 3 abnormal items were GDM Ⅲ group(27 cases).The demographic characteristics of the three groups of GDM patients were compared.The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed.Results ①With different BMI and HbA1c,there were significant differences in 75 g OGTT blood glucose items(P<0.05).BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester(P<0.05).②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose(P<0.05).③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups(P<0.05).There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose(P<0.05). Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester.The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome.Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA1c level in the third trimester.
目的 分析宫颈弹性成像(UE)参数在宫颈机能不全(CIC)孕妇妊娠结局中的预测价值。方法 选取我院收治的119例(2019年10月—2021年8月)CIC孕妇,根据妊娠结局分为早产组(孕周<37周)56例、正常组(孕周≥37周)63例,均于孕20~24周接受阴道超声、宫颈UE检查,获取宫颈长度(CL)、宫颈UE参数[超声弹性对比指数(ECI)、宫颈外口弹性应变率(EOS)、宫颈内口弹性应变率(IOS)]并进行比较,以了解宫颈UE参数在CIC孕妇妊娠结局中的应用价值。结果 早产组CL水平较正常组低,ECI、IOS、EOS水平较正常组高(P<0.05);单因素分析发现,CL、ECI、IOS、EOS均可对CIC孕妇妊娠结局产生影响(P<0.05);受试者工作特征(ROC)曲线结果显示,CL、ECI、EOS、IOS预测CIC孕妇早产的AUC分别为0.616、0.765、0.728、0.814,敏感度分别为64.29%、75.00%、73.21%、82.14%,特异度分别为42.86%、52.38%、57.14%、42.86%。结论 宫颈UE参数能有效反映宫颈组织情况,对CIC孕妇妊娠结局具有一定的预测价值。
目的 分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇接受胰岛素治疗对妊娠结局的影响及安全性。方法 将2018年7月—2020年7月接诊且行常规治疗的50例GDM孕妇作为对照组,将同期接诊且在对照组基础上行胰岛素治疗的50例GDM孕妇作为观察组,对组间血糖控制效果、生活质量(SF-36)、治疗效果、不良妊娠结局、不良反应展开分析。结果 (1)组间血糖指标在治疗前无明显差异(P>0.05);治疗后,观察组血糖控制效果优于对照组(P<0.05);(2)观察组SF-36评分高于对照组,且治疗效果(96.00%)优于对照组(82.00%,P<0.05);(3)观察组出现3例不良妊娠结局(6.00%),对照组出现11例不良妊娠结局(22.00%,P<0.05);(4)观察组发生3例不良反应(6.00%),对照组发生2例不良反应(4.00%,P>0.05)。结论 对GDM孕妇实施胰岛素治疗,可以改善孕妇血糖水平,减少不良妊娠结局,提高孕妇生活质量,安全可靠,值得推广。
Objective To analyze the effect and safety of insulin therapy on pregnancy outcome in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 50 pregnant women with GDM who received conventional treatment from July 2018 to July 2020 were induded in the control group, and 50 pregnant women with GDM who received insulin treatment on the basis of the control group were induded in the observation group. Results (1) There was no significant difference in blood glucose index between two groups before treatment(P> 0.05); after treatment, the blood glucose control effect of the observation group was better than that of the control group(P<0.05); (2) SF-36 score of the observation group was higher than that of the control group, and the treatment effect (96.00%) was better than that of the control group (82.00%,P<0.05); (3) there were 3 cases of adverse pregnancy outcomes (6.00%) in the observation group and 11 cases (22.00%) in the control group; (4) there were 3 cases of adverse reactions (6.00%) in the observation group and 2 cases (4.00%) in the control group(P> 0.05). Conclusion Insulin therapy for pregnant women with GDM could improve the blood glucose level of pregnant women, reduced adverse pregnancy outcomes, improved the quality of life of pregnant women, which is safe and reliable, and is worthy of promotion.
目的 探讨子午流注开穴法对薄型子宫内膜患者妊娠结局的影响。方法 将同期在门诊行B超监测排卵、指导受孕的薄型子宫内膜患者80例随机分为两组,每组各40例,观察组采用子午流注开穴法及药物治疗,对照组则单纯给予药物治疗。比较两组治疗前后的子宫内膜厚度、子宫内膜形态、子宫内膜血流搏动指数(PI)、血流阻力指数(RI)及临床妊娠率(PR)。结果 两组治疗后子宫内膜厚度与同组治疗前均有不同程度的改善(P<0.05),治疗后子宫内膜厚度两组间比较差异有统计学意义(P<0.05)。观察组治疗后A型子宫内膜的比例较治疗前增加,差异有统计学意义(P<0.05);与对照组比较,差异有统计学意义(P<0.05)。观察组临床妊娠率为27.5%,对照组临床妊娠率为10%,两组相比较差异有统计学意义(P<0.05)。结论 子午流注开穴法在薄型子宫内膜患者中的应用有效促进子宫内膜容受性的建立,从而改善其妊娠结局。
Objective To explore the effects of selection points by earth meridian ebb-flowing rule on infertile women suffering from thin endometrium. Methods 80 patients with thin endometrium who were monitored ovulation and guided pregnancy under B-mode ultrasound were randomly divided to two groups: the observation group and the control group, 40 patients for each group. The observation group was treated with selection points by earth meridian ebb-flowing rule and medication, while the control group was treated with medication only. The endometrial thickness, endometrial morphology, endometrial blood flow Pulsation Index (PI), Resistance Index (RI) and Clinical Pregnancy Rate (PR) before and after treatment were compared between the two groups. Results After treatment, the endometrial thickness was improved in both groups, which was statistical significant between the two groups(P<0.05). The proportion of type A endometrium in the observation group was increased compared with that before treatment and the control group, the difference was statistical significant(P<0.05). The clinical pregnancy rate was 27.5% in the observation group and 10% in the control group, and the difference between the two groups was statistically significant(P<0.05). Conclusion The application of selection points by earth meridian ebb-flowing rule in patients with thin endometrium may effectively promote the establishment of endometrial receptivity and improve the pregnancy outcome.
目的 比较细胞因子TGF-β、IL-10、TNF-α、Th17在不同妊娠结局的妊娠期亚临床甲减孕妇血清中的差异,探索细胞因子在不同妊娠结局中的作用。方法 随机选择2018年1月—2018年12月在我院就诊的66例确诊为因妊娠期亚临床甲减而出现不良妊娠结局的孕妇与同期妊娠结局正常的66例孕妇进行病例对照研究,比较不同妊娠结局孕妇的血清TGF-β、IL-10、TNF-α、Th17的差异;结果 ① 亚临床甲减组的TPOAb、TgAb、TRAb阳性率高于正常妊娠组,同时TNF-α、Th17均高于正常妊娠组,而TGF-β、IL-10均低于正常妊娠组,差异有统计学意义(P<0.05)。② 因子分析发现:在TPOAb、TgAb、TRAb、TGF-β、IL-10、TNF-α、Th17七个影响妊娠期亚临床甲减不良妊娠结局的相关因素中,TGF-β、IL-10、TNF-α、Th17在第1影响因子,特征值达2.347;TPOAb、TgAb、TRAb是次要影响因子,特征值为1.162。结论 TGF-β、IL-10、TNF-α、Th17与妊娠期亚临床甲状腺功能减退症的不良妊娠结局有密切关系,TGF-β、IL-10、TNF-α、Th17是影响妊娠期亚临床甲减不良妊娠结局的主要因子;TPOAb、TgAb、TRAb是影响妊娠期亚临床甲减不良妊娠结局的次要因子。
Objective To compare the serum levels of TGF-β, IL-10, TNF-α and Th17 in pregnant women with subclinical hypothyroidism in different pregnancy outcomes. Methods A case-control study was conducted in 66 pregnant women with adverse pregnancy outcomes due to subclinical hypothyroidism during pregnancy and 66 pregnant women with normal pregnancy outcomes during the same period. The differences of serum TGF-β, IL-10, TNF-α and Th17 among pregnant women with different pregnancy outcomes were compared. Results ①The positive rates of TPOAb, TgAb and TRAb in subclinical hypothyroidism group were higher than those in normal pregnancy group, and TNF-α and Th17 were higher than those in normal pregnancy group, while TGF-βand IL-10 were lower than those in normal pregnancy group (P<0.05). ②Factor analysis found that TPOAb, TgAb, TRAb, TGF-β, IL-10, TNF-α and Th17 were the factors related to adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy. TGF-β, IL-10, TNF-α and Th17 were the main influencing factors with a characteristic value of 2.347; TPOAb, TgAb and TRAb were the second influencing factors,with a characteristic value of 1.162. Conclusion ①TGF-β, IL-10, TNF-α, Th17 are closely related to the occurrence and pregnancy outcome of subclinical hypothyroidism in pregnancy. ②TGF-β, IL-10, TNF-α and Th17 are the main factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy;TPOAb, TgAb and TRAb are the secondary factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy,
目的 通过比较二胎孕妇和初产孕妇心电图变化探讨其对妊娠结局的影响。方法 随机选取300例孕妇,其中150例二胎孕妇为观察组,150例初产孕妇为对照组。观察2组孕妇异常心电图的类型及发生率,分析异常心电图与妊娠结局的关系。结果 初产孕妇组异常心电图35例,心电图异常发生率为23.3%,二胎孕妇组异常心电图50例,心电图异常发生率为33.3%,两组心电图异常发生率差别有统计学意义(P<0.05)。二胎孕妇组窦性心动过速、室性早搏及ST-T改变的发生率显著高于初产孕妇组,差异有统计学意义(P<0.05)。二胎孕妇心电图异常组的剖宫产率和早产率均高于二胎孕妇心电图正常组、初产孕妇心电图正常组,差别有统计学意义(P>0.05)。结论 二胎孕妇易合并心电图异常改变,心电图异常会增加剖宫产和早产的发生率,临床医生在诊治此类患者时应提高警惕。
Objective To observe the relationship between electrocardiogram(ECG) and pregnancy outcomes of the second pregnant women. Methods Pregnant women were divided into two groups by parity history: the second pregnancy group and the Primipara group. The incidence of abnormal electrocardiogram was recorded, then the pregnancy outcome including the delivery mode and the premature birth rate were followed up. Results The incidence of abnormal ECG in the second pregnancy group was significantly higher than that in primipara group(P<0.05) and the incidences of Nodal tachycardia, Premature ventricular contraction, ST-T changes in the group of the second pregnancy were higher than that in the group of Primipara (P<0.05). The incidence of cesarean delivery and premature birth in the second pregnancy group with abnormal ECG group was significantly higher than that in pregnant women with normal ECG group (P<0.05). Conclusion The second pregnant women are more likely to have ECG abnormality, the pregnant women with abnormal ECG are easily suffer from cesarean delivery and premature birth.