目的 探讨慢性乙型肝炎病毒（HBV）感染对妊娠期糖尿病（GDM）孕妇的妊娠并发症、孕晚期生殖道B族链球菌（GBS）感染情况以及妊娠结局的影响。方法 选取2020年1月1日—12月31日在广州市妇女儿童医疗中心定期产检、足月、单胎妊娠的GDM孕妇共583例,其中合并HBV感染者（GDM+HBV组）48例,无合并者（GDM组）535例。比较2组的妊娠期并发症、妊娠晚期（妊娠35~37周）生殖道GBS感染情况、妊娠结局以及阴道分娩者的母儿结局。结果 与GDM组患者相比,GDM+HBV组患者出现妊娠期肝内胆汁淤积症、孕晚期生殖道GBS感染者比例较高,孕期出现胎盘早剥者比例较高,阴道分娩过程中出现产时发热、羊水粪染和新生儿入住NICU者比例均较高（均P<0.05）。结论 与无合并慢性HBV感染的GDM患者相比,合并慢性HBV感染的GDM患者在围产期的母儿风险升高。

Objective To investigate the effects of chronic hepatitis B virus（HBV）infection on pregnancy complications,group B streptococcus（GBS）infection in third trimester and pregnancy outcome in pregnant women with gestational diabetes mellitus（GDM）．Methods A retrospective study of 583 pregnant women with GDM,singleton gestation and cephalic presentation delivered at term in Guangzhou Women and Children’s Medical Center was carried out．Including 48 GDM women complicated with chronic HBV infection（GDM+HBV group）and 535 GDM women without HBV infection（GDM group）．Pregnancy complications,GBS infection in third trimester（gestation 35-37 weeks）,pregnancy outcomes,maternal and neonatal outcomes of vaginal delivery were compared between the two groups．Results GDM+HBV group had a higher proportion of intrahepatic cholestasis of pregnancy（ICP）and GBS infection in third trimester than GDM group,and a higher proportion of placental abruption during pregnancy．GDM+HBV group showed a significantly increased proportion in intrapartum fever,meconium-stained amniotic fluid and neonatal intensive care unit admission during vaginal delivery than GDM group（all P<0.05）．Conclusions GDM women with chronic HBV infection are associated with increased maternal and fetal risk during pregnancy and delivery．

目的 探讨影响先天性甲状腺功能减低症患儿不同转归的早期因素。 方法 选取2013年12月—2017年3月期间在本中心筛查并确诊的先天性甲状腺功能减低症患儿共80例,经左旋甲状腺激素钠治疗2~3年后停药评估再随访1年以上者,根据疾病转归将患儿分为持续性甲低组(29例)与暂时性甲低组(51例)。对2组患儿的临床情况进行回顾性分析,寻求影响结局的早期因素。结果 持续性甲低与暂时性甲低患儿初筛促甲状腺激素值[ 63.89 (43.89, 114.25) vs 38.54 (27.27, 60.00) mIU/L]、促甲状腺激素恢复正常所需剂量[(4.29±1.46) vs (3.38±1.34) μg/(kg·d)]、早期甲状腺超声正常比例[58.6%(17/29)vs 90.2%(46/51)]差异有统计学意义(P<0.05)。其中初筛促甲状腺激素值(最佳临界值:37.825 mIU/L,AUC=0.745,灵敏度0.897,特异度0.490)和出生后第8个月左旋甲状腺激素钠给药剂量[最佳临界值3.38 μg/(kg·d),AUC=0.759,灵敏度 0.586,特异度 0.843]可早期区别持续性甲低与暂时性甲低患儿。结论 初筛促甲状腺激素值和出生后左旋甲状腺激素钠给药剂量对先天性甲状腺功能减低症患儿临床转归有早期预测作用。

Objective To investigate the early factors affecting different outcomes of children with congenital hypothyroidism (CH). Methods A total of 80 children with CH screened and diagnosed at Meizhou Maternal and Child Health Care and Family Planning Service Center between December 2013 and March 2017, who were treated with levothyroxine sodium for 2~3 years and then discontinued for assessment and followed up for over 1 year, were selected and divided into the permanent CH group (29 cases) and transient CH group (51 cases) according to disease outcomes. The clinical conditions of the children were retrospectively analysed to seek early factors affecting outcome. Results The initial screening thyroid hormone values [ 63.89 (43.89, 114.25) vs 38.54 (27.27, 60.00) mIU/L ], the required dose to restore normal thyroid hormone in permanent and transient CH group [(4.29±1.46) vs (3.38±1.34) μg/(kg·d)], and the proportion of early normal thyroid ultrasound [58.6% (17/29) vs 90.2% (46/51)] had significant differences(P<0.05). The initial screening thyroid hormone value (optimal threshold: 37.825 mIU/L, AUC=0.745, sensitivity 0.897 and specificity 0.490) and the levothyroxine sodium dosage at eighth month of age [optimal threshold 3.38 μg/(kg·d), AUC=0.759, sensitivity 0.586 and specificity 0.843] could early distinguish permanent and transient CH children. Conclusions Initial screening thyroid hormone values and postnatal levothyroxine sodium dosage had an early predictive effect on clinical outcome in children with CH.

目的 分析妊娠期肝内胆汁淤积症(ICP)孕妇与正常孕妇围产结局及ICP孕妇不同总胆汁酸水平对围产结局及新生儿的影响,为做好ICP孕妇的妊娠期管理及其新生儿预后评估提供参考依据。方法 以2010年3月—2020年3月在我院分娩的ICP孕妇 249例为观察组,同期分娩的249例正常孕妇为对照组,比较2组围产结局相关指标。结果 观察组羊水污染、新生儿黄疸、新生儿呼吸窘迫综合征发生率均高于对照组,根据总胆汁酸水平分组,重度组早产、羊水污染发生率高于轻度组,以上差异均有统计学意义(P＜0.05)。总胆汁酸水平是ICP孕妇发生早产的危险因素(P＜0.05)。结论 ICP孕妇总胆汁酸水平可用于发生早产的预测,及时干预有利于提高其围产期质量。

Objective To analyze the perinatal outcome of women with intrahepatic cholestasis of pregnancy (ICP) and normal pregnant women and the effects of different levels of total bile acid in ICP women on perinatal outcome and newborn. To provide a reference for the management of pregnancy and prognosis of ICP women. Methods From March 2010 to March 2020, 249 women with ICP delivered in our hospital were included as the observation group, 249 normal pregnant women delivered in the same period as the control group, the perinatal outcomes of the two groups were analyzed and compared. Results The incidences of amniotic fluid contamination, neonatal jaundice and neonatal respiratory distress syndrome in the observation group were higher than that in the control group. Grouping by the total bile acid level, the incidences of premature delivery and amniotic fluid contamination in the severe group were higher than that in the mild group, with statistical significance (P<0.05). Total bile acid level was a risk factor for premature delivery in women with ICP (P<0.05). Conclusions The level of total bile acid in women with ICP can be used to predict the occurrence of premature delivery, and timely intervention is beneficial to improve the perinatal quality of ICP women.

目的 观察聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)与重组人粒细胞刺激因子(rhG-CSF)在造血干细胞移植后促进造血恢复的疗效对比。方法 回顾分析2016年1月—2020年12月以来在深圳市第二人民医院血液科进行造血干细胞移植的恶性血液疾病患者共 100例,随机分为2组,分别在造血干细胞回输后给与聚乙二醇化重组人粒细胞刺激因子与重组人粒细胞刺激因子。结果 PEG-rhG-CSF组与rhG-CSF组中性粒细胞植入时间分别为(18.7±3.4)天、(18.0±3.1)天,P=0.281,无统计学差异。粒细胞缺乏伴发热在PEG-rhG-CSF组与rhG-CSF组分别发生26例、29例,发生率分别为53.06%、56.86%,P=0.89,无差异。用药次数分别为2.6次(2~5次)、18.1次(11~31次),P<0.05,差异有统计学意义。不良反应主要为骨痛、肌肉疼痛。结论 PEG-rhG-CSF组与rhG-CSF组结果相似,PEG-rhG-CSF具有用药次数少的优势。

Objective The efficacy of pegylated recombinant human granulocyte stimulating factor (PEG-rhG-CSF) and recombinant human granulocyte stimulating factor(rhG-CSF) in promoting hematopoiesis recovery after hematopoietic stem cell transplantation.Methods The data of 100 patients with malignant blood diseases who underwent hematopoietic stem cell transplantation in the Hematology Department of Shenzhen Second People's Hospital from January 2016 to December 2020 were retrospectively analyzed.They were randomly assigned to two groups,which accepted PEG-rhG-CSF and rhG-CSF respectively after hematopoietic stem cell transfusion.Results The time of neutrophil implantation in PEG-rhG-CSF group and rhG-CSF group were (18.7±3.4) days and (18.0±3.1) days respectively,P=0.281,showing no statistical difference.There were 26 cases of neutropenia with fever in PEG-rhG-CSF group and 29 cases in rhG-CSF group,with incidence of 53.06% and 56.86% (P=0.89),showing no statistical difference.The times of medication were 2.6 times (2-5 times) and 18.1 times (11-31 times),P<0.05,with significant statistical difference.The main adverse reactions were bone pain and muscle pain.Conclusions The outcomes of PEG-rhG-CSF group and rhG-CSF group were similar,PEG-rhG-CSF had the advantage of fewer times of medication.

目的 探讨微量喂养对早产儿早期喂养不耐受喂养结局的影响。方法 选择我院2019年1月—2020年6月胎龄≤34周、出生后1周内反复出现喂养不耐受的早产儿78例,采用随机数字表法分为微量喂养组(38例)和中断喂养组(40例),比较两组患儿喂养不耐受的改善及喂养结局的差异性。结果 相对于直接中断喂养,微量喂养3～5天的患儿喂养不耐受改善率更高、体质量增长速度更快、更早达完全肠内喂养时间、静脉营养时间和住院时间也缩短了。而且胆汁淤积症发生率也低于中断喂养组,差异具有统计学意义,两组坏死性小肠结肠炎发生率比较无差异。结论 对于胎龄≤34周、生后1周内反复出现喂养不耐受的早产儿,在排除了外科或败血症早期表现的情况下,相对于中断喂养,选择微量喂养可改善患儿的喂养结局,而且不会增加坏死性小肠结肠炎的发生。

Objective To investigate the effect of minimal feeding on the outcome of early feeding intolerance in premature infants. Methods Seventy-eight premature infants with gestational age＜34 weeks and recurrent feeding intolerance within 1 week after birth in our hospital from January 2019 to June 2020 were selected. They were randomly divided into minimal feeding group (38 cases) and interrupted feeding group (40 cases) to compare the improvement of feeding intolerance and the difference of feeding outcome between the two groups. Results Compared with discontinuation of feeding, the rates of feeding intolerance improvement were higher in children who were given minimal feeding for 3-5 days,and they had faster weight gainand, the time to complete enteral feeding got earlier, intravenous nutrition time and hospitalization time were also shortened. Moreover, the incidence of cholestasis was also lower than that of the interrupted feeding group, and the difference was statistically significant. There was no difference in the incidence of necrotizing enterocolitis between the two groups. Conclusion For premature infants with gestational age＜34 weeks and feeding intolerance happened within 1 week after birth, excluding the early manifestation of surgery or sepsis, minimal feeding can improve the feeding outcome of the infants compared with discontinuation of feeding, without increasing the incidence of necrotizing enterocolitis.

目的 探讨35周岁以下患者行D5单囊胚移植的可行性。方法 回顾性分析2016年1月—2019年7月期间,女方年龄≤35岁,在本中心行新鲜周期全胚冻后第一冻融移植的663个周期,根据胚胎发育天数及囊胚移植数目分为三组:D3双优胚移植组(D3双优组:n=508)、D5单囊胚移植组(D5单囊组:n=47)、D5双囊胚移植组(D5双囊组:n=108),对三组的临床结局进行比较分析。结果 D5双囊组临床妊娠率高于D3双优组及D5单囊组,且差异有统计学意义(P＜0.05),但D5单囊组与D3双优组相比,无统计学差异(P＞0.05);D5单囊胚的多胎率低于D5双囊组及D3双优组,差异均有统计学意义(P＜0.001),D3双优组的多胎率也低于D5双囊组,差异亦有统计学意义(P＜0.05);D5单囊组和D5双囊组的种植率都高于D3双优组,差异都有统计学意义(分别是P＜0.05,P＜0.001),而D5单囊组合D5双囊组之间无统计学差异(P＞0.05);但三组之间的早期流产率及宫外孕率均无统计学差异(P＞0.05)。结论 年龄≤35周岁的患者全胚冷冻后第一冻融移植周期选择D5单囊胚进行移植,既能获得良好的临床妊娠率和种植率,又极大降低多胎妊娠率。

Objective To investigate the clinical outcomes of the single blastocyst transfer of day 5 in the women under 35 years old. Methods A retrospective study was conducted to analyze clinical outcomes of women less than 35 years old and experienced embryo transfer in the first frozen-thawed cycles from January 2016 to July 2019 in the Center of Reproductive Medicine of Guangzhou Women and Children's Medical Center. According to the embryo developmental days and transfer blastocyst numbers, all patients were divided into three groups: double high-quality cleavage embryo transfer of day 3 (n=508), single blastocyst transfer of day 5(n=47), double blastocyst transfer of day 5(n=108). The clinical outcomes were compared. Results The clinical pregnancy rate of the double blastocyst transfer of day 5 was higher than the other two groups,and the differences were statistically significant(P＜0.05). However, there was no statistical difference between the single blastocyst transfer of day 5 and the double high-quality cleavage embryo transfer of day 3(P＞0.05). The multiple pregnancy rate of the single blastocyst transfer of day 5 was lower than the other two groups, and the differences were statistically significant (P＜0.001),and that of the double high-quality cleavage embryo transfer of day 3 was even lower than that of the double blastocyst transfer of day 5,and the difference was statistically significant(P＜0.05). The implanting rate of the double high-quality cleavage embryo transfer of day 3 was lower than the other two groups, and the differences were statistically significant (P＜0.05;P＜0.001),but there was no statistical difference between the single blastocyst transfer of day 5 and the double blastocyst transfer of day 5 (P＞0.05). However, the early miscarriage rate and the ectopic pregnancy rate did not exhibit statistical differences (P＞0.05). Conclusion Single blastocyst transfer of day 5 can ensure clinical pregnancy rate and implantation rate while effectively reducing multiple pregnancy in the women undergoing the first frozen-thawed cycles of under 35 years old.

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 观察灵芝孢子粉对中重度慢性阻塞性肺疾病(COPD)稳定期患者肺功能、6分钟步行距离及T淋巴细胞亚群的影响。方法 选取稳定期中重度COPD门诊患者19例,服用灵芝孢子粉6个月后观察患者服药前后肺功能的变化及循环血液中CD4⁺、CD8⁺T淋巴细胞的比例变化,症状评分(CAT评分)以及对6 MWT的影响。结果 服用灵芝孢子粉6个月后,中重度COPD患者的六分钟步行距离延长,平均增加19 m(P＜0.01),患者的CAT评分也有改善(P＜0.01),患者肺功能与服药前相比有改善趋势,其中FEV₁较服用前平均增加60 mL(P>0.05),FVC平均增加为130 mL(P<0.01),FEV₁/FVC比例降低0.47(P>0.05);外周血CD4⁺T淋巴细胞比例增加(P<0.01),CD8⁺和CD4⁺/CD8⁺T淋巴细胞亚群比例未见明显变化(P＞0.05)。结论 服用灵芝孢子粉6个月后对肺功能无明显作用,但能改善中重度COPD患者的CAT症状评分,可能与升高CD4⁺T淋巴细胞比例有关。

Objective To observe the effects of Ganoderma lucidum spore powder on lung function, 6-minute walking distance and T lymphocyte subsets in patients with moderate to severe chronic obstructive pulmonary disease(COPD). Methods Nineteen patients with moderate-to-severe COPD outpatients in stable phase were enrolled. After taking Ganoderma lucidum spore powder for 6 months, the changes of lung function and the proportion of CD4⁺ and CD8⁺ T lymphocytes in circulating blood, the symptom score(CAT score) and impact on the 6 MWT were observed. Results After taking Ganoderma lucidum spore powder for 6 months, the six-minute walking distance of patients with moderate to severe COPD was prolonged, with an average increase of 19 meters(P<0.01). The patient's CAT score was also improved(P<0.01). There was an improvement trend in increasing average FEV1 by 60 mL(P>0.05), FVC increased to 130 mL(P<0.01) and the FEV1/FVC ratio decreased by 0.47(P>0.05). The proportion of CD4⁺ T lymphocytes in peripheral blood increased(P<0.01), and the proportion of CD8⁺ and CD4⁺/CD8⁺ T lymphocyte subsets did not reach the significance(P>0.05). Conclusion After taking Ganoderma lucidum spore powder for 6 months, it has no significant effect on lung function, but it may improve the CAT symptom score of patients with moderate to severe COPD, which may be related to the increase of CD4⁺ T lymphocyte ratio.

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 探索冻融胚胎移植周期胚胎移植前宫腔灌注胚胎培养上清液对胚胎种植及妊娠结局的影响。方法 纳入我院 2019 年 3 月—2019 年 12 月 共计198个冻 融 胚 胎 移 植 ( frozen-thawed embryo transfer,FET)周期。根据 FET 术前是否予胚胎培养液上清液宫腔灌注操作分成 2 组,灌注组93 个周期,对照组即未灌注组105个周期。灌注组分别于FET术前 4 周和术前 1 天行宫腔灌注胚胎培养上清液,对照组未行胚胎培养上清液宫腔灌注,对比两组患者胚胎着床率、临床妊娠率、流产率。结果 灌注组患者的胚胎着床率高于对照组,差异有统计学意义(P＜0.05)。两组间的临床妊娠率、流产率未见统计学差异(P>0.05)。结论 FET术前宫腔灌注胚胎培养上清液可提高胚胎种植率。

Objective To investigate the potential impact of intrauterine perfusion of embryo culture supernatant before frozen-thawed embryo transfer (FET) on pregnancy outcome. Methods From March to December 2019, a total of 198 FET cycles were enrolled for the present study.Patients were divided into two groups: the study group included 93 cycles, patients in this group received intrauterine perfusion of embryo culture supernatant four weeks and one day before the embryo transfer, respectively; the control group included 105 cycles, and patients in this group did not receive intrauterine perfusion. Rates of implantation, pregnancy, and miscarriage were compared between the two groups. Results The implantation rate in the study group was higher than that in the control group (P<0.05). There were no significant differences in clinical pregnancy rate and abortion rate between the two groups (P>0.05). Conclusion With the performance of intrauterine perfusion of embryo culture supernatant before embryo transfer, the implantation rate may be improved in FET cycles.