CD outcome of pregnancy

寿胎丸加减治疗先兆流产合并阴道出血的临床效果肖慧欣①　刘雅倩① 【摘要】　目的：探究寿胎丸加减治疗先兆流产合并阴道出血的临床效果。

方法：选取2020年10月—2022年10月会昌县妇幼保健院收治的66例先兆流产合并阴道出血患者，根据随机数字表法分为试验组和对照组，各33例。

对照组给予地屈孕酮和黄体酮治疗，试验组在对照组基础上给予寿胎丸加减治疗。

对比两组临床疗效、中医症状积分、孕酮、雌二醇、β-人绒毛膜促性腺激素及免疫功能、妊娠结局。

结果：治疗14 d，两组阴道出血、下腹坠胀、腰酸及腹痛积分均下降，试验组均低于对照组，差异均有统计学意义（P<0.05）。

试验组总有效率高于对照组，差异有统计学意义（P<0.05）。

治疗14 d，两组孕酮、雌二醇、β-人绒毛膜促性腺激素水平均升高，试验组均高于对照组，差异均有统计学意义（P<0.05）。

治疗14 d，两组CD4+、CD4+/CD8+水平较治疗前均升高，CD8+水平较治疗前均降低，且试验组CD4+、CD4+/CD8+水平均高于对照组，CD8+水平低于对照组，差异均有统计学意义（P<0.05）。

试验组足月分娩率为87.88%，高于对照组的66.67%，差异有统计学意义（P<0.05）；两组死胎、流产、早产率比较，差异均无统计意义（P>0.05）。

结论：在地屈孕酮和黄体酮治疗基础上，寿胎丸加减治疗先兆流产合并阴道出血效果较好，有利于改善临床症状、孕酮、雌二醇、β-人绒毛膜促性腺激素及妊娠结局。

【关键词】　寿胎丸　先兆流产　阴道出血　临床症状　妊娠结局 Clinical Effect of Shoutai Pills Plus and Minus Treatment of Threatened Abortion Complicated withVaginal Bleeding/XIAO Huixin, LIU Yaqian. //Medical Innovation of China, 2024, 21(05): 093-097 [Abstract]　Objective: To explore the clinical effect of addition and reduction of Shoutai Pills in thetreatment of threatened abortion complicated with vaginal bleeding. Method: From October 2020 to October 2022,66 patients with threatened abortion and vaginal bleeding were enrolled in Huichang County Maternal and ChildHealth Care Hospital and were divided into the experimental group and the control group according to the randomnumber table method, with 33 cases each. The control group was treated with Dydrogesterone and Progesterone,and the experimental group was given Shoutai Pills plus and minus treatment on the basis of the control group.The clinical efficacy, TCM symptom score, progesterone, estradiol, β-human chorionic gonadotropin and immunefunction, and pregnancy outcomes in two groups were compared. Result: After 14 days of treatment, the scores ofvaginal bleeding, lower abdominal distension, backache and abdominal pain decreased in two groups, and thosein the experimental group were lower than those in the control group, the differences were statistically significant(P<0.05). The total effective rate of the experimental group was higher than that of the control group, the differencewas statistically significant (P<0.05). After 14 days of treatment, the levels of progesterone, estradiol and β-humanchorionic gonadotropin in two groups were increased, and those in the experimental group were higher than those inthe control group, the differences were statistically significant (P<0.05). After 14 days of treatment, the CD4+ andCD4+/CD8+ levels in two groups were higher than those before treatment, and the CD8+ levels were lower than thosebefore treatment, and the CD4+ and CD4+/CD8+ levels in the experimental group were higher than those in the controlgroup, and the CD8+ level was lower than that in the control group, the differences were statistically significant(P<0.05). The full-term delivery rate in the experimental group was 87.88%, which was higher than 66.67%in the control group, the difference was statistically significant (P<0.05). There were no statistically significantdifferences in the rates of stillbirth, abortion and premature birth between the two groups (P>0.05). Conclusion: Onthe basis of Dydrogesterone and Progesterone treatment, the Shoutai Pills plus and minus has a good therapeutic①会昌县妇幼保健院妇产科　江西　会昌　342600通信作者：肖慧欣- 93 - 先兆流产是发生于孕早期的妊娠合并症之一，而绒毛膜下血肿是先兆流产的一种病理表现，经超声检查可被诊出[1]。

泰利霉素对巨噬细胞亚群调控妊娠期弓形虫感染所致的不良妊娠结局的影响机制摘要：目的：探究泰利霉素对巨噬细胞亚群调控妊娠期弓形虫感染所致的不良妊娠结局的影响机制。

方法：筛选2014年1月~2015年8月入我院行弓形虫抗体检测的孕妇，将弓形虫抗体检查阳性孕妇随机分为A组（n=39）和B组（n=42），并从检测结果阴性的孕妇中随机抽取50例为C组（即n=50）。

观察对比三组腹腔巨噬细胞培养上清液中TNF-α、IFN-γ，IL-4的浓度和巨噬细胞M1/M2亚型比值，记录自然流产、死胎死产、出生缺陷等不良妊娠结局数量及发生率，记录A 组服药过程中不良反应情况。

结果：与C组相比，A、B两组TNF-α、IFN-γ，IL-4水平均明显升高（P<0.05），但与B组相比A组TNF-α、IFN-γ，IL-4水平均明显较低（P<0.05）。

与C组相比A、B两组M1/M2比值明显较大（P<0.05）而与A组与B组相比M1/M2比值明显较小（P<0.05）。

与C组相比，A组、B组合计不良妊娠结局发生率均明显较高（P<0.05），B组的自然流产、死胎死产、出生缺陷发生率均较C组高（P<0.05）。

与B组相比A组各不良妊娠结果发生率均明显较小（P<0.05）。

结论：泰利霉素能通过影响巨噬细胞分化方向有效降低妊娠期弓形虫感染所致的不良妊娠结局。

关键字：泰利霉素；巨噬细胞；分化；弓形虫；不良妊娠The mechanism of Telithromycin on adverse pregnancy outcomes ofT.gondii infection by macrophage regulationAbstract: Objective: To explore the mechanism of telithromycin influence the adverse pregnancy outcome caused by T. gondii infection in the pregnancy period , which is regulated by macrophage subsets.Methods: pregnant women from Jan 2014 to Aug 2015 for T.gondii antibodies testing were selected in our hospital.T.antibody positive pregnant women were randomly divided into group A (n= 39) and group B (n = 42), and 50 women whose result is negative were randomly selected called group C (n = 50). Result：Compared with the group C , TNF-α, IFN-γ, IL-4 levels in groups A and groups B were significantly elevated (P<0.05), but compared with the group A levels of TNF-α,IFN-γ, IL-4 in group B were significantly lower(P<0.05).Compared with the C group, the M1/M2 ratio of A and B was significantly larger (P<0.05) and the M1/M2 ratio was significantly smaller (P<0.05) than that in B group compared with group A（P<0.05）.Compared with group C, the adverse pregnancy outcome incidence of group A and B were significantly higher (P < 0.05). The rate of spontaneous abortion, stillbirth, born defect of group B were higher than those in group C (P < 0.05). The incidence of adverse pregnancy outcomes in B group was significantly smaller than that in A group (P>0.05).Conclusion: Telithromycin can effectively reduce the adverse pregnancy outcomes of pregnancy period ofT.gondii infection by effecting on macrophage.Key words:Telithromycin; Macrophages; Differentiation; Toxoplasma gondii; Adverse pregnancy弓形虫是一种专性胞内寄生原虫，分布于世界各地，我国弓形虫感染率达5%以上。

孕前保健对孕妇妊娠过程及妊娠结局的影响分析摘要：目的：探讨孕前保健对孕妇妊娠过程及妊娠结局的影响。

方法：收集2017年1月至2018年2月我院收治的健康孕妇36例，所有孕妇均给予优生健康检查和指导，比较孕妇妊娠前后的焦虑程度和抑郁程度，并总结妊娠结局后孕妇的满意度。

结果：妊娠后孕妇的SAS评分为43.21±8.47分，妊娠前为57.63±7.62分，P<0.05；妊娠后孕妇的SDS评分为32.18±8.91分，妊娠前为41.72±7.83分，P<0.05；本组36例孕妇中，对健康教育满意35例，一般1例，不满意0例，妊娠结局后孕妇对健康教育的满意度为100.00%。

结论：孕前保健可有效改善孕妇妊娠过程中产生的抑郁情绪和焦虑情绪，提高孕妇对妊娠结局的满意度，对于降低新生儿出生缺陷的发生率、提高出生人口的综合素质均具有积极的作用，值得临床推广及应用。

关键词：孕前保健；妊娠过程；妊娠结局；影响分析[Abstract] objective：to explore the effects of pre-pregnancy health care on pregnancy process and pregnancy outcome.Methods：collected in January 2017 to February 2018 healthy pregnant women of our hospital 36 cases，all pregnant women to give eugenics health inspection and guidance，to compare the degree of anxietyand depression before and after pregnancy，pregnant women and pregnancy outcome after pregnant women's satisfaction.Results：the SAS score of pregnant women after pregnancy was 43.21 + 8.47，and 57.63 + 7.62 points before pregnancy，P<0.05；The SDS score of pregnant women after pregnancy was 32.18 + 8.91，before pregnancy was 41.72 + 7.83，P<0.05；Among the 36 pregnant women in this group，35 cases were satisfied with education，and 1 case was not satisfactory，and 0 cases were not satisfied.The satisfaction of pregnant women after pregnancy was100.00%.Conclusion：pregnancy care can effectively improve pregnancy related process of depression and anxiety，improve pregnant women on pregnancy outcomeof satisfaction，to reduce the incidence of birth defects，improve the comprehensive quality of birth population have a positive effect，worth clinical promotion and application.[Key words] pre-pregnancy care；Pregnancy process；Pregnancy outcome；The impact analysis孕前保健是指女性在怀孕前或妊娠前期，为提高胎儿的健康，而采取的一系列相应综合措施，包括疾病的治疗和预防、孕前营养素的服用、控制饮食和计划怀孕等[1]，以减少和消除计划怀孕夫妇中存在的潜在健康问题，改善妊娠结局，从而保证孕妇和胎儿的健康，降低胎儿出生缺陷的发生率，整体提高我国出生人口的综合素质[2]。

胚胎发育动力学参数对囊胚移植周期妊娠结局的影响及预测模型建立史艳彬张婉妮邵小光银大连市妇女儿童医疗中心生殖与遗传医学中心，辽宁大连116000［摘要］目的研究胚胎发育动力学参数对囊胚移植周期妊娠结局的影响，建立妊娠结局预测模型。

方法选择2017年7月~2019年7月于大连市妇女儿童医疗中心生殖与遗传医学中心使用Time-lapse培养箱培养并囊胚移植的704个周期，排除合并影响妊娠结局要素和移植两枚囊胚仅单胎妊娠的453个周期，余下251个周期的371个胚胎作为研究对象，进行回顾性队列研究。

根据妊娠结局，分为未妊娠组(A组,N=115个周期,n=169个胚胎)和临床妊娠组(B组,N=136个周期n=202个胚胎)。

分析患者胚胎的动力学指标t2、t3、t4、t5、t8、cc2、cc3、s2、s3、tM、tSB、tB与妊娠结局的关系，通过二元Logistic回归分析的方法，探索影响囊胚移植周期临床妊娠结局的胚胎发育动力学指标，建立临床妊娠结局预测模型，并对其进行验证。

结果Logistic回归结果显示,t5、t8、s3、tM、tSB、tB对妊娠结局有预测价值。

通过预测模型的建立，得到囊胚移植周期妊娠率预测方程为:P=1/(1+y),y=exp{(-3.803+0.007伊t5-0.004xt8-0.042xs3+0.023xtM+0.005xtSB+0.043xtB)j遥根据研究数据计算的预测结局概率与实际结局数据绘制ROC曲线，求得曲线下面积为0.702(95%CI：0.679~0.791,P=0.047)遥结论影响囊胚移植周期临床妊娠结局的胚胎动力学指标风险因素包括t5、t8、S3、tM、tSB、tB°ROC曲线检验显示，根据上述风险因素建立的临床妊娠结局预测模型具有一定的预测价值。

［关键词］囊胚移植；临床妊娠;胚胎动力学；Logistic回归分析;预测模型［中图分类号］R715［文献标识码］A［文章编号］1674-4721(2021)3(a)-0008-04Influence of embryo development dynamics parameters on pregnancy out­come in blastocyst transfer cycle and establishment of prediction modelSHI Yan-bin ZHANG Wan-ni SHA O Xiao-guang银Reproductive and Genetic Medicine Center,Dalian Municipal Women and Children's Medical Center,Liaoning Province,Dalian116000,China［Abstract］Objective To study the influence of embryo development dynamics parameters on pregnancy outcome in blastocyst transfer cycle,and to establish a prediction model of pregnancy outcome.Methods A total of704cycles of blastocyst transfer cultured in Time-lapse incubator from July2017to July2019in the Reproductive and Genetic Medicine Center of Dalian Municipal Women and Children's Medical Center were collected,among of them453cycles for the factors affecting pregnancy outcome and the transfer of two blastocysts with singleton pregnancy were excluded, and the remaining371embryos of251cycles were selected as the research objects.According to the outcome of preg­nancy,the patients were divided into two groups:non pregnancy group(group A,N=115cycles,n=169embryos)and clinical pregnancy group(group B,N=136cycles,n=202embryos).The relationship between the embryo dynamics in­dexes of t2,t3,t4,t5,cc2,cc3,s2,s3,tM,tSB,tB and pregnancy outcome was analyzed.Logistic regression analysis was used to explore the embryo development dynamics parameters that affected the clinical pregnancy outcome of the blastocyst transfer cycle,and the clinical pregnancy outcome prediction model was established and verified.Results The results of Logistic regression showed that t5,t8,s3,tM,tSB and tB had predictive value for pregnancy outcome.The prediction equation of pregnancy rate in blastocyst transfer cycle was:P=1/(1+y),y=exp{(-3.803+0.007xt5-0.004x t8-0.042xs3+0.023xtM+0.005xtSB+0.043xtB)}.The ROC curve was drawn based on the predicted outcome probability calculated by the research data and the actual outcome data,and the area under the curve was0.702(95%CI:0.679-0.791,P=0.047).Conclusion The risk factors of embryo dynamics in blastocyst transfer cycle include t5,t8,s3,tM,tSB and tB.ROC curve test shows that the clinical pregnancy outcome prediction model based on the above risk factors has certain predictive value.___________________________________________________________［Key words］Blastocyst transfer;Clinical pregnancy;［基金项目］辽宁省自然科学基金项目(20180550568)__________Embryo dynamics;Logistic regression analysis;Predictive▲通讯作者model8CHINA MODERN MEDICINE Vol.28No.7March2021尽管辅助生殖技术取得了重大进展,但体外受精-胚胎移植（in vitro fertility-embryo transfer,IVF-ET）面临的主要挑战仍然是选择最佳的单胚移植技术［1］遥增强胚胎选择过程将使体外受精成功率最大化罠大量文献报道，在侵入性技术PGT-A局限性的背景下, Time-lapse技术作为以选择具有最高发展潜力的胚胎为目标来优化非侵入性技术方面展示了极大的优势［3-5］。

卵泡输出率的应用研究作者：周小花游慧娴马天仲来源：《医学信息》2019年第16期摘要：目前卵巢反应性的预测指标包括AMH、抑制素B、年龄、窦卵泡、基础性激素、卵巢敏感性（OSI）、卵泡敏感性（FSI）等，而这些指标在预测卵巢对外源性促性腺激素（Gn）的反应存在一定的局限性。

在近年生殖医学预测IVF/ICSI妊娠结局及卵巢反应性的相关研究中，提出卵泡输出率（FORT）是一个客观、较新且热门的指标。

控制性超促排卵（COH）个体化治疗方案的制定在治疗各种不孕症的过程中具有重要的意义，可以通过FORT 评估每个患者卵巢反应性来制定合适的COH方案，从而改善妊娠结局。

本文就FORT在卵巢低反应、多囊卵巢综合征（PCOS）、子宫内膜异位症（EMs）、不明原因不孕症、高龄及肿瘤患者对卵巢反应性及IVF/ICSI妊娠结局的相关性研究进行综述。

关键词：卵泡输出率;卵巢反应性;妊娠结局中图分类号：R321-33; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; 文献标识码：A; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; DOI：10.3969/j.issn.1006-1959.2019.16.008文章编号：1006-1959（2019）16-0023-04Abstract：Current predictors of ovarian response include AMH， inhibin B， age， antral follicles， basal hormones， ovarian sensitivity （OSI）， follicular sensitivity （FSI）， etc. These indicators have certain limitations in predicting the response of ovarian to exogenous gonadotropin （Gn）. In recent years， reproductive medicine predicts IVF/ICSI pregnancy outcomes and ovarian response studies; it is proposed that follicle output rate （FORT） is an objective， relatively new and popular indicator. The development of controlled ovarian hyperstimulation （COH） individualized treatment programs are of great significance in the treatment of various infertility. It can be used to determine the ovarian response of each patient by FORT to develop a suitable COH program to improve pregnancy outcomes. . This article relates to the relationship between FORT in ovarian hyporesponsiveness， polycystic ovary syndrome （PCOS）， endometriosis （EMs）， unexplained infertility， advanced age and tumor patients with ovarian response and IVF/ICSI pregnancy outcomes. The study was reviewed.Key words：Follicle output rate;Ovarian response;Pregnancy outcome在生殖醫学中不孕症是一个热门话题，受不孕症影响的夫妇数量在日益增加。

二甲双胍在多囊卵巢综合征应用中的研究进展徐丽君;杜伯涛【摘要】多囊卵巢综合征(PCOS)是一种内分泌紊乱性疾病,在育龄妇女中常见,是无排卵性不孕症中的常见原因,临床以高雄激素血症,排卵障碍或无排卵,卵巢多囊样改变为特征,常伴有胰岛素抵抗和肥胖.二甲双胍为胰岛素增敏剂,主要用于2型糖尿病患者的治疗.近20年来,二甲双胍在多囊卵巢综合征患者中的应用效果得到了越来越多的学者的关注.二甲双胍应用于多囊卵巢综合征效果显著,具有重要的临床意义.现对国内外研究成果做以综述,为临床治疗提供依据.【期刊名称】《中国生育健康杂志》【年(卷),期】2016(027)003【总页数】3页(P298-300)【关键词】二甲双胍;多囊卵巢综合征;胰岛素抵抗;高雄激素血症【作者】徐丽君;杜伯涛【作者单位】150086 黑龙江哈尔滨,哈尔滨医科大学附属第二医院妇产科;150086 黑龙江哈尔滨,哈尔滨医科大学附属第二医院妇产科【正文语种】中文多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是常见的妇科内分泌疾病[1]育龄期妇女占5%～10%[2]。

研究指出[3] 约40%的PCOS患者不孕源于不排卵或稀发排卵。

其临床表现为月经不规律，雄激素过多症，卵巢多囊改变[4]，并随着年龄的增加，胰岛素抵抗和高胰岛素血症日趋显著[5]。

血循环中增加的的胰岛素水平不仅直接对卵巢功能产生影响，而且还能促使产生于肝的胰岛素样生长因子1(IGF-1)显著增加，两者共同作用于卵巢释放高水平的睾丸激素。

此病严重影响女性排卵及生育，且因性激素紊乱增加功能失调性子宫出血、子宫内膜癌的发病率，同时增加了2型糖尿病，血脂异常，高血压等代谢综合征的风险。

二甲双胍是临床上常用的口服降糖药，也是常见的胰岛素增敏剂。

有相关研究表明，二甲双胍可作为除口服避孕药之外的第二选择，治疗高雄激素活性的相关症状,可降低雄激素、胰岛素水平，恢复卵巢排卵功能，纠正糖脂代谢异常。

· 药物与临床 ·糖尿病新世界 2023年11月糖尿病新世界 DIABETES NEW WORLD妊娠糖尿病孕妇维生素D 补充治疗效果及对妊娠结局的影响李迎，庞丽丽，卢娟徐州仁慈医院产科，江苏徐州 221000[摘要] 目的 探讨妊娠糖尿病（gestational diabetes mellitus ， GDM ）孕妇维生素D 补充治疗效果及对妊娠结局的影响。

方法 选取2022年6月—2023年6月徐州仁慈医院收治的48例GDM 患者为研究对象，应用随机数表法分为对照组（24例，胰岛素治疗）、观察组（24例，在对照组基础上维生素D 补充治疗）。

比较两组母婴不良妊娠结局、空腹胰岛素、血糖及餐后2 h 血糖水平。

结果 观察组母婴不良妊娠结局发生率4.17%，较对照组33.33%更低，差异有统计学意义（χ2=4.923，P <0.05）。

治疗前，两组胰岛素及血糖水平对比，差异无统计学意义（P>0.05）；治疗后，观察组空腹血糖、餐后2 h 血糖水平为（4.27±0.69）、（6.11±0.68）mmol/L ，均较对照组的（5.11±0.72）、（6.71±0.75）mmol/L 更低，空腹胰岛素水平为（8.66±1.24）mU/L ，较对照组的（7.75±1.13）mU/L 更高，差异有统计学意义（t =4.127、2.903、2.657，P <0.05）。

结论 GDM 患者在胰岛素及常规干预基础上予以维生素D 补充治疗，可有助于提高孕妇空腹胰岛素水平，降低血糖水平，改善妊娠结局。

[关键词] 妊娠糖尿病；维生素D ；空腹胰岛素；妊娠结局[中图分类号] R714 [文献标识码] A [文章编号] 1672-4062（2023）11（b ）-0100-04Efficacy of Vitamin D Supplementation in Pregnant Women with Gesta⁃tional Diabetes Mellitus and Its Impact on Pregnancy OutcomeLI Ying, PANG Lili, LU JuanDepartment of Obstetrics, Xuzhou Renci Hospital, Xuzhou, Jiangsu Province, 221000 China[Abstract ] Objective To investigate the effect of vitamin D supplementation in pregnant women with gestational dia⁃betes mellitus (GDM) and its impact on pregnancy outcome. Methods 48 GDM patients admitted to Xuzhou Renren Hospital from June 2022 to June 2023 were selected as the study objects, and were divided into control group (24 cases receiving insulin treatment) and observation group (24 cases receiving vitamin D supplement treatment) by ran⁃dom number table method. The adverse pregnancy outcome, fasting insulin, blood glucose and 2 h postprandial blood glucose levels were compared between the two groups. Results The incidence of adverse pregnancy outcomes in the observation group was 4.17%, which was lower than that in the control group (33.33%), the difference was statistically significant (χ2=4.923, P <0.05). Before treatment, there was no statistically significant difference in insulin and blood glucose levels between the two groups (P >0.05). After treatment, the fasting blood glucose and 2 h postprandial blood glucose levels in the observation group were (4.27±0.69) mmol/L, (6.11±0.68) mmol/L, which were lower than those in the control group (5.11±0.72) mmol/L, (6.71±0.75) mmol/L, and the fasting insulin level was (8.66±1.24) mU/L, com⁃pared with the control group (7.75±1.13) mU/L, the differences were statistically significant (t =4.127, 2.903, 2.657, P <0.05).Conclusion Vitamin D supplementation on the basis of insulin and routine intervention in GDM patients canhelp to increase fasting insulin level, reduce blood sugar level and improve pregnancy outcome.[Key words ] Gestational diabetes mellitus; Vitamin D; Fasting insulin; Pregnancy outcome妊娠期糖尿病（gestational diabetes mellitus, GDM ）为临床较常见的一类妊娠并发症，其以胰岛DOI ：10.16658/ki.1672-4062.2023.22.100[作者简介] 李迎（1987-），女，本科，主治医师，主要从事产科临床工作。

慢性子宫内膜炎诊断与治疗综述摘要：慢性子宫内膜炎(Chronic endometritis，CE)是一种以子宫内膜间质浆细胞浸润为特征的局部慢性炎症性疾病。

虽然CE临床中常无症状或症状轻微，但最近的研究表明CE对生育的存在潜在不良影响。

本文就CE的病因、诊断及治疗等方面进行综述。

子宫内膜炎定义为子宫内膜的感染或炎症，子宫内膜炎有两种类型：急性和慢性。

急性子宫内膜炎是一种症状性的子宫内膜急性炎症，在显微镜下检查可发现子宫内膜浅层有微小脓肿和中性粒细胞浸润，常见于产后子宫内膜炎。

慢性子宫内膜炎(Chronic endometritis，CE)通常无症状或仅表现为异常子宫出血、盆腔疼痛、性交困难和白带异常等轻微症状，彩超等影像学检查方法对CE缺乏特异性的临床征象，因此在临床工作中常被忽视。

近年来研究发现CE与女性不孕症、反复植入失败和反复流产密切相关[[1]]。

本文旨在对CE的病因、诊断和治疗进行综述。

CE的病因近一个世纪以来，人们一致认为子宫腔在正常情况下是无菌的，这种无菌状态被认为是由宫颈粘膜系统维持的，它提供了一个不可渗透的屏障，防止细菌从阴道上行感染[[2]]。

然而，近来这一观点被驳斥了，大量研究表明，即使在健康无症状妇女的子宫内膜腔中也能检测到微生物[[3]][[4]]。

此外，宫颈粘液栓已被证明不能完全阻止阴道细菌的上行[[5]][[6]]。

因此，子宫内微生物的存在已被接受，并被认为是导致CE的主要原因，Cicinelli 等[[7]]用微生物培养法在 CE 患者子宫内膜中检测到链球菌（27%）、粪肠球菌（14%）、大肠杆菌（11%）、解脲脲原体（11%）等，证实宫腔存在菌群体。

最近有研究表明腹膜中有微生物7[[8]]，腹膜微生物可能是从胃肠道经输卵管到达子宫。

既往细菌定植的检测依赖于培养技术，通常无法确定所有菌落的特征。

随着技术的进步，低生物量微生物群可以通过定量聚合酶链反应和新一代16S rRNA基因测序来表征。

粘附分子（ＩＣＡＭ－１、Ｐ－ｓｅｌｅｃｔｉｎ、ＳＶＣＡＭ－１、ＰＥＣＡＭ－１）在妊娠肝内胆汁淤积症中的作用导师ｔ指导小组成员。

研究生一彭芝兰教授刘淑芸教授王靖华教授赵ｔ剐教授时青云前言妊娠肝内胆汁淤积症（ｉｎｔｒａｈｅｐａｔｉｅｅｈｏｌｅｓｔａｓｉｓｏｆｐｒｅｇｎａｎｃｙＩＣＰ）是妊娠特有的并发症，以全身皮肤瘙痒、肝功能异常，或伴有不同程度的黄疸为特征。

该症可引起产后出血率增加，但其更大的危害是围产儿结局不良，早产率３５％／¨，羊水胎粪污染率２７－４０％１２】，产时胎儿窘迫率１８％【３】，围产儿死亡率高达１１０‰［４１。

目前对该症的发病原因及胎儿缺氧机理尚无定论，因此缺乏有效的防治措施。

近年来随着生殖免疫学的兴起和发展，围绕母体对半异体同种移植物为何不排斥反而里可接受状态（即正常妊娠）这一核心问题进行了一定的研究。

同时对不孕、流产、不明原因的死胎和妊高征等病理妊娠进行了大量研究发现：人类生殖活动是受激素一免疫一生长因子粘附分子网络系统的严密调控的，如网络某些环节发生异常，就可能导致病理妊娠１５～。

ＩＣＰ与妊高征一样，即便是很严重者，一旦胎儿娩出，其病情迅速好转。

但是关于ＩＣＰ免疫方面的研究极少。

Ｇｅｒｍｏｎｏｒ－ＲＴｌ７］，首先对ＩＣＰ患者免疫因素进行研究发现Ｔｓ细胞减少。

国内对ＩＣＰ患者血清中抗心磷脂抗体的研究发现ｌｓｌｌＣＰ患者血清中抗心磷脂抗体水平显著升高。

最近我们对ＩＣＰ患者细胞免疫及体液免疫研究发现，ＩＣＰ患者ＣＤｓ＋水平明显下降，ＣＤ＋＋／ＣＤ８＋比值增高，ＩｇＧ水平下降［９１。

这些研究结果提示，胎儿一胎盘作为半异体同种移植物，刺激母体产生免疫应答，发生母胎间免疫平衡失调。

粘附分子是多细胞生物的重要功能分子，不仅是急性排斥反应的始动因素而且在免疫应答、对移植物排斥反应及血管内皮活化中起重要作用【９，１ｏ，１１，１２］。

在对胚胎着床以及妊娠及妊娠并发症的研究发现，粘附分子表达的紊乱可导致胚胎的早期死亡、妊高征及早产的发生［１３，１４，１５】。