继发性不孕症发病因素的研究进展
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摘要
近年来,因继发性不孕症就诊的患者逐年增多,年龄也趋于年轻化,这对有生育要求的家庭造成严重困扰。其病因多种多样且较为复杂,主要发病因素有盆腔因素、年龄与卵巢因素、免疫因素、精神心理因素、环境及其他因素等。既往大量研究认为盆腔因素是继发性不孕症的主要原因,但随着生育年龄推迟、"二孩政策"的开放、饮食结构及生活环境的改变等,卵巢性不孕的比例或许较前有所升高,因此准确、充分、全面评估各发病因素对降低继发性不孕症的发病率及有效治疗具有重要的临床意义。
In recent years, the number of patients attending to secondary infertility has increased year by year, and the age has become younger. This has caused serious problems for families with fertility requirements. The etiology is diverse and complex. The main pathogenic factors included pelvic factors, age and ovarian factors, immune factors, mental and psychological factors, environment and other factors. A large number of previous studies had suggested that pelvic factors were the main cause of secondary infertility, but with the delay in reproductive age, the opening of the "two-child policy", changes in diet and living environment, the proportion of ovarian infertility may be higher than before, so accurate, full and comprehensive evaluation of various pathogenic factors has important clinical significance in reducing the incidence of secondary infertility and effective treatment.
In recent years, the number of patients attending to secondary infertility has increased year by year, and the age has become younger. This has caused serious problems for families with fertility requirements. The etiology is diverse and complex. The main pathogenic factors included pelvic factors, age and ovarian factors, immune factors, mental and psychological factors, environment and other factors. A large number of previous studies had suggested that pelvic factors were the main cause of secondary infertility, but with the delay in reproductive age, the opening of the "two-child policy", changes in diet and living environment, the proportion of ovarian infertility may be higher than before, so accurate, full and comprehensive evaluation of various pathogenic factors has important clinical significance in reducing the incidence of secondary infertility and effective treatment.
引文
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[2]张树永,刘振红,庞君丽,等.泌尿生殖道支原体感染特点及耐药趋势[J].传染病信息,2015,28(3):152-154.
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[13]赵一,冯力民,张君妍.宫内病变与妊娠的关系[J].实用妇产科杂志,2017,33(4):248-251.
[14]Souho T,Benlemlih M,Bennani B.Human papillomavirus infection and fertility alteration:a systematic review[J].Plos One,2015,10(5):e0126936.
[15]Tilly JL,Sinclair DA.Germline energetics,aging,and female infertility[J].Cell Metab,2013,17(6):838-850.
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[19]Frani觬-Ivaniüevi觬M,Frani觬D,Ivovi觬M,et al.Genetic E-tiology of Primary Premature Ovarian Insufficiency[J]Acta Clin Croat,2016(55):629-635.
[20]Laissue P.The molecular complexity of primary ovarian insufficiency aetiology and the use of massively parallel sequencing[J].Mol Cell Endocrinol,2018(460):170-180.
[21]Moran LJ,Thomson RL,Buckley JD,et al.Erratum to:Ster oidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome[J].Endocrine,2016,52(2):404.
[22]Boyle JA,Cunningham J,Norman RJ,et al.Polycystic ovary syndrome and metabolic syndrome in Indigenous Australian women[J].Internal medicine journal,2015,45(12):1247-1254.
[23]Azziz R.PCOS in 2015:New insights into the genetics of polycystic ovary syndrome[J].Nature reviews.Endocrinology,2016,12(3):183.
[24]Majumdar A,Mangal NS.Hyperprolactinemia[J].J Hum Reprod Sci,2013(6):168-175.
[25]Kasum M,Paviˇi′-Baldani D,Stani′P,et al.Importance of macroprolactinemia in hyperprolactinemia[J].Eur J Obstet Gynecol Reprod Biol,2014(183):28-32.
[26]刘晓丽.孕康口服液对黄体功能不全致不孕不育患者雌孕激素及受体的影响[J].中国妇幼保健,2018,33(4):877-879.
[27]梁栋,李维茹,张四友.继发性不孕妇女自身免疫抗体及性心理状态的变化观察[J].中国性科学,2018(2):121-123.
[28]Neamatzadeh H,Ramazani V,Kalantar S M,et al.Serum Immune Reactivity againstβ2-Glycoprotein-I and Anti Neutrophil Cytoplasmic auto-antibodies by eli-p-complex screening technology in recurrent miscarriage[J]Minerva Ginecologica,2014,68(3).
[29]黄启当,李泽泳,吴晓昀,等.抗核抗体联合抗心磷脂抗体、抗精子抗体和抗β2糖蛋白Ⅰ抗体检测在女性不孕不育中的价值[J].国际检验医学杂志,2016,37(7)915-916.
[30]周平,宗晓寒.618例不孕患者血清免疫学抗体检测及临床意义[J].河南预防医学杂志,2016,27(4):258-261.
[31]Gdańska P,Drozdowiczjastrzbska E,Grzechocińska B,et al Anxiety and depression in women undergoing infertility treatment[J].Ginekol Pol,2017(88):109-112.
[32]有风芝,靳艳玲,张仪,等.宫内节育器避孕后继发不孕不育问题的流行病学研究[J].中国妇幼保健,2016,31(22):4814-4816.
[33]Hart RJ.Physiological Aspects of Female Fertility:Role of the Environment,Modern Lifestyle,and Genetics[J]Physiological Reviews,2016,96(3):873.
[2]张树永,刘振红,庞君丽,等.泌尿生殖道支原体感染特点及耐药趋势[J].传染病信息,2015,28(3):152-154.
[3]罗小琼,凌燕兰,罗小花,等.1834例女性不孕症病因分析[J].右江医学,2017,45(4):483-486.
[4]王琦,张红云,陈蔚清,等.继发性不孕不育女性生殖道支原体与沙眼衣原体的感染分析[J].中华医院感染学杂志,2016,26(10):2348-2350.
[5]Hernández-Marín I,Aragón-López CI,Aldama-González PL,et al.Prevalence of infections(Chlamydia,Ureaplasma and Mycoplasma)in patients with altered tuboperitoneal fac tor[J].Ginecol Obstet Mex,2016,84(1):14-18.
[6]Tsevat DG,Wiesenfeld HC,Parks C,et al.Sexually transmitted diseases and infertility[J].Am J Obstet Gynecol,2017,216(1):1-9.
[7]He J,You X,Zeng Y,et al.Mycoplasma genitalium-derived lipidassociated membrane proteins activate NF-kappa Bthrough tolllike receptors 1,2,and 6 and CD14 in a My D88-dependent pathway[J].Clin Vaccine Immunol,2009,16(12):1750-1757.
[8]Zumla A,George A,Sharma V,et al.The WHO 2014 global tuberculosis report-further to go[J].Lancet Glob Health,2015,3(1):10-12.
[9]李晓男.女性生殖器结核与不孕症的关系及临床诊断和治疗分析[J].当代医学,2018,24(10):60-61.
[10]郑婷萍,孙爱军,郎景和,等.北京协和医院住院患者不孕症与子宫内膜异位症30年变化趋势[J].中华妇产科杂志,2015,50(8):591-595.
[11]Hudelist G,English J,Thomas AE,et al.Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis:systematic review and meta-analysis[J].Ultrasound Obst Gyn,2011,37(3):257-263.
[12]王萌莹,谢瑞,胡琳莉.宫腔镜在不孕患者宫腔病变的诊断及治疗作用[J].中华生殖与避孕杂志,2018(5):365-369.
[13]赵一,冯力民,张君妍.宫内病变与妊娠的关系[J].实用妇产科杂志,2017,33(4):248-251.
[14]Souho T,Benlemlih M,Bennani B.Human papillomavirus infection and fertility alteration:a systematic review[J].Plos One,2015,10(5):e0126936.
[15]Tilly JL,Sinclair DA.Germline energetics,aging,and female infertility[J].Cell Metab,2013,17(6):838-850.
[16]Fang T,Su Z,Wang L,et al.Predictive value of age-specific FSH levels for IVF-ET outcome in women with normal ovarian function[J].Reprod Biol Endocrinol,2015(13):63.
[17]Best KE,Ran kin,J.Is advanced maternal age a risk factor for congenital heart disease[J].Birth Defects Res AClin Mol Teratol,2016,106(6):461-467.
[18]Gowri V,Al Shukri M,Al-Farsi FA,et al.Aetiological profile of women prese nting with premature ovarian failure to a single tertiary care center in Oman[J].Post Reprod Health,2015,21(2):63-68.
[19]Frani觬-Ivaniüevi觬M,Frani觬D,Ivovi觬M,et al.Genetic E-tiology of Primary Premature Ovarian Insufficiency[J]Acta Clin Croat,2016(55):629-635.
[20]Laissue P.The molecular complexity of primary ovarian insufficiency aetiology and the use of massively parallel sequencing[J].Mol Cell Endocrinol,2018(460):170-180.
[21]Moran LJ,Thomson RL,Buckley JD,et al.Erratum to:Ster oidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome[J].Endocrine,2016,52(2):404.
[22]Boyle JA,Cunningham J,Norman RJ,et al.Polycystic ovary syndrome and metabolic syndrome in Indigenous Australian women[J].Internal medicine journal,2015,45(12):1247-1254.
[23]Azziz R.PCOS in 2015:New insights into the genetics of polycystic ovary syndrome[J].Nature reviews.Endocrinology,2016,12(3):183.
[24]Majumdar A,Mangal NS.Hyperprolactinemia[J].J Hum Reprod Sci,2013(6):168-175.
[25]Kasum M,Paviˇi′-Baldani D,Stani′P,et al.Importance of macroprolactinemia in hyperprolactinemia[J].Eur J Obstet Gynecol Reprod Biol,2014(183):28-32.
[26]刘晓丽.孕康口服液对黄体功能不全致不孕不育患者雌孕激素及受体的影响[J].中国妇幼保健,2018,33(4):877-879.
[27]梁栋,李维茹,张四友.继发性不孕妇女自身免疫抗体及性心理状态的变化观察[J].中国性科学,2018(2):121-123.
[28]Neamatzadeh H,Ramazani V,Kalantar S M,et al.Serum Immune Reactivity againstβ2-Glycoprotein-I and Anti Neutrophil Cytoplasmic auto-antibodies by eli-p-complex screening technology in recurrent miscarriage[J]Minerva Ginecologica,2014,68(3).
[29]黄启当,李泽泳,吴晓昀,等.抗核抗体联合抗心磷脂抗体、抗精子抗体和抗β2糖蛋白Ⅰ抗体检测在女性不孕不育中的价值[J].国际检验医学杂志,2016,37(7)915-916.
[30]周平,宗晓寒.618例不孕患者血清免疫学抗体检测及临床意义[J].河南预防医学杂志,2016,27(4):258-261.
[31]Gdańska P,Drozdowiczjastrzbska E,Grzechocińska B,et al Anxiety and depression in women undergoing infertility treatment[J].Ginekol Pol,2017(88):109-112.
[32]有风芝,靳艳玲,张仪,等.宫内节育器避孕后继发不孕不育问题的流行病学研究[J].中国妇幼保健,2016,31(22):4814-4816.
[33]Hart RJ.Physiological Aspects of Female Fertility:Role of the Environment,Modern Lifestyle,and Genetics[J]Physiological Reviews,2016,96(3):873.