#1
|
|||
|
|||
òîïèê ïåðåìåùåí
Óâàæàåìûå äîêòîðà!
Ïîèñêàâ ïî ñòðîêå "HLA òèïèðîâàíèå" è ïî÷èòàâ ñîîòâåòñòâóþùèå òåìû, ÿ äåëàþ âûâîä, ÷òî íà äàííîì ôîðóìå ÿâëÿåòñÿ îáùåïðèíÿòûì ìíåíèå î òîì, ÷òî ïîëåçíîé èíôîðìàöèè ïðè ëå÷åíèè áåñïëîäèÿ/íåâûíàøèâàíèÿ ýòè àíàëèçû íå íåñóò (ðàâíî êàê è ïðåäëàãàþùèåñÿ ïî èõ ðåçóëüòàòàì ìåðîïðèÿòèÿ ïî èììóíèçàöèè ëèìôîöèòàìè/êàïåëüíèöàì ñ èììóíîãëîáóëèíîì). Îäíàêî íàéäåííûå ìíîé îáñóæäåíèÿ ñî ññûëêàìè íà íàó÷íûå ðàáîòû äàòèðóþòñÿ 2004 ãîäîì. Ñ òîãî âðåìåíè â äàííîì âîïðîñå ìîãëî ÷òî-òî è ïîìåíÿòüñÿ. Êðîìå òîãî, â íàéäåííûõ ìíîé òåìàõ ðàçáèðàþòñÿ ðåçóëüòàòû àíàëèçîâ êîíêðåòíûõ ïàð, ÷èñëî ñîâïàäåíèé êîòîðûõ îòëè÷àåòñÿ îò íàøåãî. Òàêæå íà äàííîì ôîðóìå â êà÷åñòâå íåîáõîäèìûõ àíàëèçîâ â òåìå "ñàìîïðîèçâîëüíûé âûêèäûø è îáñëåäîâàíèå ïðè ïðèâû÷íîì íåâûíàøèâàíèè" HLA-òèïèðîâàíèå óêàçàí. Ïîýòîìó ïðîøó ïðîñòèòü ìíå ìîþ íàâÿç÷èâîñòü è îáñóäèòü ýòîò âîïðîñ â ìèëëèîí-ïåðâûé ðàç. (Åñëè òðåáóåòñÿ, âû òàêæå ìîæåòå îçíàêîìèòüñÿ ñ äîïîëíèòåëüíîé èíôîðìàöèåé î íàøåé èñòîðèè). Ðåçóëüòàòû íàøåãî àíàëèçà òàêîâû: Öèòàòà:
|
#2
|
|||
|
|||
Öèòàòà:
http://rusmedserv.com/forums/showpos...7&postcount=16 http://rusmedserv.com/forums/showpos...4&postcount=19 Îäíàêî, ñòàíäàðòû ðàáîòû, êîòîðûå âðà÷è îáÿçàíû âûïîëíÿòü, íàïðèìåð â óñëîâèÿõ çàïàäíûõ ñòðàõîâûõ êîìïàíèé, íå âêëþ÷àþò èììóíèçàöèþ àëëîãåííûìè ëèìôîöèòàìè â ïåðå÷åíü óñëóã, êàê ïðîöåäóðó, íå äîêàçàííóþ ñ.ò.ç. åå ïðîâåðåííîé ýôôåêòèâíîñòè. È ýòî ñïðàâåäëèâî, ïîñêîëüêó ëþáûå ñîìíåíèÿ â ìåäèöèíå äîëæíû òðàêòîâàòüñÿ â ñòîðîíó èíòåðåñîâ áåçîïàñíîñòè ïàöèåíòà. Ñ óâàæåíèåì, |
#3
|
||||
|
||||
Öèòàòà:
Öèòàòà:
Öèòàòà:
Íèæå ïðèìåð ïîèñêà íà äåêàáðü 2008 ãîäà: ïàðàìåòðû çàïðîñà óêàçàíû Keywords: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ], [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ], [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Limits: Meta-Analysis, Randomized Controlled Trial, Review [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2000 Dec;74(6):1108-13. Treatment of repeated unexplained in vitro fertilization failure with intravenous immunoglobulin: a randomized, placebo-controlled Canadian trial. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ], [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] OBJECTIVE: To evaluate the effect of intravenous immunoglobulin (IVIG) on pregnancy outcome in couples with repeated unexplained in vitro fertilization (IVF) failure. DESIGN: Prospective, randomized, double blind, placebo-controlled clinical trial. SETTING: A university-based and a free-standing IVF program. PATIENT(S): Fifty-one couples with a history of repeated unexplained IVF failure who were preparing for another fresh IVF cycle or replacement of cryopreserved embryos. INTERVENTION(S): Eligible women underwent a standard IVF stimulation using a long luteal phase GnRH analog protocol. Cryopreserved embryos were replaced after endometrial preparation with oral micronized estradiol and subsequent vaginal progesterone. The women were randomly selected to receive IVIG (500 mg/kg) or an equivalent volume of normal saline. The first infusion was given on the day of embryo transfer or during the preceding 72 hours. The second infusion was given 4 weeks later if a clinical pregnancy was confirmed by ultrasound. MAIN OUTCOME MEASURE(S): Live-birth rates. RESULT(S): Overall, the live-birth rates were 4/26 (15%) for the IVIG group and 3/25 (12%) for the placebo group (P=0. 52). There were 39 fresh IVF cycles, which yielded a clinical pregnancy rate of 28%, with live-birth rates of 4/21 (19%) for the IVIG group and 3/18 (17%) for the placebo group (P=0.59). CONCLUSION(S): In this randomized clinical trial, IVIG did not improve the live-birth rate in couples with repeated unexplained IVF failure, stringently defined by known determinants of IVF outcome. PMID: 11119735 [PubMed - indexed for MEDLINE]  ïðèâåäåííîì èññëåäîâàíèè âíóòðèâåííîå ïðèìåíåíèå èììóíîãëîáóëèíà íå óâåëè÷èâàëî ÷àñòîòó ðîäîâ ó ïàð ñ ïîâòîðíûìè íåóäà÷íûìè ïîïûòêàìè ÝÊÎ è íå ïîçâîëÿåò îïðåäåëåííî ãîâîðèòü î âëèÿíèè íà èñõîä ÝÊÎ. Ìîæíî íàéòè èññëåäîâàíèÿ íå âûñòàâëÿÿ "æåñòêèõ"ïàðàìåòðîâ èñêëþ÷åíèå, íî îíè íàïîìèíàþò ïðèìåðíî âîò ÷òî: Èç 100 ìóæ÷èí, ïîïàâøèõ â äîðîæíî-òðàíñïîðòíîå ïðîèñøåñòâèå, 80% ïîñòîÿííî óïîòðåáëÿþò â ïèùó ñîëåíûå îãóðöû. Ìîæíî ñ áîëüøîé óâåðåííîñòüþ ñêàçàòü, ÷òî ïðèìåíåíèå ýòîãî ïðîäóêòà îêàçûâàåò ñåðüåçíîå âëèÿíèå íà äîðîæíî-òðàíñïîðòíóþ îáñòàíîâêó â ñòðàíå... PS Êñòàòè åñòü ññûëêè è íà äðóãèå èñòî÷íèêè â ñîîáùåíèè ïàöèåíòîâ, íåïîñðåäñòâåííî èíòåðåñóþùèõñÿ ïðîáëåìîé. |
#4
|
|||
|
|||
Èììóíîëîãèÿ, áåñïëîäèå, èììóíîòåðàïèÿ....
Óâàæàåìûé Áîðèñ Àëåêñàíäðîâè÷!
Ìíå 35 ëåò, ìóæó 41.  áðàêå 7 ëåò, ïëàíèðóåì áåðåìåííîñòü àêòèâíî îêîëî 2õ ëåò, äî ýòîãî ïðîñòî íå ïðåäîõðàíÿëèñü. Äî ýòîãî, íà ïðîòÿæåíèè ïîñëåäíèõ ëåò 5 áûëè ñäåëàíû àíàëèçû íà ãîðìîíû, ìèëü¸í ÓÇÈ è îêîëî 5 øòóê ñïåðìîãðàìì. Èç ïîñëåäíåãî: Ò3, Ò4, ÒÒÃ, ÀÒ-ÒÏÎ, ÔÑÃ, ËÃ, Ïðîëàêòèí, Ïðîãåñòåðîí, Òåñòîñòåðîí - âñå â íîðìå. Íî Ýñòðàäèîë áûë ðåçóëüòàò 871 ïðè ðåôåðåíñíîì çíà÷åíèè äî 861. Ìàçêè íà èíôåêöèè âñå ñäàíû, âñå ÷èñòî ó îáîèõ. Ïî ðåçóëüòàòàì ÃÑà îáå òðóáû ïðîõîäèìû. Ñïàå÷íûé ïðîöåññ â ìàëîì òàçó.  ìàòêå áåç îðãàíè÷åñêèõ èçìåíåíèé. Öèêë ó ìåíÿ ñòàáèëüíûé, 26 äíåé. ÓÇÈ ïîêàçàëî âñå òîæå õîðîøî, êàê ñêàçàëà âðà÷ «êàê ïî ó÷åáíèêó»,ò.å. è ýíîìåòðèé è æåëòîå òåëî è åùå ÷åãî-òî òàì, ñìîòðåëè â ðàçíûå äíè öèêëà. Ýìäîìåòðèîç íå îáíàðóæåí. Ãðàôèê ðåêòàëüíîé òåìïåðàòóðû íîðìàëüíûé è òåñòû íà îâóëÿöèþ ïîêàçûâàþò ÷òî îíà åñòü. Ðåçóñ-êîíôëèêòà ó íàñ íåò. Ó ìóæà åñòü ðåáåíîê îò ïåðâîãî áðàêà. Ó ìåíÿ áûëî 2 áåðåìåííîñòè îò äðóãèõ ïàðòíåðîâ â 1998 è 2003 ãîäó, çàêîí÷èëèñü àáîðòàìè. Ñïåðìîãðàììà ó ìóæà îòëè÷íàÿ. Àíòèòåë ê ñïåðìå íåò.  öåíòðå ïëàíèðîâàíèÿ ñåìüè âðà÷-ãèíåêîëîã ïðîâîäèëà ñòèìóëÿöèþ îâóëÿöèè 5 öèêëîâ Êëîñòèëáåãèòîì, ðåçóëüòàòà íå áûëî. Ïîòîì íàïðàâèëà íà àíàëèç òèïèðîâàíèÿ ãåíîâ HLA 2 êëàññà : Æåíà Ìóæ DQA1 0301, 0401 0201, 0501 DQB1 0301, 0401/2 0201, 0301 DRB1 04, 08 07,11 (05) Ïîñëå ÷åãî íàïðàâèëà ê âðà÷ó-èììóíîëîãó â ÖÈÐ. Âðà÷-èììóíîëîã âûäàëà íàïðàâëåíèÿ íà ñëåäóþùèå àíàëèçû: 1. ÑÊË (ñìåøàííàÿ êóëüòóðà ëèìôîöèòîâ) – ñäàåòñÿ ïàðîé 2. Èììóíîãðàììà (èììóííûé ñòàòóñ) 3. Ïîëèôîðìèçì ãåíîâ öèòîêèíîâ (öèòîêèíîâûé ïðîôèëü, èììóííàÿ êîíñòèòóöèÿ ÷åëîâåêà) 4. Ïîëíîå îáñëåäîâàíèå, ïîëèôîðìèçì ãåíîâ ãåìîñòàçà, 11 ïîêàçàòåëåé 5. Ïîëèôîðìèçì ãåíîâ ñîñóäèñòîãî òîíóñà (ïðåäðàñïîëîæåííîñòü ê ãèïåðòîíè÷åñêèìè ñîñòîÿíèÿì, íàðóøåíèÿì ïëàöåíòàðíîé ôóíêöèè, ïðåýêëàìïñèè, èíôàðêòó ìèîêàðäà. Ìèêðîöèðêóëÿöèÿ, ñîñóäèñòûé òîíóñ, 6 ïîêàçàòåëåé). 6. Áëîê àóòîàíòèòåë (àíòèòåëà ê êàðäèîëèïèíó IgG è IgM, àíòèòåëà ê íàòèâíîé è äåíàòóðèðîâàííîé ÄÍÊ, àíòèòåëà ê ÒÏÎ, àíòèòåëà ê ÒÃ, àíòèòåëà ê B2-ÃÏ-1 IgG è IgM, àíòèòåëà ê àííåêñèíó V IgG è IgM). 7. Ãîìîöèñòåèí Ïîñëå ïîëó÷åíèÿ ðåçóëüòàòîâ âðà÷ áóäåò ïðèíèìàòü ðåøåíèå î ëèìôîèììóíîòåðàïèè ëèìôîöèòàìè ìóæà. Íî ÿ ÷èòàëà íà ôîðóìå ëèìôîèììóíîòåðàïèÿ íàçíà÷àåòñÿ ïðè ñîâïàäåíèè 3õ è áîëåå ëîêóñîâ. Ó íàñ æå ñîâïàë âñåãî îäèí. Íóæíà ëè íàì ýòà ïðîöåäóðà? Ìåíÿ ýòî î÷åíü âîëíóåò ïîòîìó, ÷òî äî êîíöà ýôôåêòèâíîñòü ëå÷åíèÿ ýòèì ìåòîäîì, ñ òî÷êè çðåíèÿ äîêàçàòåëüíîé ìåäèöèíû, ñòàâèòñÿ ïîä ñîìíåíèå ðîâíî ïîëîâèíîé èññëåäîâàòåëåé.. Íåêîòîðûå âðà÷è íå ñ÷èòàþò HLA-ñîâïàäåíèå ïðè÷èíîé áåñïëîäèÿ. Ýòî ìîæåò áûòü ïðè÷èíîé íåâûíàøèâàíèÿ, íî íå áåñïëîäèÿ, ïî èõ ìíåíèþ. Àíàëèçû ñäàþòñÿ â ëàáîðàòîðèè ýòîé æå êëèíèêè. Âûçûâàåò ñîìíåíèå â íåîáõîäèìîñòè ñäà÷è âñåãî ýòîãî ïåðå÷íÿ, ñóììó ïîëó÷àåòñÿ 26 000 ðóáëåé. Íî è âûáîðà ñäà÷è â äðóãîé ëàáîðàòîðèè îñîáîãî íåò, ò.ê. òàêèå ñïåöèôè÷åñêèå àíàëèçû äåëàþòñÿ â Ìîñêâå â ÖÈÐ è â Íàó÷íîì öåíòðå àêóøåðñòâà, ãèíåêîëîãèè è ïåðèíàòîëîãèè íà óë.Îïàðèíà.  ëàáîðàòîðèÿõ Èíâèòðî, Ìåäõåëï, Ñèòèëàá, ÌåäÖåíòðÑåðâèñ, 21 âåê, Öåíòð ìîëåêóëÿðíîé ãåíåòèêè, âñåãî ïåðå÷íÿ íå äåëàþò. Âîîáùå, êàêîâî Âàøå ìíåíèå â öåëîì, â òîì ëè íàïðàâëåíèè êîïàåì?  ÷åì ìîæåò áûòü ïðîáëåìà áåñïëîäíîãî áðàêà â íàøåì êîíêðåòíîì ñëó÷àå, êàê Âû ñ÷èòàåòå? Ìåæåò áûòü äàæå ïîñîâåòóòå ê êîìó îáðàùàòüñÿ... Ïðîøó âàñ âûñêàçàòü ñâîå ìíåíèå êàê ñïåöèàëèñòà è îòâåòèòü íà ìîè âîïðîñû. Ñïàñèáî! |
#5
|
|||||||
|
|||||||
Äóìàþ, ÷òî Áîðèñ Àëåêñàíäðîâè÷ îòâåòèò Âàì, ÿ ïîêà ëèøü ïðîêîììåíòèðóþ íàçíà÷åííûå àíàëèçû:
Öèòàòà:
Öèòàòà:
Öèòàòà:
Öèòàòà:
Öèòàòà:
Öèòàòà:
Öèòàòà:
|
#6
|
|||
|
|||
Öèòàòà:
|
#8
|
|||
|
|||
Ïîëó÷èëà áîëüøîå óäîâîëüñòâèå îò îòâåòà LupusDoc - èñ÷åðïûâàþùå ÿñíî. Äîáàâëþ òîëüêî, ÷òî ïðè íåâûíàøèâàíèè ïîñëå èììóíîòåðàïèè áåðåìåííîñòü íîðìàëüíî çàâåðøàåòñÿ â 70% ñëó÷àåâ, áåç èììóíîòåðàïèè - â 70% ñëó÷àåâ. Ïðèãëàøàþ àâòîðà ê äèñêóññèè ïî ýòîìó âîïðîñó, êîòîðàÿ ñîñòîèòñÿ âî âðåìÿ êîíôåðåíöèè ÐÀÐ× â ñåíòÿáðå. Ðåçóëüòàòû áóäóò î÷åíü øèðîêî ðàñïðîñòðàíåíû ñðåäè ïðàêòè÷åñêèõ âðà÷åé, ÷òîáû îñòàíîâèòü ñïåêóëÿöèè íà ýòó òåìó. Êñòàòè, â ðÿäó àíàëèçîâ, êîòîðûå ìîæíî çàíåñòè â "÷åðíûé ñïèñîê" è àíòè-ÕÃ.
__________________
Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
#9
|
|||
|
|||
HLA II êëàññà è ËÈÒ
Óâàæàåìûé boris! Î÷åíü èíòåðåñíà ÂÀøà òåìà "HLA ñîâïàäåíèÿ. ËÈÒ - äåëàòü èëè íåò? ÑÊË - êàê ïðàâèëüíî?" è î÷åíü èíòåðåñíàÿ èíôîðìàöèÿ, ïðåäñòàâëåííàÿ Âàìè. Ê ñîæàëåíèþ, òåìà çàêðûòà, íî î÷åíü íóæíà êîíñóëüòàöèÿ.... Ó ìåíÿ 5 íåäåëÿ áåðåìåííîñòè (ñàìîñòîÿòåëüíàÿ)  2009 ãîäó íà ñðîêå 8-9 íåäåëü áûëà çàìåðøàÿ áåðåìåííîñòü. Ïîñëå ñäà÷è àíàëèçîâ âûÿâèëîñü ñîâïàäåíèå ñ ìóæåì ïî 3 àëëåëÿì HLA II êëàññà. (ãîìîçèãîò íåò).  îäíîé èç ñàìûõ óâàæàåìûõ êëèíèê Ìîñêâû (ÍÖÀÃèÏ íà óë. Îïàðèíà, 4) íàçíà÷àþò ìíå ñðî÷íî ËÈÒ (äî áåðåìåííîñòè íå äåëàëà, ê ñîæàëåíèþ èëè ê ñ÷àñòüþ åùå íå çíàëà îá ýòîé ïðîöåäóðå). Âðà÷ ñêàçàëà, ÷òî îíà 10 ëåò çàíèìàåòñÿ ýòîé òåìîé è äàæå ïèøåò äèññåðòàöèþ! È ÷òî ýòî ýôôåêòèâíàÿ ïðîöåäóðà ïðè íåâûíàøèâàíèè áåðåìåííîñòè.  äðóãîé íå ìåíåå óâàæàåìîé êëèíèêå Ìîñêâû (ÖÏÑèÐ íà Ñåâàñòîïîëüñêîì ïðîñïåêòå,25à) ñêàçàëè, ÷òîáû ÿ íå óâëåêàëàñü ïîäîáíûìè ïðîöåäóðàìè, ò.ê. 100% ýôôåêòèâíîñòü åùå íå äîêàçàíà. Êàê ãîâîðèòñÿ - îáæåãøèñü íà ìîëîêå, áóäåøü äóòü íà âîäó....ñ îäíîé ñòîðîíû, åñëè íå ñäåëàòü íå áóäåò ëè õóæå, à ñ äðóãîé ñòîðîíû - êàê ïîâëèÿåò ËÈÒ íà ñðîêå 5 íåäåëü, êîãäà äàæå ëþáàÿ òàáëåòêà è òî âðåäíà äëÿ ïëîäà....Boris, áóäó î÷åíü Âàì ïðèçíàòåëüíàÿ çà îòâåò! Çàðàíåå áëàãîäàðþ!
|
#10
|
||||
|
||||
Ìîå ìíåíèå ñîëèäàðíî ñ ìíåíèåì êîëëåã èç ÖÏÑèÐ.
|
#11
|
|||
|
|||
Boris, áîëüøîå ñïàñèáî!
|