切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (06) : 621 -628. doi: 10.3877/cma.j.issn.1673-5250.2018.06.001

所属专题： 文献；

专家约稿

预防性接种人乳头瘤病毒疫苗对妊娠结局的影响
赖婷1, 王艳萍1, 李小洪1, 陶晶1, 朱军1,†()   
  1. 1. 610041　成都，四川大学华西第二医院出生缺陷监测中心、出生缺陷与相关妇儿疾病教育部重点实验室
  • 收稿日期:2018-05-09 修回日期:2018-09-12 出版日期:2018-12-01
  • 通信作者: 朱军

Effects of preventive vaccination of human papillomavirus vaccines on pregnancy outcomes

Ting Lai1, Yanping Wang1, Xiaohong Li1, Jing Tao1, Jun Zhu1,†()   

  1. 1. National Center for Birth Defects Monitoring, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2018-05-09 Revised:2018-09-12 Published:2018-12-01
  • Corresponding author: Jun Zhu
  • About author:
    Corresponding author: Zhu Jun, Email:
  • Supported by:
    National Key Research and Development Program of Ministry of Science and Technology(2016YFC1000102)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

赖婷, 王艳萍, 李小洪, 陶晶, 朱军. 预防性接种人乳头瘤病毒疫苗对妊娠结局的影响[J/OL]. 中华妇幼临床医学杂志(电子版), 2018, 14(06): 621-628.

Ting Lai, Yanping Wang, Xiaohong Li, Jing Tao, Jun Zhu. Effects of preventive vaccination of human papillomavirus vaccines on pregnancy outcomes[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(06): 621-628.

高危型人乳头瘤病毒(HPV)持续感染可导致宫颈癌。目前，世界各国数以百万计育龄女性预防性接种HPV疫苗。最近10年对于孕期预防性接种HPV疫苗对自然流产、出生缺陷等不良妊娠结局影响的研究结果显示，接种HPV疫苗孕妇的自然流产率和重大出生缺陷发生率与未接种孕妇，或者预防性接种抗甲型肝炎病毒(HAV)疫苗孕妇比较，差异均无统计学意义(P>0.05)。笔者拟就预防性接种HPV疫苗现状，以及围生期或孕期预防性接种HPV疫苗对妊娠结局影响的最新研究进展进行阐述。

关键词: 人乳头瘤病毒, 乳头状瘤病毒疫苗, 肝炎疫苗，甲型, 对比研究, 妊娠结局, 不良反应, 大规模疫苗接种, 孕妇

Persistent high-risk human papillomavirus (HPV) infection can lead to cervical cancer. Nowadays, millions of women in childbearing age around the world have been vaccinated with preventive HPV vaccines. Studies which mainly discussed the effects of HPV vaccines on adverse pregnancy outcomes including spontaneous miscarriage, major birth defects in the latest 10 years showed that the risks of spontaneous miscarriage and major birth defects of pregnant women with preventive vaccination of HPV vaccines during pregnancy were not significantly higher than those with preventive vaccination of hepatitis A vaccination (HAV) or without vaccination of HPV vaccines (P>0.05). In this article, we review the status of preventive vaccination of HPV vaccines, and summarize the latest research progresses of the effects of preventive vaccination of HPV vaccines on pregnancy outcomes during peri-conception or pregnancy.

Key words: Human papillomavirus, Papillomavirus vaccines, Hepatitis A vaccines, Comparative study, Pregnancy outcome, Adverse reaction, Mass vaccination, Pregnant women
表1 3种人乳头瘤病毒疫苗一般特征比较
一般特征 2价疫苗 4价疫苗 9价疫苗
生产厂家 英国葛兰素史克公司 美国默沙东公司 美国默沙东公司
全球上市时间(年) 2009 2006 2014
接种3针疫苗时间(月) 0、1、6 0、2、6 0、2、6
适用人群(岁，性别) 9～25，女性 9～26，女性/男性(美国)20～45，女性(中国) 9～15，男性；9～26，女性
有效预防HPV亚型 HPV-16、-18 HPV-6、-11、-16、-18 HPV-6、-11、-16、-18、-31、-33、-45、-52、-58
宫颈癌预防率(%) 70 70 90
尖锐湿疣预防率(%) － 90 90
阴道癌/肛门癌预防率(%) － － 85～95
佐剂 ASO4：500 μg Al(OH)3、50 μg 3-氧-脱酰-4′单磷酰脂质A AAHS：225 μg非晶形羟基磷酸铝硫酸盐 AAHS：500 μg非晶形羟基磷酸铝硫酸盐
每剂容量(mL) 0.5 0.5 0.5
注射方式 肌内注射 肌内注射 肌内注射
储存温度(°C，勿冻结) 2～8 2～8 2～8
表2 13篇有关孕期意外暴露于人2价与4价人乳头瘤病毒疫苗孕妇与妊娠结局方面的最新研究文献
疫苗类型 文献作者(发表年) 研究类型/数据来源地 孕期接种HPV疫苗时的年龄 暴露组(n/n′) 对照组(n/n′) 主要不良妊娠结局
2价HPV疫苗(Cervarix?) Wacholder等[24](2010) 2项多中心、Ⅲ期临床试验(双盲随机对照试验汇总分析)/哥斯达黎加 15～25岁(PATRICIA)或18～25岁(CVT)，均为接种HPV疫苗后发现妊娠者 2 346/13 075 2 364/13 055 胎儿胎龄<20周时自然流产
? Panagiotou等[25](2015) 双盲、随机对照试验及长期随访试验/哥斯达黎加 18～25岁(妊娠90 d内接种疫苗者) 2 279/3 727 2 225/3 739、720/2 836 c 胎儿胎龄<20周时自然流产
? Baril等[26](2015) 观察性队列研究/英国 15～25岁(末次月经前30 d至末次月经后45 d内接种疫苗者) 207/839 632/839 胎儿胎龄<23周时自然流产
? Angelo等[27](2014) 42个已完成或正在进行的临床试验汇总分析/比利时及美国 超过90%为15～25岁(末次月经前60 d至早孕期内接种疫苗者) 465/27 353 449/20 504 自然流产、选择性终止妊娠术
? Lópezfauqued等[28](2017) 妊娠暴露登记，前瞻性评估/英国及美国 14～31岁(孕期和分娩前60 d接种疫苗者) 181 a － 胎儿胎龄<22周时自然流产、胎儿先天畸形
? Descamps等[29](2009) 11个临床研究汇总分析/30个国家 超过95%为15～25岁(至少接种1针HPV疫苗者) 870/16 142 867/13 811 自然流产、早产、选择性终止妊娠术
4价HPV疫苗(Gardasil?) Garland等[30](2009) 5项Ⅲ期临床试验(随机对照临床试验汇总分析)/澳大利亚 15～45岁(孕期第1天、2个月、6个月接种疫苗者) 1 796/10 126 1 824/10 425 胎儿先天畸形、自然流产
? Dana等[31](2009) 原始研究/美国 约90%为12～26岁(孕期或末次月经前1个月接种疫苗者) 517 a － 自然流产、选择性终止妊娠术
? Moro等[32](2014) 疫苗不良事件报告系统/美国 平均年龄为17岁(孕期接种疫苗者) 147 a － 自然流产、选择性终止妊娠术、分娩重大出生缺陷新生儿
? Goss等[33](2015) 疫苗上市后产前疫苗暴露登记/美国、法国及加拿大 平均年龄为20岁(孕期或末次月经前1个月接种疫苗者) 1 752 a － 胎儿死亡、自然流产、选择性终止妊娠术、分娩重大出生缺陷新生儿
? Lipkind等[34](2017) 回顾性观察队列研究/美国 13～27岁(末次月经前2周至后2周接种疫苗的单胎、活产者) 9 554 a － 早产、重大出生缺陷新生儿
? Scheller等[35](2017) 国家登记数据，匹配分析/丹麦 20～30岁(孕期接种疫苗者) 463 b 1 852 b 自然流产
? 501 2 004 死产
? 1 665 6 660 重大出生缺陷新生儿
? Sy等[36] (2018) 疫苗上市后安全监测描述性研究/美国 9～26岁(孕期或末次月经前1个月接种疫苗者) 2 678/189 269 － 胎儿先天畸形、自然流产
表4 7篇有关孕期意外暴露于4价人乳头瘤病毒疫苗孕妇的活产率、自然流产率、重大出生缺陷/先天畸形胎儿或新生儿发生率的文献回顾分析[%(n/n′)]
文献作者 已知妊娠结局例数 活产 自然流产 重大出生缺陷/先天畸形胎儿或新生儿a
Garland等[30] 2 008 72.1(1 447/2 008) 18.2(366/2 008) 1.6(33/2 008)
Dana等[31] 517 87.2(451/517) 6.6(34/517) 2.2(10/454)
Moro等[32] 147 70.1(103/147) 10.2(15/147) 1.4(2/147)
Goss等[33] 1 752 86.6(1 518/1 752) 6.3(111/1 752) 2.4(37/1 527)
Lipkind等[34] 638 85.0(542/638) － 2.0(11/542)
Scheller等[35] － － 4.3(20/463) 3.9(65/1 665)
Sy等[36] 1 740 38.2(665/1 740) － 3.6(24/665)
表3 2价人乳头瘤病毒疫苗接种与自然流产率的关系
文献作者 HPV疫苗组[%(n/n′)] HAV疫苗组[%(n/n′)] 安慰剂组或空白对照组[%(n/n′)] RR/ P值
Wacholder等[24] 11.5(197/1 708) 10.2(176/1 727) － P＝0.16
Panagiotou等[25] 13.3(451/3 394) 12.6(316/2 507) 13.6(98/720) RR＝1.02(95%CI：0.78～1.34) /P＝0.436 a
3.5(119/3 394) 2.3(58/2 507) 3.6(26/720) RR＝1.35(95%CI：1.02～1.77) /P＝0.017 b
Baril等[26] 11.6(24/207) － 9.0(57/632) RR＝1.30(95%CI：0.79～2.12) /P＝0.30
接种2针：20.7(6/29) RR＝2.55(95%CI：1.09～5.93) /P＝0.03
接种1针：10.1(18/178) RR＝1.11(95%CI：0.64～1.91) /P＝0.71
Angelo等[27] 15.3(71/465) － 11.1(50/449) RR＝1.37(95%CI：0.94～2.01)
Lópezfauqued等[28] 7.7(14/181) － － －
Descamps等[29] 9.5(79/833) 7.6(52/683) 11.8(18/152) －
合计 12.3(836/6 788) 11.1(544/4 917) 11.4(223/1 953) －
[1]
de Martel C, Plummer M, Vignat J, et al. Worldwide burden of cancer attributable to HPV by site, country and HPV type[J]. Int J Cancer, 2017, 141(4): 664-670.
[2]
Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention[J]. Clin Infect Dis, 2002, 35(Suppl 2): S210-S224.
[3]
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008[J]. Sex Transm Dis, 2013, 40(3): 187-193.
[4]
Barr E, Sings HL. Prophylactic HPV vaccines: new interventions for cancer control[J]. Vaccine, 2008, 26(49): 6244-6257.
[5]
Jit M, Brisson M, Portnoy A, et al. Cost-effectiveness of female human papillomavirus vaccination in 179 countries: a PRIME modelling study[J]. Lancet Glob Health, 2014, 2(7): e406-e414.
[6]
Noronha AS, Markowitz LE, Dunne EF. Systematic review of human papillomavirus vaccine coadministration[J]. Vaccine, 2014, 32(23): 2670-2674.
[7]
Schiller JT, Castellsagué X, Garland SM. A review of clinical trials of human papillomavirus prophylactic vaccines[J]. Vaccine, 2012, 30 (Suppl 5): F123-F138.
[8]
Markowitz LE, Dunne EF, Saraiya M, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP)[J]. MMWR Recomm Rep, 2014, 63(RR-05): 1-30.
[9]
Westra TA, Rozenbaum MH, Rogoza RM, et al. Until which age should women be vaccinated against HPV infection? Recommendation based on cost-effectiveness analyses[J]. J Infect Dis, 2011, 204(3): 377-384.
[10]
Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk[M]. 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2011: 294.
[11]
Wise LD, Wolf JJ, Kaplanski CV, et al. Lack of effects on fertility and developmental toxicity of a quadrivalent HPV vaccine in Sprague-Dawley rats[J]. Birth Defects Res B Dev Reprod Toxicol, 2008, 83(6): 561-572.
[12]
Canfell K. Monitoring HPV vaccination programmes[J]. BMJ, 2010, 340: c1666.
[13]
de Sanjose S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study[J]. Lancet Oncol, 2010, 11(11): 1048-1056.
[14]
Joura EA, Ault KA, Bosch FX, et al. Attribution of 12 high-risk human papillomavirus genotypes to infection and cervical disease[J]. Cancer Epidemiol Biomarkers Prev, 2014, 23(10): 1997-2008
[15]
Serrano B, Alemany L, Tous S, et al. Potential impact of a nine-valent vaccine in human papillomavirus related cervical disease[J]. Infec Agent Cancer, 2012, 7(1): 38.
[16]
Petrosky E, Bocchini JA Jr, Hariri S, et al. Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices[J]. MMWR Morb Mortal Wkly Rep, 2015, 64(11): 300-304.
[17]
Centers for Disease Control and Prevention (CDC). FDA licensure of bivalent human papillomavirus vaccine (HPV2, cervarix) for use in females and updated HPV Vaccination Recommendations from the Advisory Committee on Immunization Practices (ACIP)[J]. MMWR Morb Mortal Wkly Rep, 2010, 59(20): 626-629.
[18]
Barbaro B, Brotherton JM. Assessing HPV vaccine coverage in Australia by geography and socioeconomic status: are we protecting those most at risk？[J]. Aust N Z J Public Health, 2014, 38(5): 419-423.
[19]
Widgren K, Simonsen J, Valentiner-Branth P, et al. Uptake of the human papillomavirus-vaccination within the free-of-charge childhood vaccination programme in Denmark[J]. Vaccine, 2011, 29(52): 9663-9667.
[20]
Statens Serum Institut. EPI-NEWS: HPV vaccination-coverage 2012[EB/OL]. (2013-05-15) [2018-07-20].

URL    
[21]
Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 - United States[J]. MMWR Morb Mortal Wkly Rep, 2013, 62(29): 591-595.
[22]
Markowitz LE, Hariri S, Lin C, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010[J]. J Infect Dis, 2013, 208(3): 385-393.
[23]
Flagg EW, Schwartz R, Weinstock H. Prevalence of anogenital warts among participants in private health plans in the United States, 2003-2010: potential impact of human papillomavirus vaccination[J]. Am J Public Health, 2013, 103(8): 1428-1435.
[24]
Wacholder S, Chen BE, Wilcox A, et al. Risk of miscarriage with bivalent vaccine against human papillomavirus (HPV) types 16 and 18: pooled analysis of two randomised controlled trials[J]. BMJ, 2010, 340: c712.
[25]
Panagiotou OA, Befano BL, Gonzalez P, et al. Effect of bivalent human papillomavirus vaccination on pregnancy outcomes: long term observational follow-up in the Costa Rica HPV Vaccine Trial[J]. BMJ, 2015, 351: h4358.
[26]
Baril L, Rosillon D, Willame C, et al. Risk of spontaneous abortion and other pregnancy outcomes in 15-25 year old women exposed to human papillomavirus-16/18 ASO4-adjuvanted vaccine in the United Kingdom[J]. Vaccine, 2015, 33(48): 6884-6891.
[27]
Angelo MG, David MP, Zima J, et al. Pooled analysis of large and long-term safety data from the human papillomavirus-16/18-ASO4-adjuvanted vaccine clinical trial programme[J]. Pharmacoepidemiol Drug Saf, 2014, 23(5): 466-479.
[28]
Lópezfauqued M, Zima J, Angelo MG, et al. Results on exposure during pregnancy from a pregnancy registry for ASO4-HPV-16/18 vaccine[J]. Vaccine, 2017, 35(40): 5325-5330.
[29]
Descamps D, Hardt K, Spiessens B, et al. Safety of human papillomavirus (HPV)-16/18 ASO4-adjuvanted vaccine for cervical cancer prevention: a pooled analysis of 11 clinical trials[J]. Hum Vaccin, 2009, 5(5): 332-340.
[30]
Garland SM, Ault KA, Gall SA, et al. Pregnancy and infant outcomes in the clinical trials of a human papillomavirus type 6/11/16/18 vaccine: a combined analysis of five randomized controlled trials[J]. Obstet Gynecol, 2009, 114(6): 1179-1188.
[31]
Dana A, Buchanan KM, Goss MA, et al. Pregnancy outcomes from the pregnancy registry of a human papillomavirus type 6/11/16/18 vaccine[J]. Obstet Gynecol, 2009, 114(6): 1170-1178.
[32]
Moro PL, Zheteyeva Y, Lewis P, et al. Safety of quadrivalent human papillomavirus vaccine (Gardasil) in pregnancy: adverse events among non-manufacturer reports in the Vaccine Adverse Event Reporting System, 2006-2013[J]. Vaccine, 2015, 33(4): 519-522.
[33]
Goss MA, Lievano F, Buchanan KM, et al. Final report on exposure during pregnancy from a pregnancy registry for quadrivalent human papillomavirus vaccine[J]. Vaccine, 2015, 33(29): 3422-3428.
[34]
Lipkind HS, Vazquez-Benitez G, Nordin JD, et al. Maternal and infant outcomes after human papillomavirus vaccination in the periconceptional period or during pregnancy[J]. Obstet Gynecol, 2017, 130(3): 599-608.
[35]
Scheller NM, Pasternak B, Mølgaard-Nielsen D, et al. Quadrivalent HPV vaccination and the risk of adverse pregnancy outcomes[J]. N Engl J Med, 2017, 376(13): 1223-1233.
[36]
Sy LS, Meyer KI, Klein NP, et al. Postlicensure safety surveillance of congenital anomaly and miscarriage among pregnancies exposed to quadrivalent human papillomavirus vaccine[J]. Hum Vaccin Immunother, 2018, 14(2): 412-419.
[37]
Nybo Andersen AM, Wohlfahrt J, Christens P, et al. Maternal age and fetal loss: population based register linkage study[J]. BMJ, 2000, 320(7251): 1708-1712.
[38]
Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis[J]. Birth Defects Res A Clin Mol Teratol, 2012, 94(6): 417-423.
[39]
Savitz DA, Hertz-Picciotto I, Poole C, et al. Epidemiologic measures of the course and outcome of pregnancy[J]. Epidemiol Rev, 2002, 24(2): 91-101.
[40]
Correa A, Cragan JD, Kucik JE, et al. Reporting birth defects surveillance data 1968-2003[J]. Birth Defect Res A Clin Mol Teratol, 2007, 79(2): 65-186.
[41]
Atkinson W, Wolfe S, Hamborsky J, et al. Vaccine excipient and media summary//Epidemiology and prevention of vaccine preventable diseases[M]. 11th ed. Washington DC: Public Health Foundation, 2009: B7-B10 .
[42]
Didierlaurent AM, Morel S, Lockman L, et al. ASO4, an aluminum salt- and TLR4 agonist-based adjuvant system, induces a transient localized innate immune response leading to enhanced adaptive immunity[J]. J Immunol, 2009, 183(10): 6186-6197.
[43]
Tavares F, Cheuvart B, Heineman T, et al. Meta-analysis of pregnancy outcomes in pooled randomized trials on a prophylactic adjuvanted glycoprotein D subunit herpes simplex virus vaccine[J]. Vaccine, 2013, 31(13): 1759-1764.
[44]
Matys K, Mallary S, Bautista O, et al. Mother-infant transfer of anti-human papillomavirus (HPV) antibodies following vaccination with the quadrivalent HPV (type 6/11/16/18) virus-like particle vaccine[J]. Clin Vaccine Immunol Cvi, 2012, 19(6): 881-885.
[45]
Public Health Agency of Canada. National Advisory Committee on Immunization (NACI) Statement on human papillomavirus vaccine[EB/OL]. (2007-02-15) [2018-07-20].

URL    
[46]
Garolla A, De Toni L, Bottacin A, et al. Human papillomavirus prophylactic vaccination improves reproductive outcome in infertile patients with HPV semen infection: a retrospective study[J]. Sci Rep, 2018, 8(1): 912.
[47]
World Health Organization. Global advisory committee on vaccine safety, 11-12 December 2013[J]. Wkly Epidemiol Rec, 2014, 89(7): 53-60.
[1] 宋勇, 李东炫, 王翔, 李锐. 基于数据挖掘法分析3 种超声造影剂不良反应信号[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(09): 890-898.
[2] 季思涵, 唐新宇, 王邦杰, 狄汶洋, 王佳鸣, 查小明, 谢晖, 周文斌, 潘红, 王水. 阿贝西利在激素受体阳性、HER-2 阴性乳腺癌患者中的安全性研究[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 281-286.
[3] 钱警语, 郑明明. 《2024意大利妇产科学会非侵入性和侵入性产前诊断指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 486-492.
[4] 黄蓉, 梁自毓, 祁文瑾. NLRP3炎症小体在胎膜早破孕妇血清中的表达及其意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 540-548.
[5] 何霞, 黄蓉, 祁文瑾. 胎膜早破孕妇胎盘与胎膜菌群丰度的高通量测序研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 549-555.
[6] 谢江燕, 王亚菲, 贺芳. 妊娠合并血栓性血小板减少性紫癜2例并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 556-563.
[7] 石皆春, 范子玉, 邢燕. 不同筛查方法预警宫颈原位腺癌的效能[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 575-581.
[8] 徐婷婷, 詹泳池, 王晓东, 刘兴会. 电子胎心监测结果出现正弦波形的胎母输血综合征围生期结局分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 382-389.
[9] 许月芳, 刘旺, 曾妙甜, 郭宇姝. 多粘菌素B和多粘菌素E治疗外科多重耐药菌感染临床疗效及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 700-703.
[10] 何岩, 向文采. 七氟醚与异丙酚联合氯胺酮麻醉在疝修补术中的镇静镇痛效果及安全性[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 566-569.
[11] 刘静, 徐爽, 缪亚军. 肺腺癌miR-3653表达与高危型人乳头瘤病毒感染及预后的关系[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 600-604.
[12] 赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.
[13] 俞慧慧, 尹宗智. 妊娠期胃穿孔[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 209-213.
[14] 鲁珊, 姚蕴珊, 廖色坭, 陈子恩, 张一剑, 蓝健皓, 魏薇, 刘艳杨, 陈艳红, 陈敦金. 妊娠合并急性阑尾炎100例临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 214-219.
[15] 汪文雁, 郑剑兰, 朱丽慈. 体外受精-胚胎移植术后妊娠患者孕产期风险的临床研究[J/OL]. 中华产科急救电子杂志, 2024, 13(04): 220-226.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号