巨大儿孕母血清、羊水、脐血瘦素水平测定及意义

目的探讨瘦素(1eptin)与巨大儿发病的关系.方法应用酶联免疫法(ELISA)检测20例巨大儿(巨大儿组)及20例正常体重儿(对照组)孕母血清.羊水及脐血瘦素水平.结果(1)巨大儿组孕母血清瘦素平均(25.6±8.2ng/rml),羊水瘦素平均(5.9±1.7ng/m1)与对照组(18.8±7.8ng/ml)及(3.9±1.7ng/ml)比较相差显著.分别为(P＜0.05)(P＜0.01).(2)巨大儿组脐血瘦素水平平均(16.8±7.0ng/m1)明显高于对照组(7.7±4.6rg/ml)(P＜0.001).(3)两组孕母血清瘦素与胎儿出生重量无相关性,而脐血瘦素水平与胎儿出生重量呈正相关.(r=0.65,P＜0.01)结论脐血瘦素来源于胎盘及胎儿组织.巨大儿的发病与脐血瘦素水平相关.     

血清瘦素及胰岛素和血糖测定在妊娠期糖代谢中的临床意义

目的:探讨血清瘦素及胰岛素和血糖水平与妊娠期糖代谢异常孕妇的关系。方法:采用放射免疫分析测定36例妊娠期糖代谢异常孕妇(糖代谢异常组)和34例正常孕妇(正常妊娠组)的空腹及口服50g葡萄糖后3h的血清瘦素水平;采用电化学发光法测定两组孕妇的空腹血清胰岛素水平;采用葡萄糖氧化酶法测定两组孕妇的口服50g葡萄糖后1h的血糖水平。结果:1.糖代谢异常组孕妇血清瘦素水平为(14.9±4.3)μg/L,正常妊娠组为(9.8±1.7)μg/L,两组比较差异有显著性(P<0.01);2.糖代谢异常组孕妇空腹血清胰岛素、服糖后1h血糖水平分别为(12.9±4.3)mU/L、(11.0±1.4)mmol/L;正常妊娠组孕妇分别为(8.45±3.0)mU/L、(7.84±1.3)mmol/L。糖代谢异常组孕妇血清瘦素水平与空腹血清胰岛素、服糖后1h的血糖水平呈明显的正相关关系。相关系数(r)分别为0.835、0.758。结论:空腹血清瘦素水平升高见于妊娠期糖代谢异常孕妇,其瘦素水平的高低与空腹胰岛素及血糖水平相关。     

Graves''病患者GH与IGF-1水平观察

目的:探讨Graves病(GD)患者对血清生长激素(GH)与胰岛素样生长因子-1(IGF-1)水平的影响.方法:采用放射免疫分析(RIA)检测42例GD患者、20例经治疗甲状腺功能恢复至正常水平GD患者与30例健康人血清GH与IGF-1水平.结果:GD组,血清IGF-1水平(170.8±44.4)ng/ml、GH水平(2.89±1.18)ng/ml明显升高,与对照组(IGF-1为90.5±30.5ng/ml、GH为1.58±1.20ng/m1)比较有显著性差异(p＜0.01、p＜0.05),且IGF-1与FT4正相关(r=0.58,p＜0.01).GD治疗缓解组,IGF-1水平(105.1±37.0)ng/ml、GH水平(1.71±1.36)ng/ml明显低于初诊未治疗组,差异有显著性(P＜0.01、P＜0.05).结论:GD患者血清IGF-1和GH水平明显升高,并且可能与甲状腺激素存在一定的关系.     

癫痫全面强直-阵挛发作患者的氧化应激水平

目的:观察癫痫全面强直-阵挛发作(GTCS)患者血清氧化应激指标8-羟基脱氧鸟苷酸(8-OHdG)、超氧化物歧化酶(SOD)、丙二醛(MDA)、总抗氧化力(T-AOC)的水平变化。方法:ELISA测定并比较30例GTCS患者(癫痫组)与30例健康对照者(对照组)血清8-OHdG、SOD、MDA和T-AOC的水平。结果:癫痫组血清8-OHdG水平(0.41±0.11ng/ml)高于对照组(0.32±0.08ng/ml),MDA水平(8.19±1.25nmol/ml)高于对照组(7.21±1.81nmol/ml),差异均有统计学意义(P<0.01);癫痫组血清SOD水平(80.31±14.19U/ml)低于对照组(91.01±12.76U/ml),T-AOC水平(8.94±1.78U/ml)低于对照组(10.18±2.33U/ml),差异亦有统计学意义(P<0.01)。结论:GTCS患者存在的氧化系统和抗氧化系统失衡,可能是造成癫痫发作、神经元损伤的原因之一。     

血清可溶性白细胞介素6受体的检测及其临床意义

以夹心ELISA方法检测30名正常对照者,22份可抽提核抗原(ENA)抗体阳性血清及49名Grave病患者血清sIL-6R水平.结果表明;本方法的灵敏度为80pg/ml,批内及批间误差分别为7.5%和9.6%.正常对照组、Grave病缓解组、Grave病未缓解组及ENA抗体阳性组的血活sIL-6R浓度分别为185.55±53.0ng/ml、191.65±62.0ng/ml、241.67±69.0ng/ml和264.86±108.53ng/ml.经统计学处理Grave氏病未缓解组和ENA抗体阳性组sIL-6R水平明显高于正常对照组对,Grave病缓解组与上常对照组血清sIL-6R浓度无差异提示slL-6R检测在ENA抗体产生中的作用和Grave病监测病情中的价值.     

冠心病患者高迁移率族蛋白B1水平变化的临床研究

目的:探讨冠心病(CHD)患者血清高迁移率族蛋白B1(HMGB1)水平变化及其临床意义。方法:CHD患者158例,分为急性冠脉综合征组(ACS组,87例)和稳定型心绞痛组(SA组,71例),选择30例年龄和性别匹配的健康体检者作为对照组,采用ELISA检测各组人群血清HMGB1水平,并同时检测超敏C-反应蛋白(hs-CRP)、白细胞计数(WBC)和血脂水平。结果:CHD患者血清HMGB1和hs-CRP水平较对照组明显增高(6.47±1.39ng/ml vs 2.19±0.43ng/ml,P<0.01;3.42±0.87g/ml vs 1.15±0.22g/ml,P<0.01)。ACS组患者血清HMGB1水平显著高于SA组(8.52±2.08ng/ml vs 5.38±1.26ng/ml,P<0.01)。ACS组患者血清hs-CRP水平较SA组和对照组也明显升高。CHD患者血清HMGB1水平与hs-CRP水平呈显著正相关(r=0.685,P<0.01)。结论:血清HMGB1水平的变化在CHD的发病过程中有重要意义,可作为CHD的监测指标之一。     

自然流产患者血清瘦素水平的改变

目的　探讨自然流产患者瘦素水平的变化及其临床意义。方法　用ELISA法测定 2 3名自然流产患者、2 1名正常妊娠者及 2 0名正常未孕者血清瘦素水平。结果　自然流产者血清瘦素水平平均为 875 3± 4 2 5 0ng/ml,正常妊娠者为1185 9± 4 0 3 2ng/ml,正常未孕者为 6 14 7± 15 0 2ng/ml,两两比较差异均有显著性。结论　自然流产患者血清瘦素水平明显降低 ,低瘦素水平可能是自然流产发生的又一原因。     

脑梗塞患者血液中GMP-140、sICMA-1及VEGF的检测分析

探讨脑梗塞患者血液中GMP-140、sICMA-1及VEGF水平变化关系。采用酶联免疫吸附试验检测80例脑梗塞患者及30例正常对照的血液水平变化的相关性。结果发现脑梗塞组GMP-140(36.7±5.9)ng/ml,明显高于正常对照组(17.2±3.1)ng/ml(P<0.05);脑梗塞组sICAM水平为(670.2±206.8)ng/ml,明显高于正常对照组(290±80.5)ng/ml(P<0.05);脑梗塞组VEGF水平为(317.3±105.2)pg/ml,明显高于正常对照组(81.6±10.6)pg/ml(P<0.05)。此三个变量与正常对照比较均有明显的相关性。据此上述三项水平的测定有助于评价脑梗塞患者的病理状态及转归。     

血清甘露聚糖凝集素水平及与反复呼吸道感染关系的初步研究

目的　建立儿童血清甘露聚糖凝集素 (MBL)水平正常值参考范围 ,了解血清MBL低水平与反复呼吸道感染的关系。方法　用ELISA方法检测重庆地区 91例新生婴儿脐血MBL水平 ,2 6 3例学龄前儿童、1 6例成人血清MBL水平 ,并对学龄前各年龄组血清低MBL水平的儿童进行反复呼吸道感染的病史回顾。结果　新生儿脐血MBL水平为 ( 1 .71± 1 .6 0 ) μg/ml,成人外周血 ( 2 .2 6± 1 .56 ) μg/ml,两组比较差异无统计学意义 (P >0 .0 5) ,学龄前各年龄组MBL水平分别为 ( 3.1 6±2 .0 0 ) μg/ml、( 3.1 9± 1 .88) μg/ml、( 3.30± 2 .0 5) μg/ml、( 3.6 9± 2 .2 2 ) μg/ml、( 2 .80± 1 .38) μg/ml,与新生儿比较明显增高 (P <0 .0 0 5) ,但学龄前期各组间比较差异无统计学意义 (P >0 .0 5) ;1 6例血清低MBL水平儿童中 7例在 3岁前出现反复呼吸道感染 ( 4 3.7% ) ,主要感染方式为上呼吸道感染 ,血清MBL水平低于 1 0 0ng/ml组与血清MBL水平在 1 0 0～ 2 0 0ng/ml的儿童比较反复呼吸道感染频率有增多趋势。结论　新生儿期MBL水平可达成人水平 ,但明显低于学龄前各年龄组儿童 ,学龄前儿童组间比较没有显著差异 ;低血清MBL水平儿童在免疫脆弱阶段存在反复呼吸道感染的易患倾向 ,血清MBL水平下降时 ,呼吸道感染频率有增     

妊娠期肝内胆汁淤积症的瘦素水平

目的探讨血清中瘦素与肝内胆汁淤积症(ICP)关系、发病原因.方法采用放射免疫法检测76例(观察组)ICP孕妇血清中瘦素水平与正常孕妇(对照组)血清瘦素水平;ICP孕妇的血清中瘦素水平与不同孕周、羊水污染程度的相关性.结果1.观察组76例ICP孕妇瘦素水平为(31±8.1)ng/ml,对照组正常孕妇血清瘦素水平(24.±6.3)ng/ml,两组比较有极显著性差异(P＜0.01).2.观察组按孕妇的孕周分为30.1～35w、＞35w两组,分别为48例与28例,其瘦素水平为(32.4±4)ng/ml、(32.5±7.6)ng/ml,两组比较无显著差异(P＞0.05).3.观察组共76例,ICP合并羊水Ⅲ度污染30例与无羊水Ⅲ度污染46例比较瘦素水平,分别为(35.4±6.1)ng/ml、(29.8±7.5)ng/ml,即瘦素水平ICP合并羊水Ⅲ度污染明显高于ICP无合并羊水Ⅲ度污染的孕妇,有显著差异(P＜0.05).ICP孕妇血清中瘦素水平与各不同孕周相关指数(0.22;P＞0.05)无相关性;而ICP孕妇血清中瘦素水平与羊水污染程度相关指数(0.67;P＜0.01)有明显的相关性.结论ICP与瘦素有着密切的关系,即瘦素与ICP疾病在免疫功能失常、雌激素发病学说有相关联系,以及在胎盘缺氧时反映出来的瘦素水平升高,有助于我们对ICP合并胎儿窘迫进行监察,可作为临床观察指标.     

早孕绒毛及妊娠滋养细胞疾病中癌基因表达的研究

目的:研究癌基因c-myc和N-ras在早孕绒毛及GTD中的表达。方法:地高辛标记的c-myc、N-ras裸核探针与石腊包埋的18例早孕绒毛及54例GTD组织进行原位杂交。结果:c-myc mRNA在早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中阳性表达率分别为27.8%、44.4%、55.5%和84.4%。N-ras mRNA在早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌组织中阳性表达率分别为83.8%、88.9%、77.8%和44.4%。Ⅲ-Ⅳ期GTT中c-myc阳性表达率高于Ⅰ期。c-myc和N-ras在GTT组织中共同表达率为47.2%。结论:c-myc与GTD病变的发展及临床分期有关,N-ras为GTT发生的早期事件。     

妊娠期糖尿病患者孕期规范化管理临床分析

目的探讨妊娠期糖尿病患者的孕期管理方法以及对母儿的预后情况。方法将我院2004年诊治的179例妊娠期糖尿病人,经规范化管理后,观察其治疗效果及母儿合并症的情况。就其母儿合并症与50g糖筛查异常但未确诊GDM的358例孕妇进行比较。结果179例妊娠期糖尿病人中通过饮食控制与适当锻炼,血糖控制良好,勿需应用胰岛素治疗的138例,余下41例饮食控制与适度锻炼的同时,需加用胰岛素治疗。其母儿并发症除巨大儿,羊水过多高于对照组,剖宫产率与对照组有显着差异外,其余均无差异。结论加强妊娠期糖尿病的管理,用饮食控制疗法,辅以有规律的定量活动,必要时加用胰岛素治疗,选择正确的方法,适时终止妊娠,可有效降低母婴并发症的发生。     

Lymphocyte sub-populations in gestational diabetes

PROBLEM: We hypothesize that the normal immunologic responses by the maternal immune system during pregnancy are not as well-regulated in gestational diabetes (GD) patients as in healthy pregnant women. METHOD OF STUDY: Using two-color flow cytometry we evaluated frequencies of peripheral blood lymphocytes in 20 GD patients being treated with insulin; 43 GD patients treated with dietary therapy but no insulin; 44 women experiencing normal pregnancies; and 48 non-pregnant women. RESULTS: When compared with healthy pregnant women, both GD cohorts showed higher percentages CD4(+)CD25(+) (P < 0.05), CD4(+)CD45RO(+) (P < 0.05) and CD4(+)CD29(+) (P < 0.01) but lower percentages of CD4(+)CD45RA(+) (P < 0.05). Higher percentages of the activated phenotypes CD8(+)CD25(+) and CD8(+)HLA-DR(+) cells in the diet-treated cohort and CD4(+)HLA-DR(+) cells in insulin-treated GB cohort, were observed compared with healthy pregnant subjects (P < 0.05). CONCLUSIONS: Expanded populations of activated peripheral blood T cells are associated with GD, suggesting that normal maternal immunosuppression is less effective in GD-afflicted women.     

脂肪细胞因子与妊娠期糖尿病

 妊娠期糖尿病严重威胁母婴健康,是社会公共卫生事业的关注重点。目前妊娠期糖尿病的发病机制尚未完全阐明, 近年来脂肪因子在其发病机制中的作用备受关注。这些脂肪因子包括脂联素、瘦素、视黄醇结合蛋白-4、Visfatin、Vaspin、抵抗素和chemerin等。     

Unilateral gestational macromastia--a rare disorder

Macromastia is the massive enlargement of the breast, unilateral or bilateral, disproportionate to the growth of the rest of the body. It is called gravid macromastia or gigantomastia of pregnancy when it occurs during pregnancy. It may or may not regress following parturition. Gestational macromastia is exceptionally rare. We report a 28-year-old female with gigantomastia of the left breast. She presented at four months post-partum with painful massive enlargement of the left breast since the third month of pregnancy. The overlying skin was stretched out and showed multiple ulcers with foul smelling discharge. The nipple and areola were unremarkable. Simple mastectomy was done, as fine needle aspiration cytology was suggestive of phylloides tumour. The breast specimen measured 30 x 30 x 9 cm and was replaced totally by grey-white tissue involving all the resection margins. No normal breast tissue or fat was identified. Histopathology showed periductal as well as diffuse fibrosis, adenosis and lactational changes. No features of phylloides tumour or carcinoma were present and it was diagnosed as unilateral gestational macromastia.     

Ionized magnesium in gestational diabetes.

A longitudinal prospective study was performed in order to describe variations in ionized magnesium in patients with gestational diabetes. Twenty-two gestational diabetic women and 24 healthy pregnant women were included consecutively. Blood samples were obtained in the second and third trimester and 2 days postpartum in both groups. The blood samples were analysed for serum ionized magnesium, serum ionized calcium and pH. None of the groups demonstrated any time-related changes in ionized magnesium. However, in the third trimester the level of ionized magnesium was statistically significantly elevated in patients with gestational diabetes compared to controls (0.57 +/- 0.05 mmol/l vs. 0.51 +/- 0.06 mmol/l; p < 0.01). The level of ionized calcium remained stable throughout the study period in both groups. In conclusion our findings suggest that gestational diabetes is associated with elevated levels of ionized magnesium.     

Obstetric prognosis of the gestational thrombocytopenia

To define clinical outcomes of marked gestational thrombocytopenia (GT) (<100,000/mm3) we identified twenty-nine infants born to 28 pregnancies at 26 women with GT among 8,364 deliveries during the years 1993- 1999. Cordocentesis was performed in 7 mothers with platelet counts less than 75,000/mm3. Cord blood platelet count was checked in all cases at delivery. The most significant decrease of platelet count in pregnancy with GT was less than 50,000/mm3 in 6 pregnancies (21.4%) and between 50,000 and 100,000/mm3 in 22 pregnancies (78.6%). In pregnancies with GT, 2 neonates (6.9%) had mild thrombocytopenia and 1 neonate (3.4%) moderate thrombocytopenia. Severe thrombocytopenia was not observed in any neonate born to mothers with GT. There were no cases of coagulation disturbance at delivery or in the postpartum period. Fourteen cases for which follow-up was carried out recovered platelet counts to more than 100,000/mm3 within one month postpartum. Two patients who became pregnant twice noticed recurrence of GT. In conclusion, GT is not associated with bleeding diathesis in the mother, resolves spontaneously during the postpartum period, and can recur in subsequent gestations, and the association of severe fetal/neonatal thrombocytopenia is very rare. No intervention is necessary during pregnancy or delivery, apart from a careful maternal and fetal surveillance if there is no obstetric indication.     

维生素D与妊娠糖尿病

维生素D具有广泛的生理作用,近期动物以及人体研究提示维生素D能够改善胰岛素抵抗及胰岛β细胞功能。本文总结了孕期维生素D的代谢状况及其在糖代谢中的作用机制,并综述维生素D与妊娠糖尿病相关性的研究结果。但现有研究结果并不一致,还需要设计良好的随机对照试验探索补充维生素D能否降低妊娠糖尿病的发生率或改善孕期糖代谢。