妊娠高血压综合征患者血清sICAM-1含量测定及其在妊高征发病中的作用

目的　探讨可溶性细胞间粘附分子 1(soluble intercellular adhesion molecule- 1,s ICAM- 1)在妊娠高血压综合征 (简称妊高征 )发病中的作用。　方法　应用酶联免疫吸附法 (EL ISA)测定 6 5例妊高征患者 (妊高征组 ,包括轻度 15例 ,中度 2 4例 ,重度 2 6例 )及 2 5例同期正常妊娠孕妇(对照组 )外周血清中 s ICAM- 1的含量 ;应用化学发光酶联免疫分析法测定两组孕妇血清中白细胞介素 1(interleukin- 1,L I- 1β)及肿瘤坏死因子 (tum or necrosing factor alpha,TNF- α)含量 ;并记录新生儿体重及妊娠结局。　结果　轻、中、重度妊高征组母血清中 s ICAM- 1的含量 [(36 8.5 6± 6 2 .81) μg/L、(6 0 6 .6 3± 10 5 .0 4 ) μg/ L、(85 9.36± 2 0 0 .92 ) μg/ L]均显著高于对照组 [(2 36 .6 9± 96 .33) μg/ L](P<0 .0 5 ,P<0 .0 1,P<0 .0 1) ,中、重度妊高征组母血清中 IL- 1β及 TNF- α的含量均显著高于对照组(P<0 .0 5 ,P<0 .0 1) ;中、重度妊高征组 s ICAM- 1的水平与相应 IL- 1β及 TNF- α的水平呈显著的正相关 (r=0 .6 97,P<0 .0 1;r=0 .74 6 ,P<0 .0 1)。重度妊高征组伴胎儿生长受限 (fetal growth restric-tion,FGR)者血中 s ICAM- 1含量显著高于同组其他孕妇之含量 (P<0 .0 5 )。妊高征组     

妊娠高血压综合征患者外周血与脐血血小板蛋白激酶C活性变化的研究

目的　探讨不同程度妊娠高血压综合征 (简称妊高征 )患者血小板蛋白激酶 C(PKC)活性变化与妊高征病情程度及胎儿宫内生长受限 (FGR)之间的关系。　方法　底物蛋白磷酸化法检测35例妊高征患者及正常孕妇外周血和新生儿脐血血小板细胞膜和细胞浆的 PKC活性。　结果　无论外周血还是脐血 ,轻度妊高征患者血小板的细胞膜及细胞浆 PKC活性与正常妊娠组相比无明显差异。中度及重度妊高征患者血小板的细胞膜及细胞浆 PKC活性显著高于正常妊娠组 [(4 6± 6与 37±4) pmol/ (min· mg protein) ,P<0 .0 1];正常妊娠组血小板的细胞膜及细胞浆活性无明显差异。中度及重度妊高征患者血小板的细胞膜 PKC活性显著高于细胞浆且随病情加重而逐渐明显 [(16± 4与12 .8± 2 .7) pmol/ (min· mg protein) ,P<0 .0 5 ],中、重度妊高征患者合并 FGR组血小板细胞膜的PKC活性均明显高于中、重度妊高征患者非合并 FGR者 [(4 8± 8与 40± 7) pmol/ (m in· mgprotein) ,P<0 .0 1,(4 6± 10与 39± 6 ) pmol/ (min· m g protein) ,P<0 .0 1]。　结论　中度及重度妊高征患者外周血及脐血中血小板 PKC存在异常活化状态 ,其异常活化程度随妊高征病情加重而增高 ;血小板 PKC异常活化可能介导 FGR的发生和发展     

妊高征患者血清瘦素水平变化的研究

目的 :探讨妊娠高血压综合征 (妊高征 )患者血清瘦素 (leptin)水平的变化及其与妊高征发病的关系。方法 :采用放射免疫分析法测定了 36例妊高征患者 (妊高征组 )和 30例正常孕妇 (正常妊娠组 )产前及产后血清瘦素水平。结果 :中、重度妊高征患者产前瘦素水平为 15 .19± 6 .74 ng/ ml明显高于正常妊娠组的 10 .11± 2 .80 ng/ m l(P<0 .0 5 ) ;轻度妊高征组患者产前瘦素水平 12 .77± 4 .6 8ng/ ml与正常妊娠组比较 ,差异无显著性 (P>0 .0 5 )。妊高征患者产后瘦素水平为 5 .91± 2 .6 8ng/ ml,与产前 14 .5 6± 6 .30 ng/ ml相比 ,差异显著 (P<0 .0 5 )。妊高征组产后瘦素水平与正常妊娠组 5 .74± 2 .38ng/ ml相比 ,差异无显著性。结论 :妊高征患者血清瘦素水平升高 ,与妊高征的发生有关     

妊娠高血压综合征患者外周血单个核细胞产生Th1、Th2型细胞因子失衡的研究

目的　研究妊娠高血压综合征 (简称妊高征 )患者外周血单个核细胞 (peripheral bloodmononuclear cell,PBMC)产生 Th1、Th2型细胞因子的功能变化。　方法　妊高征组 4 3例 ,正常孕妇组 15例 ,健康非孕组 15例 ,采用 EL ISA方法检测外周血 PBMC体外培养上清液中白细胞介素 2(interleukin- 2 ,IL- 2 )、干扰素 γ(interferon- γ,IFN- γ)及白细胞介素 4 (interleukin- 4 ,IL- 4 )水平。　结果　 PBMC体外培养上清液中 ,IL- 2在正常妊娠组为 (14 0 .3± 73.2 ) ng/ L,与健康非孕组 (2 5 9.5± 114 .4 ) ng/ L 相比水平下降 (P<0 .0 1) ;在妊高征组为 (2 34.6± 10 7.2 ) ng/ L,与正常妊娠组相比水平升高 (P<0 .0 1)。IFN- γ在正常妊娠组为 (30 7.5± 10 6 .4 ) ng/ L,与健康非孕组 (4 83.7± 177.8) ng/ L相比水平下降 (P<0 .0 1) ;在妊高征组为 (4 13.5± 14 9.7) ng/ L,与正常妊娠组相比水平升高 (P<0 .0 1)。IL- 4在正常妊娠组为 (4 1.9± 11.4 ) ng/ L,与健康非孕组 (2 7.4± 8.3) ng/ L 相比水平升高 (P<0 .0 0 1) ;在妊高征组为 (32 .1± 12 .0 ) ng/ L,与正常妊娠组相比水平下降 (P<0 .0 1)。IL- 2 / IL- 4比值在正常妊娠组为 3.5± 1.9,与健康非孕组 10 .1± 4 .8相比比值下降 (P<0 .0 0 1) ;在     

妊高征患者血浆和胎盘中环磷酸鸟苷浓度的变化及其意义

目的　探讨环磷酸鸟苷 (c GMP)在妊高征发病中的作用。　方法　采用放射免疫法测定 12 4例正常妊娠各期、32例妊高征患者及 30例健康对照者血浆 c GMP浓度。其中 32例正常足月孕妇和 32例妊高征患者于剖宫产时取胎盘组织测其匀浆 c GMP浓度。　结果　 (1)正常妊娠各期血浆 c GMP(2 6 .2 5± 4.30 )、(2 3.40± 4.5 4)、(2 6 .2 0± 6 .6 0 )、(34 .14± 8.41)、(32 .32± 8.11) nm ol/ L 显著高于健康对照者 (2 0 .2 2± 3.44 ) nm ol/ L (P均 <0 .0 5 )。 (2 )妊高征血浆及胎盘 c GMP(2 8.49± 8.98) ) nmol/ L与 (2 .76± 0 .49) nmol/ g均显著低于正常足月孕妇 (34 .14± 8.41) nmol/ L与(3.78± 0 .81) nmol/ g(P<0 .0 5 ,P<0 .0 0 1)。轻度妊高征患者血浆及胎盘 c GMP显著高于中度及重度患者 (P<0 .0 0 5 ,P<0 .0 5及 P<0 .0 5 ,P<0 .0 0 1)。妊高征患者血浆及胎盘 c GMP与舒张压均呈负相关 (P<0 .0 5 ,P<0 .0 5 )。 (3)妊高征患者胎盘 c GMP显著低于其血浆 c GMP(P<0 .0 0 1)。　结论　妊娠期间胎盘产生的 c GMP可能在妊高征的发病中起重要作用     

阴道分娩与剖宫产对母儿血清胃泌素水平的影响

目的　探讨经阴道分娩与剖宫产对母血和新生儿脐血胃泌素水平的影响。　方法　采用放射免疫法测定择期剖宫产、阴道分娩的孕妇及产后 3～ 5 d的产妇各 2 0例的血清胃泌素水平。同时测定 2 0例经阴道产儿和 2 2例剖宫产儿的脐血胃泌素水平。　结果　分娩发动后母血清胃泌素水平为 (10 8.2 3± 2 4.39) ng/ L ,较未发动宫缩的足月孕妇血清胃泌素水平 (78.2 8± 31.13) ng/ L升高(P<0 .0 5 ) ;产后 3～ 5 d母血清胃泌素水平为 (143.33± 35 .6 1) ng/ L ,较产前明显升高 (与阴道分娩和剖宫产相比分别为 P<0 .0 5 ;P<0 .0 1)。经阴道产儿脐血胃泌素水平为 (138.37± 2 0 .2 8) ng/ L ,明显高于剖宫产儿脐血胃泌素水平 (10 1.2 3± 18.16 ) ng/ L (P<0 .0 5 )。　结论　阴道分娩有利于新生儿胃肠功能的成熟与完善     

正常孕妇和妊娠高血压综合征患者外周血红细胞内钙含量测定及其临床价值

目的　探讨正常妊娠与不同程度妊娠高血压综合征 (妊高征 )患者血红细胞内钙含量(IECa2 +)、病理机制、危害和对策。　方法　应用 Fluo- 3/ AM导入红细胞经流式细胞术检测 IECa2 +的方法 ,对 42例不同程度的妊高征患者 IECa2 +进行定量测定 (观察组 ) ,32例正常孕妇为对照组 ,并研究与疾病程度和胎儿宫内窘迫发生的关系。　结果　轻度妊高征患者 IECa2 +含量产前 (10 94±90 ) ,产时 (12 0 4± 88)与正常妊娠产前 (110 2± 89)及产时 (1174± 86 )差异无显著性 (P>0 .0 5 ) ;中、重度妊高征者 (产前 :中度 1195± 72、重度 12 0 6± 96 ;产时 :中度 12 5 6± 81、重度 130 8± 84)较正常妊娠者明显增加。具体表现为 :妊高征患者 IECa2 +含量显著高于正常妊娠 ,且产时较产前显著性增多 (P<0 .0 5 ,P<0 .0 1) ;IECa2 +含量与妊高征患者平均动脉压 (MAP)呈正相关系 (P<0 .0 5 ,P <0 .0 1)。　结论　采取有效的降压措施是使 IECa2 +含量趋于正常水平以减低其危害的主要对策     

妊娠高血压综合征患者血浆C-型利钠肽水平变化的相关性研究

目的　探讨妊娠高血压综合征 (妊高征 )患者血浆C 型利钠肽水平的变化 ,及其与妊高征发病的关系。方法　采用放射免疫分析法测定了 89例妊高征患者 (妊高征组 )、193例正常妊娠妇女 (正常妊娠组 )和 46例正常孕龄妇女 (正常妇女组 )血浆C 型利钠肽水平。结果　妊高征组血浆C 型利钠肽水平明显升高 ,为 (30 .5 1± 33.6 1)ng/L ;正常妊娠组为 (19.43± 5 .13)ng/L ,正常妇女组为(17.15± 3.82 )ng/L。妊高征患者血浆C 型利钠肽水平明显高于正常妊娠妇女。妊高征组轻、中、重患者之间 ,血浆C 型利钠肽水平亦有极显著差别 ,分别为 (9.88± 2 .74)ng/L、(2 2 .15± 8.90 )ng/L和(6 4.2 6± 44 .0 3)ng/L ,3者比较 ,差异有极显著性 (P <0 .0 1)。结论　血浆C 型利钠肽水平由低到高的变化反映妊高征的疾病严重程度 ,可作为判断妊高征病情发展的一个生化指标。     

妊高征孕妇血清中可溶性Fas的变化

目的探讨中度、重度妊高征血清中可溶性Fas的变化及意义.方法采用ELISA方法测定23例重度妊高征患者和12例中度妊高征患者血清可溶性Fas抗原(sFas)水平,并与同期23例年龄相仿的健康足月妊娠者相比较.结果中度、重度妊高征组和正常妊娠组血清sFas含量分别为(1024±302)ng/L、(713±256)ng/L和(673±214)ng/L;重度妊高征组血清sFas含量明显高于正常妊娠组(P<0.01),也明显高于中度妊高征组(P<0.01);正常妊娠组和中度妊高征组血清sFas含量比较差异无显著性(P>0.05).结论重度妊高征母体血清sFas升高,提示存在Fas/FasL介导的淋巴细胞激活诱导的细胞死亡(activation-induced cell death,AICD)的改变,导致母体对胚胎的免疫排斥增强和细胞免疫不适当激活.     

妊娠高血压综合征孕妇血清一氧化氮与雌三醇水平的相关性研究

目的 :探讨一氧化氮 (NO)含量和雌三醇 (E3 )水平在正常妊娠与妊高征中的相互作用及其与妊高征的关系。方法 :采用硝酸还原酶法与放射免疫测定法 ,测定同期住院的妊高征 5 0例 (PIH组 )及正常晚期妊娠 5 1例 (对照组 )静脉血中的NO代谢产物亚硝酸基 /硝酸基 (NO2 - /NO3 - )及E3 。结果 :PIH组血清NO2 - /NO3 - 含量为 4 5 .92±11.31μmol/L ,对照组为 60 .16± 2 0 .92 μmol/L ;PIH组血清NO2 - /NO3 - 含量明显低于对照组 ,有极显著差异 (P =0 .0 0 0 1)。PIH组E3 水平 (67.2 2± 14.5 3ng/ml)显著低于对照组(81.0 6± 36.5 9ng/ml) ,差异有显著性 (P =0 .0 15 6)。妊高征组及对照组NO含量与E3 水平均呈正相关 (r =0 .5 5 964,P =0 .0 0 0 1;r =0 .5 7349,r =0 .0 0 0 1)。结论 :妊高征患者血清NO含量与E3 水平均降低 ,NO合成障碍可能是妊高征的发病原因之一 ,E3 对NO合成可能起一定作用     

Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups. Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05). Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition.     

Diagnosis and management of Candida of the nipple and breast

Diagnosis and treatment of ductal and/or nipple candidiasis in breastfeeding women is complicated by the variety of symptoms women experience. The differential diagnosis includes candidiasis of the nipple, candidiasis of the breast, bacterial infection of either nipple or breast, and other less common problems such as Raynaud's syndrome. Diagnosis and treatment are based on history, physical examination, and presenting symptomatology because cultures of breast milk are often inconclusive. Differential diagnoses and treatment options are reviewed.     

关于妇产科综合征的理解和应用

综合征(syndrome)来源于希腊语syn("一起"、"共同"之意)和drómos(事件),并起意为"同时发生或同时发生的事件"(concurrence).其实,这也是医学词汇里最古老的名词之一,可以追溯到希腊的波克拉底和盖伦时代,就已被用于描述同时发生的一组症状[1].     

Vitamin and homocysteine status of mothers and infants and the risk of nonsyndromic orofacial clefts

OBJECTIVE: This study was undertaken to investigate the involvement of maternal and infant B vitamins and homocysteine as risk factors for orofacial clefting. STUDY DESIGN: Venous blood samples were taken from 96 infants with nonsyndromic orofacial clefts and 88 infants without a congenital malformation and from their mothers at approximately 14 months after the index pregnancy. Red blood cell and serum folate, serum vitamin B(12), whole blood vitamin B(6) as pyridoxal-5'-phosphate (PLP), and plasma homocysteine concentrations were measured. RESULTS: A vitamin B(12) concentration of 185 pmol/L or less and a PLP concentration of 44 nmol/L or less in mothers increased the risk of having a child with an orofacial cleft (odds ratio [OR]=3.1; 95% CI: 1.3-7.4, OR=2.9; 95% CI: 1.2-7.1, respectively). Infants with orofacial clefts had a 15% lower serum folate concentration compared with controls (P=.06). CONCLUSION: A low vitamin B(12) and PLP concentration in mothers increased the risk of orofacial clefts in the offspring. A possible role of the infant's folate status is suggested.     

植物雌激素与中老年女性骨质疏松症

大多数的临床试验结果提示植物雌激素可以增加中老年女性腰椎骨密度,降低骨吸收指标尿脱氧吡啶啉（urine deoxypyridinoline,DPD）水平,从而降低中老年女性骨折的风险。但是,现有的研究证据还不足以推荐植物雌激素作为治疗中老年女性骨质疏松症的标准方案,仅可作为个体化治疗的一种有益的选择。     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

Accuracy and correlates of maternal recall of birthweight and gestational age

Objective  To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates.
Design  Comparison of data from the DBR and the European Youth Heart Study (EYHS).
Setting  Schools in Odense, Denmark.
Population  A total of 1271 and 678 mothers of school children participated with information in the accuracy studies of BW and GA, respectively. The reliability sample of BW was composed of 359 women.
Method  The agreement between the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland–Altman's plots. The misclassification of the various BW and GA categories were also estimated.
Main outcome measures  Differences between recalled and registered BW and GA.
Results  There was high agreement between recalled and registered BW (MD =−0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression revealed that the most important variables in the discordance between recalled and registered BW were ethnicity and parity. Maternal recall of BW was highly reliable (MD =−5.5 g; ICC = 0.93), and reliability remained high across subgroups.
Conclusion  Maternal recall of BW and GA seems to be sufficiently accurate for clinical and epidemiological use.     

Irisin与糖脂代谢性疾病的研究进展

Irisin是一种新发现的肌肉因子,其前体物质为Ⅲ型纤连蛋白结构域5(FNDC5)。运动使骨骼肌中的过氧化物酶体增殖活化受体γ(PPARγ)辅助激活因子1α(PCG-1α)的表达增加,PCG-1α能诱导FNDC5表达,FNDC5断裂后可形成分泌性的肌肉因子Irisin,从而诱导白色脂肪棕色化,导致能量消耗增多,体质量减轻,改善糖耐量和胰岛素抵抗,调节糖脂代谢和能量代谢。因此,Irisin有望成为治疗糖脂代谢性疾病的新靶点。本文对Irisin与糖脂代谢性疾病的相关性研究进行综述。