组织因子在足月妊娠羊水中的测定及临床分析

目的　检测正常足月妊娠羊水中是否存在组织因子 (tissue factor,TF)这一凝血反应启动因子。　方法　用 EL ISA方法分别测定正常足月妊娠 (16例 )血浆、羊水、羊水上清液及羊水沉渣中 TF抗原水平。　结果　正常足月妊娠血浆、羊水、羊水上清液、羊水沉渣中 TF抗原水平分别为(31± 9) ng/L、(4 0 4± 186 ) ng/L、(34 8± 177) ng/L、(136 0± 6 39) ng/L,三种不同成分的羊水 TF抗原水平与血浆比较 ,差异均有显著性 (P<0 .0 1) ,尤其羊水沉渣与血浆比较 ,差异有极显著性 (P<0 .0 0 1)。羊水沉渣中 TF抗原水平与未离心羊水、羊水上清液比较 ,差异亦有显著性 (P<0 .0 1)。　结论　正常足月妊娠羊水中有大量的 TF,羊水有形成分中 TF抗原水平最高 ,羊水中的 TF可能是羊水栓塞引发 DIC的启动因子     

孕妇静脉血及其新生儿脐血硒水平及谷胱甘肽过氧化物酶活性与妊娠肝内胆汁淤积症的关系

目的　探讨孕妇静脉血及其新生儿脐血硒水平及谷胱甘肽过氧化物酶 (GSH Px)活性与妊娠肝内胆汁淤积症 (ICP)的关系。方法　采用催化极谱法及 5 ,5 ' 二硫代双 (二硝基苯甲酸 )直接法检测健康未孕妇女 30例 (健康未孕组 )血硒水平及GSH Px活性 ;检测ICP孕妇 (ICP组 )和正常妊娠妇女 (正常妊娠组 )各 30例孕晚期及产后母血、脐血硒水平及母血、脐血GSH Px活性。结果　 (1)ICP组产前、后母血硒水平分别为 (0 .0 389± 0 .0 0 90 )mg/L和 (0 .0 46 3± 0 .0 0 92 )mg/L ,GSH Px活性分别为 (5 9.31± 11.42 )活力单位 (U)和 (6 8.12± 11.46 )U ,正常妊娠组产前、后母血硒水平分别为 (0 .0 477± 0 .0 0 94)mg/L和 (0 .0 5 10± 0 .0 0 93)mg/L ,GSH Px活性分别为 (6 8.48± 10 .47)U和 (72 .6 7±9.83)U ,两组比较 ,差异均有显著性 (P <0 .0 0 5 )。 (2 )ICP组脐血硒水平为 (0 .0 387± 0 .0 0 93)mg/L ,GSH Px活性为 (5 7.6 6± 12 .2 5 )U ,正常妊娠组脐血硒水平为 (0 .0 46 1± 0 .0 0 89)mg/L ,GSH Px活性为(6 7.46± 11.93)U ,两组比较 ,差异均有极显著性 (P <0 .0 0 5 )。 (3)血硒水平与GSH Px活性呈正相关(P <0 .0 0 1)。结论　ICP患者血硒水平降低 ,导致GSH Px活性下降 ,自由基形成 ,破坏了肝细胞膜     

妊娠高血压综合征患者血浆止凝血分子标志物水平变化的意义

目的探讨妊娠高血压综合征(妊高征)患者血浆止凝血分子标志物水平变化的意义.方法对45例妊高征孕妇(妊高征组,其中轻度20例、中度15例、重度10例)及20例正常孕妇(正常妊娠组)分娩前后的血浆止凝血分子标志物进行检测.其中,采用酶联免疫吸附试验(ELISA)检测两组孕妇分娩前后的P-选择素、凝血酶原片段1+2(F1+2)、D-二聚体、纤溶酶抗纤溶酶复合物(PAP);采用发色底物法检测两组孕妇分娩前后的抗凝血酶活性.结果 (1)P-选择素妊高征组中、重度孕妇分娩前分别为(66±24)μg/L、(80±30)μg/L,正常妊娠组为(49±15)μg/L,两组比较,差异有显著性(P<0.05).分娩后妊高征组重度孕妇为(65±34)μg/L,正常妊娠组为(40±12)μg/L,两组比较,差异有显著性(P<0.05).(2)F1+2妊高征组轻、中、重度孕妇分娩前分别为(2.2±0.2)nmol/L、(2.3±0.4)nmol/L、(2.2±0.2)nmol/L,均明显高于正常妊娠组的(1.2±0.3)nmol/L,两组比较,差异有显著性(P<0.05).(3)D-二聚体妊高征组轻、中、重度孕妇分别为(0.7±0.1)mg/L、(0.7±0.3)mg/L、(0.8±0.2)mg/L,正常妊娠组为(0.4±0.1)mg/L,妊高征组显著高于正常妊娠组(P<0.05),且妊高征组重度孕妇D-二聚体水平高于中度及轻度孕妇.(4)PAP妊高征组轻、中、重度孕妇分娩前分别为(0.7±0.4)mg/L、(0.8±0.4)mg/L、(0.8±0.4)mg/L,均高于正常妊娠组的(0.7±0.3)mg/L(P<0.05),且妊高征组轻、中、重孕妇PAP的升高水平与疾病的严重程度呈正相关(P<0.05).两组孕妇分娩后PAP水平比较,差异无显著性(P>0.05).(5)抗凝血酶活性正常妊娠组为(108±17)%,而在妊高征组则显著降低,其中重度孕妇为(44±37)%、中度孕妇为(64±25)%、轻度孕妇为(83±39)%,两组比较,差异有极显著性(P<0.01).妊高征组中、重度孕妇又显著低于轻度孕妇(P<0.01).结论 P-选择素及 F1+2可用于高危妊娠的筛查,D-二聚体可作为妊高征孕妇早期DIC的监测,抗凝血酶活性是反映妊高征疾病严重程度的有效指标.以上这些止凝血分子标志物可作为妊高征患者血栓前状态的监测指标.     

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     

血管内皮生长因子在胎儿生长受限患者及胎儿脐血中的表达

目的检测胎儿生长受限(FGR)患者外周血中血管内皮生长因子(VEGF)的水平,并探讨其与FGR的关系。方法2002年1月至2004年1月汕头大学医学院第二附属医院应用双抗体酶联免疫吸附法(ELISA)检测晚期正常妊娠妇女(妊娠组,30例)以及FGR(FGR组,37例)母体外周血中VEGF的水平和脐血中的VEGF水平。结果(1)正常孕晚期母体外周血VEGF为(753±157)ng/L,新生儿脐血VEGF为(1074±343)ng/L;(2)FGR组母体外周血VEGF水平(424±137)ng/L,新生儿脐血VEGF水平为(745±243)ng/L。FGR组母体外周血和新生儿脐带血中VEGF均明显低于妊娠组孕晚期水平(P<0001)。结论妊娠晚期VEGF水平显著下降可能是FGR发病机制中的一个重要因素。     

妊娠期高血压疾病患者血浆中抑制素和表皮生长因子水平的研究

目的探讨抑制素(INH)与表皮生长因子(EGF)在妊娠期高血压疾病发病中的变化及意义.方法取2004-10-2005-03在解放军沈阳202医院妇产科住院单胎、剖宫产分娩65例妊娠期高血压疾病患者及21例正常妊娠妇女血浆,采用酶联免疫吸附技术(ELISA)测定其血浆中INH及EGF水平.结果妊娠期高血压疾病患者血浆INH质量浓度为(498.76±52.26)ng/L,明显高于对照组(421.26±36.33)ng/L,差异有显著性意义(P＜0.01).妊娠期高血压疾病患者血浆EGF质量浓度为(407.79±59.58)ng/L,明显低于对照组(463.07±87.00)ng/L,差异有显著性意义(P＜0.05).结论孕妇血浆中INH水平升高、EGF水平下降可能与妊娠期高血压疾病的发病及病情轻重有关.     

妊娠合并甲状腺功能减退症孕妇的新生儿脐血甲状腺功能筛查的意义

目的 研究妊娠合并甲状腺功能减退症(甲减)者新生儿脐静脉血甲状腺功能检测的临床意义及其影响因素.方法 对67例在北京协和医院产科分娩的妊娠合并甲减行脐血甲状腺功能检查者进行回顾性分析.比较脐血与新生儿生后5～7 d静脉血的甲状腺功能及甲状腺自身抗体(抗-TGAb/抗-TPOAb)结果;分析甲状腺自身抗体水平在母血、脐血和新生儿生后5～7 d静脉血之间的相关性;并进一步分析脐血促甲状腺激素(thyroid stimulating hormone,TSH)的影响因素.TSH结果以中位数(第25～75百分位)表示.结果 (1)母亲患甲减时,新生儿脐血中TSH升高的比例为9.0%(6/67).(2)脐血TSH水平与新生儿生后5～7 d静脉血TSH水平无相关性.阴道分娩组脐血TSH显著高于剖宫产组[10.20 mU/L(6.10～12.80 mU/L)和5.86 mU/L(4.02～7.74 mU/L),P=0.001],胎儿窘迫或早产者脐血TSH分别高于无胎儿窘迫或足月产者[胎儿窘迫:10.36 mU/L(6.61～13.37 mU/L)和6.89 mU/L(4.18～9.70 mU/L),P=0.046;早产:8.90 mU/L(7.60～10.33 mU/L)和6.84 mU/L(4.17～9.80 mU/L),P=0.049].(3)脐血抗-TGAb和抗-TPOAb水平与新生儿5～7 d静脉血水平分别呈正相关(r分别=0.960和0.975,P均=0.000).母血抗-TGAb和抗-TPOAb水平对脐血的抗体结果有显著影响(P=0.003和0.000),但与新生儿TSH水平无关(P>0.05).结论 脐血TSH受多种分娩因素的影响,使其预测新生儿先天性甲减的意义受到影响.但母亲甲减时其新生儿脐血TSH水平升高和抗-TGAb及抗-TPOAb阳性的风险明显增加,成为其发生甲减的危险因素,因此,对这些新生儿需要进一步随访.     

瘦素及瘦素受体与胎儿生长受限的关系

目的　探讨母血、脐血和胎盘瘦素及瘦素受体表达与胎儿生长发育的关系。　方法　采用ELISA法和逆转录定量聚合酶链反应检测 2 3例小于胎龄儿 (SGA)和 4 4例适于胎龄儿 (AGA)母血、脐血瘦素和可溶性瘦素受体 (sOB R)浓度 ,胎盘组织瘦素mRNA和瘦素受体 (OB R)mRNA表达水平。　结果　SGA组和AGA组母血瘦素浓度分别为 (33.80± 14 .0 5 ) μg/L和 (2 7.0 1± 14 .81)μg/L(P =0 .0 89) ;母血sOB R浓度分别为 (2 5 .5 6± 10 .78) μg/L和 (2 6 .6 1± 9.6 9) μg/L(P =0 .70 1) ;脐血瘦素浓度分别为 (6 .79± 4 .5 9) μg/L和 (16 .30± 11.6 1) μg/L(P =0 .0 0 0 ) ;脐血sOB R浓度分别为 (18.2 4± 6 .0 2 ) μg/L和 (13.80± 4 .39) μg/L(P =0 .0 0 2 ) ;胎盘组织瘦素mRNA表达分别为 0 .77±0 .13和 0 .99± 0 .2 9(P =0 .0 0 2 ) ;OB RmRNA表达分别为 0 .5 6± 0 .2 1和 1.0 7± 0 .2 7(P =0 .0 0 0 )。脐血瘦素、胎盘瘦素和OB RmRNA表达水平分别与新生儿体重、身高、体脂、头围呈正相关 ,脐血sOB R分别与上述新生儿指标呈负相关。　结论　脐血瘦素浓度降低和胎盘瘦素、OB R受体表达低下与胎儿生长受限密切相关 ,脐血瘦素可能通过与不同剪接体的受体结合实现对胎儿生长发育的调控作用。     

胎儿窘迫孕妇静脉血及脐血中内源性阿片肽水平的测定

目的　探讨内源性阿片肽与胎儿窘迫发生的关系。方法　采用放射免疫法测定 40例正常妊娠妇女 (正常妊娠组 )及 43例胎儿窘迫孕妇 (胎儿窘迫组 )静脉血及其新生儿脐血中阿片肽 (β 内啡肽、强啡肽A1 13和亮啡肽 )的水平 ,胎儿窘迫组孕妇同时行新生儿脐动脉血血气分析。结果　 (1)胎儿窘迫组脐血中 β 内啡肽、强啡肽A1 13和亮啡肽的水平分别为 (45 3± 68)ng/L、(2 42± 3 3 )ng/L及(498± 68)ng/L ;正常妊娠组分别为 (2 5 1± 3 9)ng/L、(10 3± 2 2 )ng/L及 (3 2 2± 40 )ng/L。与正常妊娠组比较 ,胎儿窘迫组脐血中 3种阿片肽水平均显著升高 (P <0 0 5 )。 (2 )胎儿窘迫组脐血血气分析结果 :pH为 (7 0± 0 1) ,PO2 为 (1 7± 0 6)kPa ,PCO2 为 (8 9± 0 7)kPa ;其中 β 内啡肽水平与脐血pH、PO2呈显著负相关 [相关系数 (r)为 - 0 418及 - 0 43 7,P <0 0 1],与PCO2 呈显著正相关 (r =0 44 2 ,P <0 0 1) ;强啡肽A1 13水平与脐血pH及PO2 呈负相关 (r为 - 0 3 3 7及 - 0 3 83 ,P <0 0 5 ) ,与PCO2 呈正相关 (r=0 3 46,P <0 0 5 )。 (3 )胎儿窘迫组孕妇血中 β 内啡肽、强啡肽A1 13和亮啡肽水平分别为(40± 13 )ng/L、(64± 16)ng/L及 (2 19± 40 )ng/L ;正常妊娠组分别为 (3 7± 9)ng/L、(5     

几种易栓症孕产妇凝血功能的变化及意义

目的 观察几种易栓症(thrombophilia)孕产妇凝血功能的变化及意义.方法 2006年9月至2007年12月对南方医科大学南方医院85例易栓症孕产妇和30例正常孕产妇分娩前后的P-选择素、凝血酶原片段1 2(F1 2)、D-二聚体(DD)、纤溶酶抗纤溶酶复合物(PAP)的含量和抗凝血酶活性(AT-Ⅲα)进行检测.结果 病例组中P-选择素、F1 2、DD、PAP水平分娩前均明显增高(P＜0.05);分娩后子(癎)前期重度组P-选择素水平明显高于正常妊娠组(P＜0.05);AT-Ⅲα在妊娠合并系统性红斑狼疮(SLE)、子(癎)前期组中与正常妊娠组比较分娩前后均有降低(P＜0.05);妊娠合并糖尿病组AT-Ⅲα与正常妊娠组比较,差异无统计学意义(P＞0.05).结论 P-选择素、F1 2、DD、AT-Ⅲα可作为易栓症孕产妇的临床监测指标.     

Anonymous and non-anonymous gamete and embryo donations: pros and cons

Consequences of legal restrictions concerning gamete and embryo donation have been increasingly discussed during the last three decades, partly dependent upon the fact that assisted reproductive technologies have opened up new medico-technical possibilities. In the present communication we want to elucidate some of the problems and consequences of a Swedish law from 1985 requiring that all sperm donors should be non-anonymous. A similar law was passed in 2003 for oocyte donation. Such legal restrictions do not seem to be in the interest of the infertile couple who, to a large extent, seek treatment abroad where the laws are more liberal or non-restrictive (reproductive tourism). Whether or not the Swedish law is in the best interest for the offspring remains to be seen.     

Blood lead and cadmium and birth weight among sub-arctic and arctic populations of Norway and Russia

BACKGROUND: Delivering women and their newborns in the Kola Peninsula of Russia and the neighboring arctic area of Norway were studied to explore relationships between maternal cadmium and lead status and birth weight as a pregnancy outcome. METHODS: Life-style information, maternal blood and cord blood specimens were collected from 50 consecutive mother-infant pairs from hospital delivery departments in three Russian and three Norwegian communities. Pregnancy outcomes were verified by consulting medical records. Lead and cadmium were determined in the blood samples by electrothermal atomic absorption spectrometry. RESULTS: The median blood-cadmium concentration for the Russian mothers was 2.2 nmol/L (n = 148) versus 1.8 nmol/L in the Norwegian group (n = 114, p = 0.55). A weak association was observed between maternal cadmium and amount smoked (r = 0.30, p<0.001); no correlation was found between maternal blood cadmium and birth weight. The corresponding maternal lead values were 0.14 (Russia) and 0.06 micromol/L (Norway), p<0.001. The latter lead concentration constitutes one of the lowest adult population values reported to date. Maternal and cord blood lead levels were strongly correlated (r = 0.88, p<0.001). In a multivariate linear regression model, maternal blood lead was recognized as a negative explanatory variable (p<0.05) for birth weight and child's body mass index (BMIC), with or without adjustment for gestational age. A similar association was suggested by ANOVA-analysis of maternal blood lead by quartiles. CONCLUSION: Maternal blood-lead level as an environmental factor is an apparent predictor of low birth weight and BMIC. It reduced substantially the contribution of a country factor in explaining the observed differences in birth weight.     

Adiposity and Endometriosis Severity and Typology

Study ObjectivePrior research has collectively shown that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology.DesignCross-sectional study among women with no prior diagnosis of endometriosis.SettingFourteen clinical centers in Salt Lake City, UT, and San Francisco, CA.PatientsA total of 495 women (of which 473 were analyzed), aged 18–44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study.InterventionsGynecologic laparoscopy/laparotomy regardless of clinical indication.Measurements and Main ResultsParticipants underwent anthropometric assessments, body composition measurements, and evaluations of body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised American Society for Reproductive Medicine staging (I–IV) and typology of disease (superficial endometriosis [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation, were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I–IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. Although most confidence intervals were wide and overlapping, 3 general impressions emerged: (1) women with incident endometriosis had the lowest anthropometric/body composition indicators compared with those without incident endometriosis, (2) women with stage I or IV endometriosis had lower indicators compared with women with stage II or III, and (3) women with OE and/or DIE tended to have the lowest indicators, whereas women with SE had the highest indicators.ConclusionOur research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.     

Toll样受体与子宫内膜及子宫内膜异位症

子宫内膜异位症(EMs)发病机制尚未完全阐明.大量研究表明,免疫因素在EMs的发病机制中起重要作用.EMs免疫应答异常主要是巨噬细胞数量和活性增加及其分泌产物,如生长因子、细胞因子和血管生成因子的改变.Toll样受体(TLRs)识别特异性的病原体相关分子模式,启动和介导免疫应答,在固有免疫中发挥重要作用,并诱导产生适应性免疫反应.TLRs在正常子宫内膜中的生理作用以及在EMs中的相关研究已逐步开展,对其深人认识和研究将为EMs诊断、治疗和预后判断提供新思路和手段.