肝性脑病患者预后的危险因素分析

目的研究肝性脑病患者预后的危险因素。方法收集290例肝性脑病患者的40项临床指标,运用Logis-tic回归模型分析这些因素与预后的关系。结果 290名患者中好转102例,恶化死亡188例,病死率64.8%(188/290)。多因素Logistic回归模型分析,与肝性脑病患者预后有统计学意义的因素有:肝肾综合征(HRS)(OR=16.27,95%CI:3.52～74.90)、腹水(OR=7.00,95%CI:2.12～23.10)、原发性细菌性腹膜炎(SBP,OR=7.00,95%CI:2.12～23.10)、肌酐(OR=1.02,95%CI:1.01～1.03)、血氨(OR=1.02,95%CI:1.00～1.03)、凝血酶原活动度(PTA,OR=0.56,95%CI:0.47～0.65)。结论 HRS、腹水、SBP、肌酐、血氨、PTA是肝性脑病预后的独立危险影响因素,提示尽早采取有针对性的措施预防并发症的发生,并动态监测PTA、血清肌酐及血氨,有望降低病死率。     

三亚市先天性心脏病患儿相关影响因素研究

目的 分析先天性心脏病发生的相关影响因素,为三亚市先天性心脏病的预防和进一步研究提供科学依据。方法 通过《围产环境-行为健康调查问卷》收集三亚市本地200例先天性心脏病儿童及200例健康组儿童家庭相关资料,采用单因素和多因素逻辑回归分析三亚市先天性心脏病的相关影响因素。结果 早产(OR=2.783,95%CI:1.088～7.117)、父亲年龄的增长(OR=1.095,95%CI:1.035～1.157)、母亲过敏性疾病家族史(OR=3.624,95%CI:1.447～9.074)、孕期接触宠物(OR=2.789,95%CI:1.363～5.708)、频繁食用腌制类食品(OR=15.085,95%CI:4.135～55.033)是增加三亚市先天性心脏病发病率的危险因素。家庭收入较高(OR=0.270,95%CI:0.093～0.784)、饮用牛奶或酸奶类食品(OR=0.123,95%CI:0.042～0.357)、孕早期服用叶酸(OR=0.263,95%CI:0.109～0.632)及维生素C (OR=0.247,95%CI:0.118～0.518)是降低三亚市先天性心脏病发病率的保护...     

老年患者颅内外动脉硬化危险因素研究

目的 研究老年患者颅内外动脉硬化的危险因素.方法 随机选择老年患者2 115例进行现状调查,经螺旋CT脑血管成像、数字减影CT全脑血管造影诊断为颅内外动脉硬化.用Logistic回归模型进行多因素分析.结果 年龄(OR=1.02,95%CI=1.12～1.66)、糖尿病(OR=1.02,95%CI=1.12～1.66)、高尿酸血症(OR=1.02,95%CI=1.12～1.66)、原发性高血压(OR=1.02,95%CI=1.12～1.66)、高血脂症(OR=1.02,95%CI=1.12～1.66)与颅内外动脉硬化密切相关.结论 老年患者颅内外动脉硬化危险因素为年龄、糖尿病、高尿酸血症、原发性高血压、高血脂症等.     

过敏高风险婴儿罹患过敏性疾病的多因素分析及干预

目的探讨过敏高风险婴儿发生过敏性疾病的危险因素及早期干预措施。方法对具有过敏性疾病家族史(父母一方或双方)的新生儿进行1年的随访,观察过敏性疾病的发生情况。对影响过敏性疾病发生的因素进行单因素分析后,选取有统计学意义的指标,应用logistic逐步回归模型进行统计分析。结果254名婴儿中,有114例在生后1年内出现1种或多种过敏症状。单因素分析中有12项指标具有统计学意义,7项指标入选logistic逐步回归方程,分别为母孕期过敏性疾病发作史(OR=2.523,95%CI为1.263～5.041,P<0.01)、双亲有过敏性疾病史(OR=6.116,95%CI为2.546～14.692,P<0.01)、母亲血清IgE值(OR=2.413,95%CI为1.710～3.404,P<0.01)、被动吸烟(OR=2.778,95%CI为1.402～5.502,P<0.01)、出生后6个月内添加鸡蛋(OR=2.693,95%CI为1.238～5.859,P<0.05)、纯母乳喂养(OR=0.196,95%CI为0.086～0.447,P<0.01)和部分水解配方奶(pHF)喂养(OR=0.099,95%CI为0.038～0.255,P<0.01)。结论妊娠期加强对有过敏史妇女的保护,防止过敏性疾病的复发,避免过敏高风险婴儿过早接触香烟、过早添加鸡蛋,母乳喂养及pHE喂养等综合措施可减少过敏高风险婴儿过敏性疾病的发生。     

109例孕妇早产的影响因素调查研究

目的:探讨109例早产的危险因素,为降低早产的发生率和预防早产发生提供科学依据。方法 :选择早产产妇109例和对照533例进行回顾性调查。收集产妇一般情况、既往生育史、孕期生活状况及患病等资料,使用单因素#2检验和多因素Logistic回归进行统计分析。结果:单因素分析显示,病例组产妇年龄>30岁、高中及以下学历、有自然流产史和人工流产史、孕期接触二手烟、孕期患病、孕期叶酸服用不足的比例均高于对照组,差异有统计学意义(P<0.05)。多因素分析母亲为高中及以下学历(OR=1.847,95%CI:1.191~2.683)、孕期接触二手烟(OR=2.335,95%CI:1.354~4.025)、有人工流产史(OR=1.652,95%CI:1.040~2.623)是早产的危险因素。结论 :鼓励育龄期妇女优生优育,加强孕期保健,减少流产次数,采取综合措施预防早产。     

遗传因素和环境因素对儿童外向性行为影响的双生子研究

目的 探讨遗传和环境因素对双生子外向性行为的影响.方法 运用Achenbach儿童行为评定量表(CBCL,家长版)评定双生子的外向性行为,一般情况问卷、FACESII-CV、GHQ-12等量表调查双生子家庭环境因素,通过Mx软件构建单因素结构方程模型,分析加性遗传效应、共享环境因素、个体特异性环境因素对双生子外向性行为的影响.结果 纳入分析6～16岁的双生子共168对.在外向性行为的总变异方差中加性遗传效应、共享环境因素、个体特异性环境因素分别占0.39(95%CI:0.22～0.62)、0.51(95%CI:0.28～0.67)、0.10(95%CI:0.07～0.15).外向性行为与父亲、母亲的GHQ-12总分相关(r=0.24,P<0.01;r=0.30,P<0.01),与家庭实际适应性呈负相关(r=-0.27,P<0.01).对外向性行为与一般环境因素进行logistic回归分析,结果显示儿童的外向性行为与其母亲的生活习惯吸烟、饮酒有关.结论 儿童的外向性行为主要受共享环境因素的影响;儿童的外向性行为与其父亲和母亲的心理健康状况有关,父母的心理问题越多,儿童的外向性行为分值越高;儿童的外向性行为与其母亲的生活习惯吸烟、饮酒有关.     

孕期焦虑与抑郁情绪调查及相关危险因素分析

目的 了解孕期焦虑、抑郁情绪的发生情况及其相关危险因素.方法 采用状态-特质焦虑量表(STAI)、自评抑郁量表(SDS)以及自制的孕妇基本情况调查表,对269名孕32～34周孕妇进行测试,并与269名健康已婚未孕妇女比较.结果 269名孕妇状态焦虑情绪发生率为12.3%,特质焦虑情绪发生率为6.3%,抑郁情绪发生率为9.3%.孕期状态焦虑情绪评分和抑郁情绪评分均显著高于健康已婚未孕妇女(t=6.69、18.86,P＜0.01).孕期与焦虑有关的主要危险因素有:户籍类型(OR=2.89,95%CI=1.95～3.86)、既往胎儿-婴儿死亡(OR=4.88,95%CI=3.15～5.03)、担忧产后经济问题(OR=3.27,95%CI=2.05～3.71)、夫妻关系(OR=43.36,95%CI=38.26～47.53)、婆媳关系(OR=39.22,95%CI=35.61～41.39)、担忧分娩安全(OR=1.58,95%CI=1.26～1.90)和担忧孩子患遗传性疾病(OR=6.31,95%CI=5.11～7.22);孕期与抑郁情绪有关的主要危险因素有:户籍类型(OR=2.76,95%CI=1.83～3.68)、夫妻关系(OR=39.38,95%CI=37.23～44.53)、担忧产后婴儿健康(OR=7.12,95%CI=5.99～8.33)、是否参加孕妇学校(OR=3.76,95%CI=2.58～4.83)和担忧产后经济问题(OR=3.52,95%CI=2.28～4.36).结论 孕期焦虑、抑郁情绪是普遍存在的,在今后的孕期保健中,不仅要关注孕妇的生理状况,还应注意其心理状态,避免孕妇不良情绪的发生.     

原发性头痛患者血清维生素D水平变化及相关性分析

目的观察原发性头痛中偏头痛及紧张型头痛患者维生素D水平,并分析其与临床特点的相关性。方法选择2017年6月—2018年6月上海交通大学医学院附属仁济医院神经内科就诊的紧张型头痛患者150例、偏头痛患者277例作为研究对象,另选择同时期于体检中心健康体检者250例作为健康对照组。详细记录3组临床资料并测量血清25-(OH)D水平。比较3组受试者维生素D水平的差异,同时根据维生素D是否正常分亚组,分析其与紧张型头痛及偏头痛患者临床特点的相关性。结果紧张型头痛及偏头痛患者的维生素D水平均低于健康对照者(F=57.698,P<0.001),调整性别、年龄及季节后这种差异仍存在(P<0.05)。在紧张型头痛中,维生素D缺乏亚组较正常亚组头痛程度重(t=3.034,P=0.004),调整性别、年龄及季节后这种差异仍存在(P<0.05);在偏头痛中未发现头痛特点与维生素D缺乏有关(P>0.05),但正常亚组年龄较缺乏亚组高(t=3.827,P<0.001),接受维生素D检测的季节差异有统计学意义(χ~2=17.217,P<0.001)。经二元Logistic回归分析,在紧张型头痛中发现,校正性别及年龄后,头痛程度与维生素D的缺乏显著相关(OR=1.487,95%CI 1.153～1.918,P=0.002),接受检测的季节也与维生素D缺乏相关(OR=0.384,95%CI 0.168～0.876,P=0.023)。在偏头痛中发现,校正性别和年龄后,接受检测的季节与维生素D缺乏相关(OR=0.186,95%CI 0.082～0.424,P<0.001)。结论维生素D缺乏可能与原发性头痛相关,尤其紧张型头痛,维生素D缺乏可能与其疼痛程度有关。     

产科并发症与精神分裂症的病例对照研究

目的 探讨产科并发症与精神分裂症的关系。方法 病例对照研究,单因素、多因素分析。并计算相对危险度和95%的可信限。结果 单因素分析显示,孕期并发症（OR=4.63,95%CI=1.27-20.66）、生产并发症（OR=3.29,95%CI=1.06-11.29)达到统计学意义。特别分层分析,男性生产并发症发生率明显高于对照组。多因素分析,孕期营养差、孕期并发症与精神分裂症有密切的关系,OR（95%CI）分别为3.98(1.13-14.07),4.93(1.44-16.86)。结论 精神分裂症的发生与孕期、生产期环境因素密切相关,孕期、生产期损伤者为精神分裂症的高危人群。     

早产危险因素病例对照研究

目的 :了解早产的危险因素 ,为制定预防策略和措施提供科学依据 .方法 :采用成组病例对照研究 ,针对早产的5 5项可疑危险因素 ,对 95例早产产妇和 1 1 6例足月产产妇进行问卷调查 .结果 :单因素分析 ,得到 1 7项早产危险因素 ,经进一步多因素logistic回归分析发现产检次数过少 (OR =1 1 .8,95 %CI=3.7～ 37.4 )、暴露视频终端 (VDT)每日 >2 .5h (OR=4 .6 ,95 %CI=1 .6～ 1 3.2 )、孕期接触有毒化学物 (OR =76 .6 ,95 %CI=5 .7～ 1 0 32 .1 )、负性事件 (OR =2 0 .5 ,95 %CI=2 .5～ 1 70 .4 )、妊高征 (OR =7.6 ,95 %CI =2 .0～ 2 8.7)、妊娠合并贫血 (OR =4 .3,95 %CI=1 .4～ 1 3.4 )是早产的主要危险因素 .结论 :产前检查次数过少 ,孕期暴露VDT时间较长 ,孕期接触有毒化学物、负性事件、妊高征和妊娠合并贫血是早产的主要危险因素 .     

云南撒尼族新生儿、孕母及非孕妇女血清游离与总甲状腺激素水平的研究

研究45对撒尼族新生儿、孕母及30例非孕妇女的血清甲状腺激素水平及其相关性,发现:①新生儿(脐血)组甲状腺激素浓度与孕母组间有极显著差异,具有活性高者浓度低、活性低者浓度高的特征;②孕母组与非孕组比较,前者TT_4偏高,FT_3,FT_4偏低,其FT_3降低有显著意义;③脐血与孕母血中的FT_3,FT_4值完全无相关性,相对浓度亦各异,据此,对胎盘能通透FT_3,FT4的结论提出质疑。     

乙型肝炎病毒携带产妇预防干预措施与母乳喂养的安全性研究

目的:调查乙型肝炎病毒(HBV)携带产妇的母乳喂养和人工喂养后婴儿血清HBV标志物(HBVM)的阳性率,为指导母乳喂养提供证据.方法:用ELISA法检测孕妇和婴儿血清中的HBVM,用荧光定量聚合酶链反应(PCR)法检测HBV携带产妇血清和初乳中HBV-DNA含量,并分析婴儿血清HBVM与母乳喂养和人工喂养的关系.结果:67例HBsAg抗原阳性(大、小三阳),产妇中,HBV血清‘大三阳'的产妇血液、初乳中HBV-DNA阳性率较高.母亲血清HBVM为‘大三阳'者分别占人工喂养组和母乳喂养组的41%和13%,两组间有显著性差异(P＜0.05);婴儿在12～18个月时作血清HBVM检测,人工喂养组和母乳喂养组婴儿血清抗-HBs阳性率分别为84%和87%,两组无显著性差异(P＞0.05).结论:只要对HBV携带产妇在孕期进行预防干预及对所产婴儿进行被动和主动免疫防范措施,HBV携带产妇的母乳喂养是相对安全的.     

妊娠期肝病早产临床因素分析

目的 :探讨妊娠期肝病孕妇早产的相关因素及对母婴的影响。方法 :回顾性分析 1993年至 2 0 0 2年 2 6 5例妊娠期肝病孕妇早产的原因及对母婴的影响 ,并与同期随机抽取的 2 6 5例足月产妊娠期肝病孕妇进行比较。结果 :胎膜早破、ICP、妊高症、臀位、肝炎病毒感染、前置胎盘为早产的前 6位因素 ,两组差异显著 (P <0 .0 5 ) ;两组间新生儿窒息、死胎、死产、产后出血及剖宫产等差异显著 (P <0 .0 5 )。结论 :胎膜早破、ICP是肝病孕妇早产的主要原因 ;重症肝炎、ICP等是导致早产肝病孕妇发生死胎、死产的主要原因     

用荧光探针定量多聚酶链反应技术检测乙肝病毒宫内传播的研究

目的探讨孕妇血中乙肝病毒(HBV)DNA数量与宫内传播的关系.方法用荧光探针定量多聚酶链反应(FQ-PCR)方法,检测76例乙肝病毒表面抗原(HBsAg)阳性孕妇血清中HBV DNA数量.26例HBV DNA阳性者肌注乙肝免疫球蛋白,新生儿出生后24h内取末梢静脉血检测HBV DNA.结果孕妇血中HBV DNA阳性者其宫内感染率为33.3%,宫内感染与孕妇血中HBV DNA数量有关,HBV DNA数量高易导致胎儿宫内感染,乙肝免疫球蛋白免疫注射后可降低HBV宫内感染率.结论孕妇血中HBV DNA数量高易导致胎儿宫内感染,孕期应用乙肝免疫球蛋白可减少宫内传播.     

Congenital toxoplasmosis: a large survey in western Australia

OBJECTIVE: To determine the birth prevalence of congenital toxoplasmosis in Western Australia. DESIGN: A prospective serological study of randomly selected pregnant women and their newborn infants. Paired sera collected from the mothers at their first antenatal visit and cord blood specimens taken from their infants were tested for toxoplasmosis by the direct agglutination test and Toxoplasma IgM-capture enzyme-linked immunosorbent assay. SETTING: A major Perth metropolitan obstetric teaching hospital where approximately one-quarter of infants born in Western Australia during January 1986 to December 1989 inclusive were delivered. PARTICIPANTS: Sera were obtained from 10,207 pregnant women presenting for routine clinical evaluation at their first antenatal visit. Cord blood specimens were taken from 18,908 infants; 7523 of these could be paired to maternal specimens. MAIN OUTCOME MEASURES: Maternal infection was indicated in cases where Toxoplasma specific IgM antibody was present or where an initial maternal specimen gave negative results for Toxoplasma antibody but the paired cord blood specimen gave positive results. Toxoplasma specific IgM antibody in a cord blood specimen indicated fetal infection. RESULTS: Of the 10,207 women 3544 (35%) were Toxoplasma immune at their first antenatal visit; in 11 Toxoplasma specific IgM antibody was detected. There was no serological or clinical evidence of congenital toxoplasmosis in any of the offspring of these 11 mothers. The rate of maternal infection in susceptible pregnancies was 1.6 per 1000; the maternal-fetal transmission rate was estimated to be no greater than 24%. Three of the 18,908 cord blood specimens tested gave positive results for Toxoplasma specific IgM antibody giving a birth prevalence of congenital infection of 0.23 per 1000 births to non-immune mothers. There were no clinical features of congenital infection in these three infants but they will require long-term follow-up. Thirteen of the 14 mothers infected during pregnancy were interviewed retrospectively and in only three was a known risk factor for infection present. CONCLUSIONS: a toxoplasmosis screening programme for pregnant mothers is not justifiable in Western Australia. A public education programme is also likely to have limitations.     

Serological and parasitological screening of Trypanosoma cruzi infection in mothers and newborns living in two Chagasic areas of Mexico

BACKGROUND: Maternal-fetal transmission of Trypanosoma cruzi generally occurs in 2-12% of pregnant infected mothers. This transmission form has been poorly studied in Mexico where only one case of congenital infection published in 1998 has been reported. METHODS: We screened 145 mothers and their delivered babies in two hospitals of endemic regions in Mexico (states of Chiapas and Veracruz) searching for anti-T. cruzi antibodies and circulating parasites by hemoculture and PCR. RESULTS: In Poza Rica, Veracruz, 3/85 (3.5%) mothers were seropositive for T. cruzi infection and in Palenque, Chiapas, 3/60 (5%) cases. In total 6/145 (4.1%) were seropositive subjects. Although cord blood samples of delivered babies from seropositive mothers have IgG anti-T. cruzi antibodies, none presented PCR and positive hemoculture. CONCLUSIONS: Although a high relative seroprevalence of T. cruzi infection in pregnant women was detected, no case of vertical transmission was recognized. Undoubtedly, further studies of large samples are necessary to evaluate maternal transmission risk in Mexico.     

Maternal and Perinatal outcome among the booked and unbooked pregnancies from catchments area of BP Koirala Institute of Health Sciences, Nepal

Objectives: To examine the differences in maternal and perinatal outcome among booked and unbooked pregnant women and their perception for underutilization of services targeted for them. Methods: Two thousand two hundred and twenty eight pregnant women, booked and unbooked, attending emergency obstetrics care during Jan.-Dec. 2005, were included in the study; Investigators followed cases till discharge. Results: Tendency for mothers to be booked was found to be significantly associated with age. Booked and unbooked mothers differed by distance to the hospital and parity. There was difference between the periods of gestation at which they presented to the hospital among both the groups (p<0.0001). Nearly eighty percent (81.4%) of unbooked mothers did not know the period of gestation. Most of these women conceived during lactational or depo provera-induced amenorrhea. The maternal mortality rate for unbooked mothers was 16 out of 1056 and none among the booked. Perinatal mortality is 3 times less in booked mothers. Higher perinatal mortalities are associated with unbooked mothers and had a higher proportion of maternal intensive care unit admissions and perinatal deaths compared with the booked group. Focus group discussion revealed that the reasons for underutilizations of services are; Distance, cost, disempowerment of women and attitudes of hospital personnel. Conclusion: The opportunities to enhance utilizations are based on distance, cost and client friendly environment of hospital personnel. It has been observed, building teaching hospitals alone, will not have much impact to maternal and perinatal outcome, unless peripheral health institutions are equipped with facilities and service provisions. Keywords: Booked mothers, Unbooked mothers, maternal complication, perinatal outcome.     

母婴ABO血型不合对HDN的影响

目的:探讨孕妇IgG血型抗体效价与胎儿血型的关系及其抗体滴度对新生儿溶血病(HDN)发病率的作用。方法:用DIANA全自动血型仪对丈夫A型、B型和O型,Rh阳性孕妇做IgG抗A(B)效价测定。对69例有HDN危险的孕妇所生新生儿做HDN血型血清学检查(即ABO血型鉴定,COOMB'S实验,游离,放散实验),以证实胎儿血型对母亲产生IgG血型抗体的影响及产前抗体效价高低与HDN发病的关系。结果:413例孕妇IgG抗A(B)≥64者共255例占61.7%。O型组新生儿与A、B型组新生儿中母亲IgG抗A或抗B抗体效价分布不同,差异有显著性(P<0.05)。A型组新生儿与B型组新生儿之母亲IgG抗体效价分布相同。69例母婴血型不合且产前有HDN危险的孕妇中有25例新生儿患HDN占36.2%。新生儿ABO溶血的发生率与母亲抗体效价相关,效价越高,新生儿ABO溶血发生率越高,差异有显著性(P<0.05)。结论:母婴血型不合时胎儿血型物质可能刺激母亲产生抗相应血型的IgG抗体,但这种作用与胎儿A,B血型类别无关。新生儿HDN发病率与母亲体内相应IgG血型抗体效价高低成正比。     

弓形虫、巨细胞病毒、衣原体、解脲支原体宫内感染与围产儿质量的研究

目的 :探讨弓形虫、巨细胞病毒、沙眼衣原体、解脲支原体宫内感染与围产儿的质量。方法 :采集 2 0 0 0例孕妇的静脉血及其孕妇TOX IgM、CMV IgM、CT IgM、UU IgM抗体阳性者的围产儿脐血 ,用ELISA法检测血清中抗TOX IgM、CMV IgM、CT IgM、UU IgM抗体。结果 :孕妇血弓形虫、巨细胞病毒、衣原体、解脲支原体阳性率分别为8 4%、5 3%、6 4%、5 9% ;孕妇抗TOX、CMV、CT、UU IgM抗体阳性者 5 18例 (共 34 6人 ) ;围产儿脐血TOX、CMV、CT、UU -IgM阳性 14 7例 (共 12 0人 ) ,母婴间传播率为 2 8 4% ,宫内感染 12 0人中围产儿异常者 2 6例 ,其发生率2 1 7% ;四种病原体抗IgM抗体阴性者孕妇的围产儿 1682例 ,异常 2 0 4例 ,发生率 12 1%。结论 :胎儿宫内感染TOX、CMV、CT、UU可使围产儿异常率升高 ,质量下降。     

乙型肝炎病毒宫内感染情况分析

目的：探讨乙型肝炎病毒宫内传播的危险因素。方法：对我院分娩的１１００ 例产妇抽取静脉血和新生儿脐血检测乙型肝炎病毒标志物。结果：母亲ＨＢｓＡｇ 阳性合并ＨＢｅＡｇ 阳性新生儿脐血ＨＢｓＡｇ 阳性明显高于母亲单项ＨＢｓＡｇ 阳性（Ｐ＜ ０．０１）,母亲抗－ＨＢｓ 阳性新生儿脐血９７．５％ 抗－ＨＢｓ 阳性。结论：母亲ＨＢｓＡｇ、ＨＢｅＡｇ 阳性对胎儿威胁最大,胎儿能从母体获得抗－ＨＢｓ 抗体