肿瘤坏死因子-α与子痫前期-子痫患者胰岛素抵抗关系的研究

目的:探讨肿瘤坏死因子-α(TNF-α)与子痫前期-子痫患者胰岛素抵抗的关系。方法:分别检测38例子痫前期-子痫患者(研究组)及34例正常健康孕妇(对照组)空腹胰岛素、血糖及血清TNF-α水平,用胰岛素敏感指数(ISI)反映机体胰岛素抵抗程度。结果:研究组空腹血清TNF-α及胰岛素分别为18.34±7.54pg/m l、16.55±4.56mU/L明显高于对照组的9.13±4.41pg/m l、10.38±2.94mU/L(P<0.05),ISI(取自然对数)研究组为-3.84±0.59,显著低于对照组的-3.46±0.45,差异有统计学意义(P<0.05),TNF-α与ISI呈显著负相关(r=-0.476,P<0.05)。结论:子痫前期-子痫患者胰岛素抵抗程度增加,可能与血清TNF-α水平升高有关。     

重度子癎前期终末器官受累不平行性及其围产结局探讨

目的探讨重度子痴前期（severe preeclampsia，S-PE）终末靶器官（end target organ）受累特点，分析早发型和晚发型重度子痫前期各种终末器官受累类型与围产结局的关系。方法对191例重度子痢前期的前瞻性观察研究资料进行分析总结。将S-PE起病时间以34孕周为界分为早发型SPE（early-onset severe preeclampsia）和晚发型S-PE（1ate-onset severe preeelampsia）两组。根据器官受累情况分为单器官、两器官和多器官受累。分析比较两组一般临床资料、器官受累类型和并发症发生情况以及围产结局。结果191例S-PE中有71．70％为单器官受累，明显高于两器官和多器官受累（P〈0．05）。单器官受累患者中，早发型S-PE终末器官损害以胎盘（55．26％）和肝损害（15．79％）为主，而晚发型S-PE则以胎盘（18．42％）、心肺（10．53％）和脑损害（10．53％）为多。两组之间胎盘损害发生率在早发型组比晚发型组有显著增高（P〈0．05）。两器官受累患者中，早发型终末器官损害以胎盘并肝损害为主，晚发型以心肺并肾损害为多。多器官受累类型中，早发型和晚发型各终末器官累及情况无明显差异。伴有器官受累者的胎儿及新生儿死亡率与无器官受累者相比均明显升高（P〈0.05）。在伴有器官受累者中，早发型的胎儿及新生儿死亡率较晚发型明显升高（P〈0．05）；单器官受累的早发型较晚发型明显升高（P〈0．05）；两器官和多器官受累早发型与晚发型间无统计学意义（P〉0．05）。早发型中各器官累及类型间胎儿及新生儿死亡率没有统计学意义（P〉0．05）；晚发型中则差异有统计学意义（P〈0．05），两器官和多器官受累较单器官受累明显升高。结论本研究显示重度子痢前期的终末器官受累存在着明显的不平行性。重度子痢前期发病时间、终止孕龄、疾病严重程度和器官受累等影响围产预后。个体的遗传异质性可能决定着不同的触发机制。     

LMP2基因多态性及夫妻共享率与重度子痫前期的相关性研究

目的 测定重度子痫前期（severe pre-eclampsia，S-PE）患者和正常孕妇多功能蛋白酶（large muhifunctional protease，LMP2）基因多态性及夫妻共享率，探讨该基因与S-PE发病的相关性。方法 选择102例S-PE患者及其配偶为研究对象，随机选择200例正常孕妇及其配偶作为对照。所选孕妇均为单胎初孕，孕35～40周。各取2ml外周静脉血抽提DNA，应用PCR—RFLP方法进行LMP2基因分型。结果 LMP2R／H在S-PE患者中的分布频率显著高于正常孕妇组（53．9％和35．5％，P〈0．01），LMP2R／R在S-PE患者中的分布频率显著低于正常孕妇组（41．2％和58．5％，P〈0．01）。LMP2R／H在S-PE组的夫妻共享率与正常孕妇组的相比显著增高（24．5％和10．5％，P〈0．01）。结论 LMP2R／H很可能为S-PE发病的易感基因；而LMP2R／R可能是S-PE的保护基因。     

氧化应激和炎症反应在子盖(癎)前期中的作用及其相互关系

目的通过测定子前期患者氧化应激产物和炎症标志物的水平,进一步研究子前期的发病机制。方法以53例子前期孕妇为研究组(其中轻度子前期32例、重度子前期21例),20例同期分娩的正常孕妇为对照组。检测血浆8-异前列腺素(8-isoprostane)、丙二醛(MDA)、氧化低密度脂蛋白(ox-LDL)和高敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的浓度。结果(1)子前期患者血浆8-异前列腺素、MDA、ox-LDL的浓度分别为(153.07±44.84)pg/ml、(5.25±0.11)μmol/L、(772.04±151.00)μg/L,均高于对照组[(82.86±20.91)pg/ml、(4.67±0.38)μmol/L、(431.45±200.69)μg/L,P<0.01、>0.05和<0.05];(2)子前期患者血浆hs-CRP、IL-6、TNF-α水平分别为(2.17±1.29)mg/L、(26.49±12.73)pg/ml、(18.47±4.17)pg/ml均明显高于对照组[(1.46±1.00)mg/L、(13.35±5.01)pg/ml、(8.86±1.39)pg/ml,P均<0.01];(3)子前期患者8-异前列腺素与hs-CRP、IL-6、TNF-α呈显著正相关(P<0.01),而MDA及ox-LDL均与hs-CRP、IL-6、TNF-α无相关性(P>0.05)。结论氧化应激及炎症反应可能在子前期中发挥重要作用,干预氧化应激及炎症反应可能有利于控制子前期的发生和发展。     

Hématome rétroplacentaire. Diagnostic,prise en charge et pronostic maternofœtal : étude rétrospective de 100 cas

ObjectivesTo update knowledge on placental abruption because there are few recent series published although the perinatal care has progressed.Patients and methodsA retrospective observational study has been conducted on 100 consecutive cases of abruptio placentae, occurring from January 2008 to June 2011, in the two maternity units of the University Hospital of Strasbourg (France).ResultsOne hundred and five births among which five twin pregnancies were included. Clinical context was evident in 91% of cases, but the classic clinical triad was present in only 4% of cases. Clots were found at immediate placenta examination in 77% of cases. Pathological diagnosis was directly in accordance with clinical diagnosis in half the cases. Mean date of childbirth was 33 weeks of amenorrhea and 6 days. Sixty-seven patients gave birth prematurely. Among them, 50 patients delivered before 34 weeks. Sixty caesareans were performed in emergency before labor, including 47 with general anesthesia. Twelve patients had post-partum haemorrhage and ten coagulation disorders. There was no maternal death. Perinatal mortality was 19% with 13 fetal deaths in utero (12.4%), four children born in an apparent death state with resuscitation failure (3.8%) and three neonatal deaths (2.8%).Discussion and conclusionPlacental abruption is a serious and unpredictable situation. Joint medical care of obstetricians and intensivists is often required. Perinatal mortality mainly occurs in utero.     

妊娠期高血压和子痫前期对肾脏功能的长期影响

目的:评估妊娠期高血压(GH)和子痫前期(PE)对肾脏功能的长期影响。方法:回顾性分析本院2013年1月—2015年8月3 583例GH(GH组)、811例PE(PE组)和10 457例健康(对照组)初产妇的临床资料。随访2年,比较3组孕妇慢性肾脏病(CKD)、肾病入院等情况。结果:GH和PE初产孕妇的CKD发生率分别为5.2%(188/3 583)和7.5%(61/811),对照组CKD发生率为3.9%(405/10 457)。校正前PE组CKD危险比为2.02(95%CI:1.53~2.67),GH组为1.37(95%CI:1.15~1.64);校正年龄、产龄、体质量指数(BMI)、文化程度和吸烟状况后,CKD危险比分别为1.92(95%CI:1.45~2.56)和1.36(95%CI:1.14~1.63)。Logistic回归分析显示,PE组CKD危险比高于GH组,且两组CKD危险比、肾病入院危险比皆高于对照组(危险比为1)。结论:GH和PE增加了初产孕妇的CKD风险,发病早于血压正常初产孕妇。     

Exploring knowledge of pre-eclampsia and views on a potential screening test in women with type 1 diabetes

Objectiveto explore knowledge of pre-eclampsia and opinions on potential screening tests for pre-eclampsia in women with type 1 diabetes.Designa qualitative study using semi-structured interviews of women planning a pregnancy, currently pregnant or post-partum with experience of pre-eclampsia.Setting, Participants and Methodseleven women with type 1 diabetes were recruited from a pre-pregnancy planning clinic or antenatal clinic. Semi-structured interviews were conducted with the women, asking a series of open-ended questions about their current knowledge of pre-eclampsia and their views on screening for pre-eclampsia. Data analysis was conducted using inductive thematic analysis.Findingsfour main themes were identified: Information, sources of stress, awareness and acceptability of screening. Generally, women's knowledge of pre-eclampsia was limited. Most did not appear to be aware of their increased risk of developing the disease. Similarly, the majority of women were unaware as to why their blood pressure and urine were checked regularly. The introduction of a screening test for pre-eclampsia was favoured, with only a small number of women raising concerns related to the screening tests.Conclusionshealth care professionals need to raise awareness of pre-eclampsia in this high risk group. The introduction of a screening test for pre-eclampsia appears to be acceptable in this population, however, further research is required to validate these findings and also to explore the views of women in other high risk groups.     

自噬对人类胎盘发育及相关疾病的作用

自噬在人类胎盘的生成及发育中发挥重要作用,但其在人类胎盘中的生物学意义仍不十分明确,可能的作用之一是防止因低氧或营养不足导致的滋养层细胞凋亡。人类胎盘是血窦绒毛型,即母体血液直接接触绒毛。因此,绒毛滋养细胞很容易暴露于因母体血液变化而导致的应激状态下。妊娠并发症(如子痫前期和胎儿生长受限)自噬通路被激活以维持细胞内稳态,从而允许滋养细胞在氧气和葡萄糖不足的情况下继续生存。因而,自噬参与人类胎盘及相关疾病的发展,细胞滋养细胞氧气和葡萄糖水平变化参与调节自噬的改变。     

Partial HELLP syndrome with unilateral exudative retinal detachment treated conservatively

Peripartum vision loss, an uncommon, often reversible complication of pregnancy usually occurs in the setting of pre-eclampsia or eclampsia. The HELLP syndrome is characterized by hypertension, elevated liver enzymes and low platelets. This is a rare case of unilateral exudative retinal detachment associated with the Partial HELLP syndrome that occurred after delivery in a 23-year-old Indian woman. The retinal detachment subsequently reattached with good visual improvement under conservative treatment. This case highlights the importance of early intervention by the ophthalmologist when pregnant women complain about visual symptoms.     

血清叶酸、维生素B12、同型半胱氨酸水平在孕妇子痫前期中的表达及相关性

摘要：目的 分析妊娠妇女血清叶酸、维生素B12、同型半胱氨酸水平在孕妇子痫前期中的表达及相关性。方法 选取2016年7月至2018年7月在我院接受治疗与进行分娩的68例子痫前期孕妇作为研究对象,根据病情的轻重情况分为重度组（重度子痫前期,28例）,轻度组（轻度子痫前期,40例）,将同期在我院进行产检与正常分娩且一般资料与子痫前期孕妇均衡可比的50例健康孕妇作为健康组进行对照。对比三组产妇血清中叶酸、维生素B12、同型半胱氨酸（Homocysteine,Hcy）水平情况的差异,采用Spearman检验评估孕妇子痫前期血清中叶酸、维生素B12、Hcy水平与病情程度的相关性。结果 重度组叶酸、维生素B12水平显著低于轻度组与健康组,Hcy水平显著高于轻度组与健康组;轻度组叶酸、维生素B12水平显著低于健康组,Hcy水平显著高于健康组,差异均具有统计学意义（P＜0.05）;子痫前期不同病情严重程度患者在叶酸水平、Hcy水平差异有统计学意义（X2=9.112,4.089;P＜0.05）,在维生素B12水平差异无统计学意义（X2=0.899,P＜0.05）;Spearman相关性分析提示子痫前期孕妇血清中叶酸水平与子痫前期病情严重程度呈负相关（r=-0.613,P<0.001）,维生素B12水平与子痫前期严重程度不具有相关性（r=-0.236,P=0.076）,Hcy水平与子痫前期严重程度呈正相关（r=0.602,P=0.001）。结论 子痫前期孕妇血液中叶酸含量较低,且病情越严重叶酸表达水平越低,应加强对孕妇孕期叶酸的检测及监控。