糖化血红蛋白对妊娠高血压综合征发病的队列研究

目的:探讨糖化血红蛋白(GHbA1c)对妊娠高血压综合征(PIH)发病的影响.方法:2010年1月6日至2011年8月12日,从广东省人民医院妇科招募符合入选标准的孕妇2 491例作为研究对象.孕(20±1)周时测定GHbA1c等指标后,随访至产后12周,记录PIH等不良妊娠事件.用非条件Logistic回归模型校正各种混杂因子,分析GHbA1c对PIH发病的影响.结果:研究人群中PIH的累积发病率为9.4％;GHbA1c≥6.5％的人群中,PIH的累积发病率为26.4％;GHbA1c＜6.5％的人群中,PIH的累积发病率为8.9％.GHbA1c高水平组相对于低水平组,PIH发病的相对危险度(RR)及其95％置信区间为3.40[1.96 ～ 5.90];用非条件Logistic回归模型校正各种混杂因子后,PIH发病的RR及其95％置信区间依然达2.24[1.23～ 4.09].结论:妊娠中期高水平的GHbA1c是PIH发病的独立危险因子.     

The role of resistance and aerobic exercise training on insulin sensitivity measures in STZ-induced Type 1 diabetic rodents

Individuals with Type 1 Diabetes Mellitus (T1DM) can develop insulin resistance. Regular exercise may improve insulin resistance partially through increased expression of skeletal muscle GLUT4 content.     

Hb H Disease with Various β Hemoglobinopathies: Molecular,Hematological and Diagnostic Aspects

We report the molecular, hematological and diagnostic features of three Thai patients with Hb H (β4) disease in combination with different β hemoglobinopathies. The first case was a boy with a hitherto undescribed condition of Hb H-Hb Tak (HBB:c.441_442insAC) syndrome. The second case was an adult male with the Hb H-Hb Hope (HBB:c.410G>A) disease. The last case was a male patient with a combination of Hb H-Hb Constant Spring (Hb CS) (HBA2:c.427T>C) and a high Hbs A₂/F β⁰-thalassemia (β-thal) trait (the 3.4 kb deletion). In all cases, no Hb H was detected and Hb H inclusion was absent, accurate diagnosis could be obtained after DNA analysis. All of them had mild hypochromic microcytic anemia with hemoglobin (Hb) values ranging from 8.8–10.4 g/dL, PCV 0.31–0.36 L/L and MCV 57.6–66.9 fL and none had ever received a blood transfusion. The levels of Hb Tak (7.8%) and Hb Hope (21.6%), respectively, observed in the first two cases were relatively lower than values found in heterozygotes for these two variants. In the last case, the level of Hb A₂ (4.8%) was within the diagnostic range for a β-thal trait. The Hb F level was not elevated but a small amount of Hb Bart’s was observed. Hematological findings and diagnostics using combined Hb and polymerase chain reaction (PCR) analyses are presented and compared with those of the other Thai patients with Hb H-β⁰-thal, Hb H-Hb CS-Hb J-Bangkok (HBB:c.170G>A) and Hb H-Hb CS-Hb Pyrgos (HBB:c.251G>A) previously observed in our series.     

孕妇人体质量指数、C反应蛋白和糖化血红蛋白与妊娠期糖尿病的关系及预测意义

目的探讨孕妇人体质量指数(BMI)、C反应蛋白(CRP)及糖化血红蛋白(HbA1c)水平，与其发生妊娠期糖尿病(GDM)的关系，以及上述3项指标对预测GDM的价值。 方法选择2016年12月至2018年12月，于南京市中西医结合医院进行干预治疗和分娩的100例GDM孕妇为研究对象，将其纳入GDM组；选择同期与GDM组在同一家医院进行产前检查和分娩的60例健康孕妇作为对照，纳入对照组。采用成组t检验和χ²检验，对2组孕妇空腹血糖(FPG)、餐后2 h血糖(2 h PPG)、BMI、CRP及HbA1c水平，以及2组孕妇围生结局指标的发生率，进行统计学比较；采用Pearson相关性分析，对GDM组孕妇的BMI、CRP、HbA1c分别与其FPG及2 h PPG的相关性进行分析。本研究遵循的程序，符合2013年修订的《世界医学协会赫尔辛基宣言》要求，与所有受试者均签署临床研究知情同意书。 结果① GDM组孕妇的FPG、2 h PPG、BMI、CRP及HbA1c水平分别为(7.8±1.0) mmol/L、(11.0±1.6) mmol/L、(25.8±1.2) kg/m²、(12.8±2.9) mg/L及(8.5±1.7)%，均显著高于对照组孕妇的(5.6±0.6) mmol/L、(7.6±1.1) mmol/L、(22.2±1.1) kg/m²、(7.7±2.4) mg/L及(4.0±1.0)%，并且差异均有统计学意义(t＝14.139、13.394、17.455、10.726、16.705，均为P<0.001)。② Pearson相关性分析结果显示，GDM孕妇的BMI、CRP及HbA1c水平分别与FPG、2 h PPG，均呈正相关关系(r＝0.438、0.408，P<0.001；r＝0.389、0.410，P<0.001；r＝0.413、0.442，P<0.001)。③GDM组孕妇早产、胎膜早破、羊水过多、分娩巨大儿、胎儿窘迫及产后出血发生率，分别为21.1%、23.3%、22.2%、17.8%、16.7%、12.2%，均显著高于对照组孕妇的6.0%、8.0%、6.0%、4.0%、4.0%、2.0%，并且差异均有统计学意义(χ²＝5.542、P＝0.019，χ²＝5.152、P＝0.023，χ²＝6.161、P＝0.013，χ²＝5.446、P＝0.020，χ²＝4.834、P＝0.028，χ²＝4.286、P＝0.038)。GDM组孕妇分娩新生儿的1 min Apgar评分为(7.1±0.7)分，低于对照组健康孕妇分娩新生儿的(8.3±1.0)分，并且差异有统计学意义(t＝8.469，P<0.001)。 结论孕妇BMI、CRP及HbA1c水平与GDM相关，应加强对孕妇这3项指标的早期监测，以早期预测GDM的发生。     

pH值对两种胶体金试剂条检测胃液潜血的影响

目的:研究在胃液潜血实验中不同pH值对结果的影响。方法:在中性环境下逐渐增加血红蛋白浓度,测定两种潜血试纸条的最低检测限;用5 mol/L NaOH调节新鲜胃液的pH值,确定能检测出血红蛋白的临界pH值;在临界pH的环境里,改变血红蛋白浓度和测定时间,检测时间与浓度对检出率的影响。结果:两种试纸条的最低检测限为0.2μg/ml和0.4μg/ml;pH值3.7时不能检测出血红蛋白;在pH<3.7的酸性环境里,血红蛋白浓度升高会暂时延长潜血实验结果阳性的时间。结论:胃液潜血实验在pH<3.7酸环境中检测,使结果出现假阴性,可以通过调节pH值和镜下观察得出正确结论。     

Comparison of hemoglobin and hematocrit levels at 1, 4 and 24 h after red blood cell transfusion

Previous studies have shown that equilibration following a red cell transfusion had occurred by 24 h. A shorter time to follow the hemoglobin (Hb) and hematocrit (Hct) after transfusion may help physicians to provide earlier and more pertinent treatment. This was a prospective study conducted from December 2014 to August 2015. This research aimed to determine the equilibration time point of the level of Hb and Hct after one unit red blood cell (RBC) transfusion. Patients were randomized into three groups and Hb level and Hct were assessed at one, four or 24 h after transfusion. The mean differences in Hb level and Hct before and after transfusion were compared between each group. Sixty patients were eligible for enrollment onto this study; 20 patients were therefore allocated to each group. The median age was 51 years old, male predominating (83.33%). The most common indication for transfusion was post-operative anemia (88.33%). There were no significant differences between the baseline characteristics baseline Hb, Hct and volume of RBC transfusion in each group. The mean differences in Hb (g/dl)/Hct (%) level at the different time points of one, four and 24 h were 1.21/3.62, 1.19/3.63, and 0.95/3.09 respectively (P = 0.109 and P = 0.398, respectively). The equilibration of Hb and Hct did not differ between one, four and 24 h after a RBC transfusion. The target Hb and Hct can be determined at one hour after transfusion.