Lifetime risk of cardiovascular disease and life expectancy with and without cardiovascular disease according to changes in metabolic syndrome status

Background and aimsThe relationship between dynamic changes in metabolic syndrome (MetS) status and lifetime risk of cardiovascular disease (CVD) has not been reliably quantified. This study aimed to estimate lifetime risk of CVD and life expectancy with and without CVD according to dynamic MetS status.Methods and ResultsDynamic changes in MetS status were assessed: MetS-free, MetS-chronic, MetS-developed, and MetS-recovery groups. We used Modified Kaplan–Meier method to estimate lifetime risk and used multistate life table method to calculate life expectancy. Participants free of CVD at index ages 35 (n = 40 168), 45 (n = 33 569), and 55 (n = 18 546) years. At index age 35 years, we recorded 1341 CVD events during a median follow-up of 6.1 years. Lifetime risk of 33.9% (95% CI: 26.9%–41.0%) in MetS-recovery group was lower than that of 39.4% (95% CI: 36.1%–42.8%) in MetS-chronic group. Lifetime risk of 37.8% (95% CI: 30.6%–45.1%) in MetS-developed group was higher than that of 26.4% (95% CI: 22.7%–30.0%) in MetS-free group. At index age 35 years, life expectancy free of CVD for MetS-recovery group (44.1 years) was higher than that for MetS-chronic group (38.8 years). Life expectancy free of CVD for MetS-developed group (41.9 years) was lower than that for MetS-free group (46.7 years).ConclusionsRecovery from MetS was associated with decreased lifetime risk of CVD and a longer life expectancy free of CVD, whereas development of MetS was associated with increased lifetime risk of CVD and a shorter life expectancy free of CVD.     

地黄叶总苷胶囊联合阿魏酸钠治疗慢性肾小球肾炎的临床研究

目的探讨地黄叶总苷胶囊联合阿魏酸钠片治疗慢性肾小球肾炎的临床疗效。方法选取2017年6月—2018年6月在上海市松江区泗泾医院治疗的慢性肾小球肾炎患者94例,根据门诊号分为对照组(47例)和治疗组(47例)。对照组患者口服阿魏酸钠片,100 mg/次,3次/d;治疗组在对照组基础上口服地黄叶总苷胶囊,0.4 g/次,2次/d。两组患者均连续治疗4周。观察两组患者临床疗效,同时比较治疗前后两组患者中医证候评分、24 h尿蛋白定量(24 h UPR)、血尿素氮(BUN)、血肌酐(Scr)和尿红细胞(RBC)水平及血清学指标和T淋巴细胞亚群水平。结果治疗后,对照组和治疗组临床有效率分别为80.85%和95.74%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者中医症候评分显著下降(P0.05),且治疗组患者中医证候评分明显低于对照组(P0.05)。治疗后,两组患者24 h UPR、Scr、BUN及尿RBC水平显著降低(P0.05),且治疗组患者24 h UPR、Scr、BUN及尿RBC水平明显低于对照组(P0.05)。治疗后,两组血清白细胞诱导素1(LKN-1)、纤溶酶原激活物抑制物-1(PAI-1)、组织金属蛋白酶原抑制剂-1(TIMP-1)、转化生长因子-β1(TGF-β1)水平显著降低(P0.05),组织型–纤维蛋白溶解酶原激活剂(t-PA)和基质金属蛋白酶-9(MMP-9)显著升高(P0.05),且治疗组上述血清学指标水平明显好于对照组(P0.05)。治疗后,两组患者血清CD3~+、CD4~+、CD4~+/CD8~+水平均明显升高(P0.05),CD8~+水平显著降低(P0.05),且治疗组上述指标水平明显好于对照组(P0.05)。结论地黄叶总苷胶囊联合阿魏酸钠片治疗慢性肾小球肾炎可有效改善患者临床症状和肾功能,促进机体免疫功能改善,具有一定的临床推广应用价值。     

前置胎盘合并胎盘植入致难治性产后出血的救治体会

目的通过对前置胎盘合并胎盘植入引起难治性产后出血救治经验的总结,提高发生紧急产后出血时的急救能力,达到降低孕产妇死亡率的目的。方法对我院3年内发生的15例难治性产后出血病例进行回顾性分析,内容包括发生原因、治疗方法、输血情况和产后并发症等信息,总结因前置胎盘合并胎盘植入引起难治性产后出血的救治经验。结果 15例难治性产后出血中,有8例为前置胎盘合并胎盘植入,6例为宫缩乏力,1例为子宫内翻。8例前置胎盘合并胎盘植入者中,4例采用B-Lynch缝合,3例宫腔内纱布填塞,1例子宫切除,无孕产妇死亡,急救成功率为100%。结论⑴难治性产后出血发生的首要原因为前置胎盘合并胎盘植入,其次为宫缩乏力,如瘢痕子宫、多胎妊娠和子痫前期等,另有极少见原因如子宫内翻。(2)对前置胎盘合并胎盘植入引起难治性产后出血应采用相应的治疗方法,准确判断,争取抢救时间,可提高急救成功率。     

早产发生相关因素及预防对策探讨

目的:分析母体因素与早产发生的关联性,寻求降低早产儿出生率的方法。方法:回顾性分析该院2008年1月～2010年12月出生的968例早产儿母亲的一般情况、文化程度、分娩史、孕期情况。结果:(1)2008～2010年早产率逐年上升,分别为3.06%、3.32%、4.20%;前3位早产原因依次为胎膜早破占33.70%,胎盘因素占17.84%,妊娠期高血压疾病占13.33%。⑵非本市户籍产妇的早产发生率(3.70%)明显高于本市户籍产妇早产发生率(2.31%);⑶早产的发生与母体多种因素有关,其中胎膜早破、胎盘因素、妊娠期高血压疾病、妊娠合并内外科疾病是发生早产的主要因素;⑷年龄小或高龄、文化程度低、孕产次数多及未正规产检者早产发生率高。结论:早产的发生与母体多种因素有关,胎膜早破位居首位,需要采取综合积极措施才能减少早产儿的发生。     

正常高值血压孕产妇凝血指标与妊娠结局的临床分析

目的:探讨正常高值血压孕产妇的凝血指标与妊娠结局。方法:回顾性分析2015～2017年在本院产检并分娩的1 500例孕妇的临床资料,其中正常高值血压组、正常血压组、妊娠期高血压疾病(HDP)组各500例,将一般资料、孕晚期血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)与妊娠结局进行分析。结果:正常高值血压组孕产妇孕次、产次、孕前体质指数(BMI)、孕期增重(GWG)以及孕晚期PT、FIB、剖宫产率,与正常血压组孕产妇差异有统计学意义(P0.05)。正常高值血压组孕产妇孕前BMI,孕晚期PLT、MPV、PDW、PT、APTT,胎盘早剥、产后出血、剖宫产率、早产、羊水过少、小于孕龄儿及胎儿窘迫,与HDP组孕产妇差异有统计学意义(P0.05)。结论:正常高值血压孕产妇部分凝血指标发生变化,除剖宫产率升高外,不良妊娠结局并未显著增加,临床一般无需特别纳入妊娠期高血压疾病管理。     

Heightened susceptibility: A review of how pregnancy and chemical exposures influence maternal health

Pregnancy is a unique period when biological changes can increase sensitivity to chemical exposures. Pregnant women are exposed to multiple environmental chemicals via air, food, water, and consumer products, including flame retardants, plasticizers, and pesticides. Lead exposure increases risk of pregnancy-induced hypertensive disorders, although women’s health risks are poorly characterized for most chemicals. Research on prenatal exposures has focused on fetal outcomes and less on maternal outcomes. We reviewed epidemiologic literature on chemical exposures during pregnancy and three maternal outcomes: preeclampsia, gestational diabetes, and breast cancer. We found that pregnancy can heighten susceptibility to environmental chemicals and women’s health risks, although variations in study design and exposure assessment limited study comparability. Future research should include pregnancy as a critical period for women’s health. Incorporating biomarkers of exposure and effect, deliberate timing and method of measurement, and consistent adjustment of potential confounders would strengthen research on the exposome and women’s health.     

异丙酚血浆靶控输注不同浓度用于宫腔镜手术的比较

目的:分析宫腔镜手术静脉麻醉时不同异丙酚血浆靶控浓度的临床效应,以寻找宫腔镜手术中比较合适的异丙酚靶控血浆浓度。方法:选择静脉麻醉下行宫腔镜手术的患者90例,随机分成3组。静脉注射芬太尼1μg/kg后,异丙酚血浆靶控浓度设为低剂量4.0μg/mL组(LP组)、中等剂量4.5μg/mL组(MP组)和高剂量5.0μg/mL组(GP组)。持续监测脑电双频指数(bispectral index,BIS),分析3组患者的异丙酚用量、意识丧失时间以及呼吸循环的变化和术毕清醒时间。结果:与注药前相比,LP组扩宫颈时平均动脉压和心率显著升高(P<0.05),MP组无显著变化(P>0.05),GP组显著降低(P<0.05);LP组和MP组脉搏氧饱和度无显著变化(P>0.05),GP组显著下降(P<0.05);3组BIS值在扩宫颈时出现了不同程度的下降,其中GP组最低(P<0.05)。MP组和GP组意识丧失时间短于LP组(P<0.05),GP组意识丧失时间短于MP组(P<0.05)。LP组和MP组清醒时间短于GP组(P<0.05)。LP组出现体动反应的例数显著多于其他2组(P<0.05);GP组呼吸抑制的例数显著多于其他2组(P<0.05)。3组患者的异丙酚用量以及手术时间均无显著差异(P>0.05)。结论:异丙酚血浆浓度4.5μg/mL可能是宫腔镜手术静脉麻醉较适宜的输注浓度。     

Concentrations of Polybrominated Diphenyl Ethers in Maternal Blood,Placental Size,and Risk for Fetal Growth Restriction: A Nested Case-control Study

ObjectiveTo explore the effects of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on placental size and birth outcomes.MethodsBased on the perspective Wenzhou Birth Cohort, this nested case-control study included 101 fetal growth restriction (FGR) and 101 healthy newborns. Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry. The basic information of mother-newborn pairs was collected from questionnaires, whereas the placental size and birth outcomes of newborns were obtained from hospital records.ResultsA total of 19 brominated diphenyle ether (BDE) congeners were detected in maternal serum samples. Higher concentrations of BDE-207, -208, -209, and ∑₁₉PBDEs were detected in FGR cases than in controls. Increased BDE-207, -208, -209, and ∑₁₉PBDEs levels in maternal serum were related to decreased placental length, breadth, surface area, birth weight, birth length, gestational age, and Quetelet index of newborns. After adjusting for confounders, BDE-207 and ∑₁₉PBDE concentrations in maternal serum were significantly associated with an increased risk of FGR.ConclusionA negative association was found between PBDE levels in maternal serum and placental size and birth outcomes. Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.     

醋酸纤维薄膜电泳在早期发现妊娠高血压疾病中的作用

目的:利用传统的醋酸纤维薄膜电泳技术,为妊娠高血压疾病临床早期发现提供及时、可靠的诊断依据;方法:随机抽取初次孕检孕妇311例,常规尿检后进行蛋白成分电泳分析并予以追踪;根据有无血压升高分为两组,两组孕妇的年龄、产次、孕周无限定;用美国HELENA公司所研发的HELENA扫描光密度计软件对试验电泳图胶片进行编辑、定位、分析。结果:大多数高血压组孕妇尿中蛋白以2+为主,高血压孕妇尿液蛋白成分多于非高血压孕妇,高血压孕妇尿γ蛋白成分高于非高血压孕妇(P<0.05)。结论:醋酸纤维薄膜电泳具有操作简便、易于量化、便于分析、费用低廉等特点,能及时发现尿中蛋白的微量变化,可作为早期发现妊娠高血压疾病的检查方法。