内皮型一氧化氮合酶运输介导物在子痫前期患者胎盘组织中的定位及定量研究

目的探讨内皮型一氧化氮合酶运输介导物(endothelial n itric oxide synthase traffic inducer,NOSTR IN)在子痫前期(pre-ec lampsia,PE)患者胎盘血管内皮细胞中表达的变化及其在子痫前期发病过程中的作用。方法HE染色后镜下观察胎盘组织及血管的病理变化,免疫组织化学方法及W estern b lot检测子痫前期患者胎盘组织中NOSTR IN的表达。结果HE染色显示子痫前期患者胎盘绒毛血管变细,数目减少,血管合体膜增厚,纤维素样坏死明显多于正常妊娠;免疫组织化学显示正常妊娠和子痫前期患者胎盘血管内皮细胞中都有NOSTR IN的表达,但子痫前期患者胎盘血管内皮细胞胞浆染色较正常妊娠明显增强;W estern b lot显示子痫前期患者胎盘组织中NOSTR IN的表达显著高于正常妊娠(P<0.01)。结论胎盘组织中NOSTR IN表达增加可能是子痫前期发病机制的重要环节之一。     

HLA-DM基因夫妇共享率与子痫前期相关性

目的:探讨HLA-DM基因夫妇共享率与子痫前期的相关性。方法:用PCR-SSO方法分别测定30对子痫前期患者夫妇及63对正常孕妇夫妇的HLA-DM基因型。结果:夫妇共享等位基因数为2个时,子痫前期组的例数明显多于正常妊娠组,差异有显著性(P﹤0.05);HLA-DM的各等位基因型在子痫前期组夫妇共享率与正常妊娠组夫妇共享率差异无显著性。结论:夫妇共享HLA-DM基因数与子痫前期发病有关。     

Total and free tissue factor pathway inhibitor in pregnancy hypertension.

OBJECTIVE: To clarify the role played by tissue factor pathway inhibitor (TFPI) in pregnancy hypertension. METHODS: Using enzyme-linked immunosorbent assays, hemostatic measurements were obtained for women with pre-eclampsia (n=51), nonproteinuric hypertension of pregnancy (n=62), postpartum pre-eclampsia 24 h after childbirth (n=31), and no hypertension (healthy pregnant controls, n=100). RESULTS: There was a significant increase in circulating free TFPI levels in women with pre-eclampsia (9.7+/-6.2 ng/mL) or nonproteinuric hypertension of pregnancy (8.3+/-5.3 ng/mL) compared with healthy controls (5.3+/-2.1 ng/mL). In women with pre-eclampsia the levels remained elevated after placental delivery (10.6+/-4.0 ng/mL). Free protein S levels were significantly higher in women with pre-eclampsia (40.0%+/-10.7%), nonproteinuric hypertension of pregnancy (37.1%+/-12.5%), or postpartum pre-eclampsia (39.3%+/-9.1%) than in healthy pregnant controls (32.2%+/-8.5%). CONCLUSION: Increased levels of the physiologically active free forms of TFPI and free protein S, 2 coagulation inhibitors, may protect women with pregnancy-induced hypertension from the risks of hemostatic activation.     

妊高征患者胎盘床滋养细胞内皮素(ET-1)的表达与临床意义

目的:观察妊高征患者胎盘床浸润的滋养细胞内皮素(ET-1)的表达情况,探讨妊高征的发病机理。方法:收集正常妊娠病例30例,妊高征共70例,其中轻度30例,中度20例,重度20例,用免疫组化方法对妊高征和正常妊娠的胎盘床蜕膜段和肌层浸润的滋养细胞进行ET-1的标记。结果:ET-1在妊高征胎盘床蜕膜段浸润的滋养细胞的表达与正常妊娠无明显差别(P>0.05),ET-1在妊高征胎盘床肌层浸润的滋养细胞的表达明显高于正常妊娠(P<0.05)。讨论:妊高征时胎盘床肌层浸润的滋养细胞分泌的内皮素明显增多,提示妊高征的发生可能与肌层浸润的滋养细胞分泌的内皮素增多有关。     

Pregnancy outcomes among visually impaired women in Washington State, 1987–2014

BackgroundWomen with visual impairment may have reduced ability to access standard care resources, however, information on their pregnancy and neonatal outcomes is limited.ObjectiveTo assess risk of adverse pregnancy and neonatal outcomes among visually impaired women in Washington State from 1987 to 2014.MethodsWe conducted a retrospective cohort study using linked Washington State birth/fetal death hospital discharge records to compare outcomes among women with and without visual impairment noted at their delivery hospitalization. Pregnancy conditions and outcomes evaluated included gestational diabetes, pre-eclampsia, labor induction and cesarean delivery. Neonatal outcomes included preterm delivery and birth weight <2500 g. We assessed length of maternal and infant delivery hospitalization. We performed Poisson regression to estimate relative risks (RR) and 95% confidence intervals (CIs) for each outcome, adjusting for year of delivery, maternal age, and parity.ResultsMost adverse pregnancy and neonatal outcomes were similar for visually impaired (N = 232) and comparison women (N = 2362). However, visually impaired women had increased risks of severe pre-eclampsia (RR 3.77, 95% CI 1.69–8.43), labor induction (RR 1.33, 95% CI 1.10–1.61) and preterm delivery (RR 1.60, 95% CI 1.06–2.42). They were also more likely to have delivery hospitalizations of 3 or more days following a vaginal (RR 1.86, 95% CI 1.41–2.47). Among cesarean deliveries, infants of visually impaired women had increased risk (RR 1.24, 95% CI 1.02–1.51) of hospitalization for 3 or more days postpartum.ConclusionOur findings may be useful for obstetric providers in counseling their visually impaired patients.     

子痫前期并发胎儿生长受限的临床特征及妊娠结局分析

目的探讨子痫前期并发胎儿生长受限(fetal growth restriction，FGR)的临床特征及母儿结局。 方法回顾性分析2009年1月1日至2019年12月31日在广州医科大学附属第三医院产科就诊并分娩的单胎子痫前期患者的病例资料，根据是否合并FGR，分为FGR组和对照组，分析两组的临床特征及母儿结局。 结果(1)2960例单胎子痫前期患者合并FGR的发生率为20.68%，早发型及晚发型子痫前期合并FGR的发生率分别为30.3%及13.7%(P<0.05)；(2)两组受教育程度、妊娠次数、受孕方式及入院类型比较差异均有统计学意义(P均<0.05)；(3)FGR组活产分娩孕周[(33.44±3.13)周]明显小于对照组[(35.82±3.78)周]，FGR组死胎率(15.03%)、剖宫产率(80.39%)及住院天数[(9.21±4.70)d]，均明显高于对照组[10.78%、71.12%、(8.45±6.34)d]，FGR组胎儿窘迫(24.18%)、羊水过少(13.89%)的发生率明显高于对照组(10.09%、6.39%)，差异均具有统计学意义(P<0.05)；(4)FGR组≥28周不同孕周阶段的新生儿平均体重、平均身长及平均头围均低于对照组，FGR组新生儿窒息(21.0%)、新生儿呼吸窘迫(18.65%)、肺透明膜病(4.62%)、新生儿贫血(17.69%)的发生率都明显高于对照组(14.1%、10.60%、2.82%、7.97%)，差异均具有统计学意义(P<0.05)。 结论子痫前期与FGR的发生密切相关，子痫前期患者合并FGR时出现不良母儿结局的风险增加。     

早发型与晚发型子痫前期的临床特点及母儿结局分析

目的分析早发型与晚发型子痫前期的临床特征及母儿结局。 方法收集2015年1月至2020年12月6年间在广州医科大学附属第三医院分娩的诊断为子痫前期的单胎孕产妇2693例的临床资料，采用回顾性研究方法分析早发型(873例)与晚发型子痫前期孕妇(1820例)的临床特征及母儿结局。 结果早发型和晚发型子痫前期患者孕次比较[(2.68±1.58)次与(2.27±1.38)次，Z＝-6.80，(P<0.05)]，转诊患者比例(42% vs 6.3%, χ²＝519.02，P<0.05)，合并慢性高血压比例(2.4% vs 0.8%, χ²＝12.31，P<0.05)，剖宫产率(77.8% vs 60.1%, χ²＝82.35，P<0.05)，胎盘早剥率(0.9% vs 0.3%, χ²＝3.93，P<0.05)，重症监护病房入住率(9.7% vs 2.4%, χ²＝69.3，P<0.05)，住院天数(9.44±4.76)d与(6.30±5.15)d，Z＝-20.52，(P<0.05)，死胎发生率(22.3% vs 0.3%, χ²＝381.1，P<0.05)。 结论早发型子痫前期与晚发型子痫前期患者临床特点不同，母儿围产期结局不同，两种子痫前期类型应被区分对待。