中晚期早产儿不良神经发育结局的研究进展

近年来,随着医疗水平的不断提高,早产儿存活率得以大幅提升,但由于胎龄不足,早产儿相比足月儿不良神经发育结局发生的风险比例增高,神经发育问题逐渐成为早产儿早期发展面临的突出问题。中晚期早产儿约占早产儿总人数的80%,但目前极早产和超早产与神经发育障碍相关性的研究较多,中晚期早产与神经发育障碍相关性的研究较少。本文对中晚期早产儿神经发育结局进行综述,为临床早期评估中晚期早产儿神经发育状态提供依据。通过胎盘-脑轴生物标志物预测中晚期早产儿神经发育结局,对开展早期干预具有重要意义。     

基于Robson分类系统的医院剖宫产率变化及其产妇特征分析

目的 分析医院剖宫产率变化和收治产妇的人群特征,为妇幼卫生政策和临床实践提供参考。方法 选择安徽医科大学附属巢湖医院2010年10月1日至2016年9月30日住院分娩的12 041名产妇作为研究对象,应用Robson分类系统分析各组产妇的剖宫产率变化,以及其与二孩政策、出生婴儿性别比之间的关系。结果 近6年医院总剖宫产率从66.9%降低至44.2%,其中单胎头位足月妊娠初产妇（R1+R2）降低至32.1%,经产妇无子宫疤痕者（R3+R4）降低至14.2%,早产者降低至22.9%,组内差异有统计学意义（P<0.01）;自然分娩组（R1、R3）、疤痕子宫再妊娠组（R5）、双胎妊娠组（R8）产妇构成比呈上升趋势,组内差异有统计学意义（P<0.01）;医院年度总出生婴儿男女性别比是110~128：100,R1组女婴多且比例稳定,R10组（早产）和经产妇组（R4、R5）男婴比例高,但R4组2015、2016年度男婴下降明显。结论 单胎头位初产妇、无子宫疤痕经产妇和早产者是医院降低剖宫产率的重点监测人群,疤痕子宫再妊娠、臀位、双胎妊娠者的剖宫产率及构成比变化存在不确定性,应用Robson分类法可提高剖宫产率监测数据的可比性。     

大学前不同阶段同伴欺凌经历与大学生生活质量的关联研究

目的 探讨大学前不同阶段同伴欺凌经历对大学生生活质量的影响。方法 2018年10月采用分层整群抽样方法选取安徽省合肥市4所高校4 034名在校大学生作为研究对象,调查研究对象大学前不同阶段同伴欺凌经历和当前的生活质量。采用t检验和方差分析比较不同组各维度得分差异,采用多元线性回归模型分别分析大学前不同阶段欺凌经历、不同欺凌种数与大学生生活质量的关系。结果 4 034名大学生生活质量4个维度（生理、心理、社会关系和环境）得分分别为12.61±2.02、14.09±2.62、13.72±2.71和13.77±2.46。多元线性回归分析（控制相关混杂因素）结果显示,大学生在小学（β=-0.21）、中学（β=-0.27）和两阶段（β=-0.56）被言语欺凌、中学阶段被关系欺凌（β=-0.21）、中学阶段被躯体欺凌（β=-0.38）和两阶段躯体欺凌（β=-0.67）均与大学生生活质量生理维度得分呈负相关;大学生在两阶段被言语欺凌（β=-0.41）和中学阶段被关系欺凌（β=-0.42）与大学生生活质量心理维度得分呈负相关;大学生在中学阶段被关系欺凌（β=-0.32）、中学（β=-0.51）和两阶段被躯体欺凌（β=-0.57）均与大学生生活质量社会关系维度得分呈负相关;大学生在小学和两阶段被言语欺凌（β=-0.20、-0.46）和关系欺凌（β=-0.35、-0.90）均与大学生生活质量环境维度得分呈负相关,差异均有统计学意义（P<0.05）。欺凌受害指数与大学生生活质量生理、心理、社会关系和环境4个维度得分呈负相关（β=-0.33、-0.36、-0.30、-0.33）;实施欺凌指数与大学生生活质量4个维度得分也呈负相关（β=-0.28、-0.31、-0.23、-0.28）,相关性差异均有统计学意义（P<0.001）。结论 大学前不同阶段欺凌经历均与大学生生活质量各维度得分降低有关联,应加强大学前不同阶段同伴欺凌的预防控制。     

孕20周内母体甲状腺功能与婴幼儿体格及神经精神发育剂量反应关系的前瞻性队列研究

目的 通过前瞻性队列研究，评价孕20周内母体甲状腺功能相关激素指标水平与新生儿出生体格和婴幼儿期神经精神发育水平之间的剂量反应关系。方法 在安徽省马鞍山市建立945名孕妇队列，留取队列孕妇血清标本，使用电化学发光免疫法检测孕妇血清甲状腺功能相关激素水平；收集孕妇的一般社会人口统计学资料，测量新生儿出生体格和婴幼儿神经精神的发育情况等。结果 孕期母体血清促甲状腺激素（TSH）水平处于不同百分段的孕妇所分娩的活产儿出生时身长和头围差异均有统计学意义（P<0.05）。孕期母体TSH水平<P₅和≥ P₉₅的新生儿出生身长和头围比母体TSH水平位于P₂₅~P₇₅的新生儿偏低，差异均有统计学意义（P<0.05）。新生儿出生头围与母体TSH-Z分呈倒"U"形分布模式（Y=33.940+0.003X-0.109X²，F=4.685，P=0.009）。孕期母体TSH水平处于不同百分段的孕妇所分娩后代在出生后18~30个月时的精神发展指数（MDI）差异有统计学意义（P<0.05），孕期母体TSH水平≥ P₉₀的婴儿MDI评价水平比母体TSH水平P₂₅~P₇₅的婴儿低6.39分（95% CI：2.29~10.49；P=0.002）。婴幼儿18~30个月时MDI与母体TSH-Z分亦呈倒"U"形分布模式（Y=103.249-1.524X-0.939X²，F=6.616，P=0.001）。结论 孕妇血清TSH水平与新生儿出生时身长、头围，以及婴幼儿18~30个月时MDI关系密切；孕期母体TSH-Z分与新生儿头围和婴幼儿18~30个月时MDI均呈现倒"U"形的分布模式。     

Association of maternal arsenic exposure with birth size: A systematic review and meta-analysis

ObjectivesChronic exposure to arsenic during pregnancy or early life continues to be a major global health problem worldwide, affecting hundreds of millions of people. However, its effects on birth size are uncertain. The aim of this study is to summarized the association between maternal arsenic exposure and birth size.MethodsA comprehensive literature search was conducted on the maternal arsenic exposure and birth size (birth weight, birth length, head circumference and chest circumference) through databases (PubMed, Qvid Medline, Web of Science, Cochrane and EMBASE), the last search was in March 2019. Heterogeneity was testes by using the Q statistic and stratifying for epidemiological factors. The possibility of publication bias was assessed through Begg’s test.ResultsA total of 12 studies provided sufficient data were included. Meta-analysis revealed that maternal arsenic exposure was associated with the decrease of birth weight (β = −25.0 g; 95% CI: −41.0, −9.0) and head circumference (β = −0.12 cm; 95% CI: −0.24, −0.01) in random-effect model, birth length (β = −0.12 cm; 95% CI: −0.17, −0.07) in fixed-effect model, no significant reduction was suggested in chest circumference (β = −0.74 cm; 95% CI: −1.78, 0.3). In addition, we found that the birth weight decreased stronger in women living in the Americas, or appling the exposure marker of urine.ConclusionsMaternal arsenic exposure is associated with the decrease of the birth weight, length and head circumference. Millions of people are still exposured to high-level arsenic, therefore, high quality epidemiologic studies that involve large samples are necessary to determine the precise relationships between maternal arsenic exposure with birth size. And that effective mitigation measures are also need to prevent arsenic exposure in women of reproductive age.     

Chicoric acid alleviates lipopolysaccharide-induced acute lung injury in mice through anti-inflammatory and anti-oxidant activities

Acute lung injury (ALI) is a severe clinical disease with high mortality rates. Chicoric acid (CA), an active component extracted from traditional Chinese medicine, was suggested to have anti-inflammatory and anti-oxidant activities. Inflammation and oxidative damage are implicated in the pathogenesis of ALI. In this study, we explored the protection effect of CA on LPS-induced ALI, and further discussed the possible molecular mechanisms. The results showed that CA could significantly improve the histological changes of LPS-induced acute lung injury. In addition, CA not only decreased LPS-stimulated protein leakage and lung wet/dry ratio but also reduced inflammatory cell infiltration, myeloperoxidase (MPO) activity and the generation of pro-inflammatory cytokines in bronchoalveolar lavage fluid (BALF). Meanwhile, CA lessened the reactive oxygen species (ROS) generation, and malondialdehyde (MDA) formation, and decreased glutathione (GSH) and superoxide dismutase (SOD) depletion, which were caused by LPS challenge. Furthermore, CA dramatically inhibited LPS-stimulated MAPK and NLRP3 activation and increased the expression of NAD (P) H: quinone oxidoreductase (NQO1), and dismutase (SOD), glutamate-cysteine ligase catalytic/modifier (GCLC/GCLM) subunit and heme oxygenase-1 (HO-1), as well as its upstream genes nuclear factor-erythroid 2-related factor 2 (Nrf2), which might be central to the protective effects of CA. In conclusion, these data indicated that the protective effects and mechanisms of CA on LPS-induced ALI and provided new insights for its application.