孕产妇可逆性后部白质脑病综合征的CT及MRI表现

目的探讨孕产妇可逆性后部白质脑病综合征（RPLS）的CT及MRI诊断特点。方法回顾性分析11例出现头痛、呕吐、视物障碍等先兆子痫及子痫症状且并发RPLS的孕产妇患者的临床及影像学资料。结果 RPLS病灶CT表现为稍低密度影,MR表现为T1WI等或稍低、T2WI高、FLAIR高信号,病灶主要分布于双侧大脑后部皮质下脑白质。10例累及两侧大脑半球（其中枕叶受累8例,顶叶受累8例,额叶受累6例,颞叶受累4例,另有2例累及两侧基底节区）,1例仅累及左侧顶枕叶。MRV成像的5例患者中均没有观察到明显静脉血栓征象。MR显示病灶较CT更清楚,尤其是FLAIR序列。患者经治疗后症状均有明显好转、甚至消失,8例复查后发现病变范围明显缩小、消失。结论孕产妇可逆性后部白质脑病综合征有较特征的影像学改变,认识这些特点并正确诊断对治疗具有重要意义。     

Anterior dislocation of shoulder in eclampsia: a case report

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia.This is an unusual mechanism of injury,but simila...     

抑制素A与子痫前期及子痫的相关性研究

[目的]探究抑制素A与子痫前期及子痫的相关性.[方法]选取本院2014年5月至2015年5月收治的子痫前期(25例)以及重度子痫(22例)患者作为研究对象(观察组),以同一时期入院的正常孕妇作为对照组.在基因和蛋白水平通过荧光定量PCR、酶联免疫反应以及Western-blotting技术对子痫前期以及重度子痫患者外周血中抑制素A表达量进行测定,并通过免疫组化染色技术对其表达量进行测定.[结果]与对照组孕妇血清中抑制素A mRNA表达量相比,抑制素A在重度子痫以及子痫前期孕妇血清中含量显著升高,观察组与对照组之间存在显著性差异(P＜0.05);蛋白检测结果表明,与对照组孕妇血清中抑制素A含量[(6.8±0.6)μg/L]相比,子痫前期[(12.6±1.2)μg/L]以及重度子痫患者[(38.4±1.3) μg/L]血清中抑制素A含量显著升高,并且重度子痫孕妇血清中抑制素A含量与子痫前期抑制素A含量之间也存在显著性差异(P＜0.05).通过免疫组化实验发现,抑制素A在重度子痫以及子痫前期孕妇中表达量较高,这与RT-PCR以及ELISA,Western-blotting结果一致.[结论]抑制素A与子痫发病之间存在相关性,且随着抑制素A含量升高,子痫病情逐渐加重.     

Permanent Bilateral Vision Loss in Eclamptic Posterior Reversible Encephalopathy Syndrome

Posterior reversible encephalopathy syndrome (PRES) classically consists of reversible vasogenic oedema in the posterior circulation territories, which is reversible both clinically and radiologically in the majority of patients after the control of hypertension. The authors describe a 27-year-old eclamptic patient with PRES in accelerated hypertension who revealed permanent vision loss associated with bilateral Purtscher retinopathy. One of the two competing theories that explain vasogenic brain oedema in PRES is excessive autoregulation leading to the dilation of cerebral arterial vessels, particularly in the occipito-parietal vasculatures. Dysfunction of endothelial cells that results in constriction of vessels has also been hypothesised as a cause of PRES. The concurrence of bilateral vaso-occlusive retinopathy and PRES supports the hypothesis that vasoconstriction is a more plausible mechanism of vasogenic oedema in PRES.     

Late Onset Preeclampsia is not an Innocuous Condition

Objective: To describe the profile and outcome of late-onset preeclampsia (LOPE). Methods. Retrospective study of 264 singleton pregnancies presenting before delivery at two referral centres in South Africa. Results: Primigravid patients constituted 56.8% of the group, while 57.6% were graded as severe. Median gestational age at diagnosis was 37 (34–43) weeks. 30.7% of patients experienced ≥1 major maternal complication including 34 (12.9%) cases of eclampsia. There were no maternal or early neonatal deaths. Five intrauterine deaths occurred, all due to placental abruption. The perinatal mortality rate was 18.9 per thousand births. Conclusions: Late-onset preeclampsia often presents as severe disease.     

Increased plasma hyaluronan in severe pre-eclampsia and eclampsia

Pre-eclampsia is a serious multi-system disorder with general endothelial disease, often with a component of hepatic dysfunction. The pathogenesis of preeclampsia is not fully understood, and no specific diagnostic tests are available for early and reliable diagnosis, or for monitoring of the disease process. Hyaluronan is an extracellular matrix polysaccharide present at low concentrations in plasma. Normally, it is rapidly eliminated from the blood by the liver. Increased concentrations of circulating hyaluronan are seen in conditions with impaired hepatic function such as liver cirrhosis, and hyaluronan concentrations have previously been used to evaluate hepatic function in other diseases. In the present study, 11 pregnant women admitted to the intensive care unit with severe pre-eclampsia or eclampsia were studied. As control 31 healthy pregnant women, 18 undergoing vaginal delivery and 13 caesarean section, were included. Plasma hyaluronan was measured before and after delivery. Increased concentrations of plasma hyaluronan were found in the pre-eclampsia group both before (171 (75 - 586) µg/L (p<0.01)) and after delivery (215 (124 - 768) µg/L (p<0.001)) (median and inter-quartile range), as compared to both caesarean section (13 (7- 28) µg/L before and 28 (18 - 48) µg/L after delivery) and vaginal delivery healthy controls (12 (8- 24) µg/L before and 30 (13 - 63) µg/L after delivery). In the control groups, a small increase in plasma hyaluronan was seen after delivery, after both caesarean section (p<0.05) and vaginal delivery (p<0.01). In conclusion, plasma hyaluronan is increased in severe pre-eclampsia and eclampsia. The cause of the increase is unknown.     

子痫前期子宫螺旋动脉血流与孕妇血清胎盘生长因子表达的相关研究

目的观察子宫螺旋动脉血流动力学参数与孕妇血清中胎盘生长因子（PLGF）含量,两者结合分析子痫前期的严重程度。方法对30例初诊子痫前期孕妇及154名健康孕妇,通过彩色多普勒超声技术（CDFI）检测子宫螺旋动脉血流动力学参数：搏动指数（PI）值、阻力指数（RI）值、收缩期峰值流速与舒张末期血流速度之比值（S／D）。使用酶联免疫吸附试验（ELISA）法测定孕妇血清中PLGF的含量。结果（1）子痫前期组的PI值、RI值、S／D值较对照组有所增高,差异有统计学意义（P〈0．01）。子痫前期重度组较轻度组的值增高,差异有统计学意义（P〈0．001）。（2）子痫前期组的血清PLGF含量较对照组降低,差异有统计学意义（P〈0．001）,子痫前期重度组低于轻度组,差异有统计学意义（P〈0．001）。（3）子痫前期血清PLGF分别与PI（r=-0．55,P〈0．05）、RI（r=-0．58,P〈0．05）、S／D（r=-0．62,P〈0．05）,呈显著负相关。结论（1）彩色多普勒超声技术检测子宫螺旋动脉血流、孕妇血清PLGF含量都与子痫前期严重程度相关。（2）子宫螺旋动脉血流动力学参数与子痫前期孕妇血清PLGF表达之间呈显著负相关。     

超声评价子痫前期患者胎儿主动脉峡部血流指数

目的 通过测量峡部血流指数（IFI）定量分析子痫前期（PE）患者胎儿主动脉峡部（AOI）血流变化特点与规律。方法 纳入38例PE患者（PE组）和孕周相匹配的38名正常单胎妊娠孕妇（对照组）。采集胎儿AOI、脐动脉（UA）、静脉导管（DV）的多普勒频谱,计算IFI,并分为Ⅰ~Ⅲ型,计算PE组胎儿AOI、UA舒张期血流及心房收缩波（DA-a）消失或反向率。结果 对照组胎儿IFI均为Ⅰ型,IFI值为1.40±0.09,AOI舒张期血流均为前向;PE组胎儿IFI Ⅰ型21胎,Ⅱ型10胎,Ⅲ型7胎,IFI值为0.81±0.80;2组IFI差异有统计学意义（t=4.439,P<0.001）。PE组胎儿AOI、UA舒张期血流和DV-a波消失或反向率分别为44.74%（17/38）、13.16%（5/38）和0,与对照组比较差异有统计学意义（χ²=25.796,P<0.001）。结论 PE患者胎儿IFI降低。检测胎儿AOI多普勒频谱可于胎儿循环缺氧早期检测其血流动力学变化。