孕妇妊娠不同时期血浆D-二聚体和凝血四项的变化情况

目的:研究孕妇妊娠不同时期血浆D-二聚体和凝血四项的变化情况,探讨血浆D-二聚体和凝血四项检测的临床意义。方法:选择2010年5月～2012年9月孕妇452例,检测血浆D-二聚体、凝血酶原时间(PT)、凝血活酶时间(TT)、活化部分凝血酶时间(APTT)和纤维蛋白原含量(FIB),按孕妇妊娠不同时期分为早期、中期、晚期和临产期四组,分析孕妇妊娠不同时期血浆D-二聚体和凝血四项的变化情况。结果:妊娠早期、中期、晚期至临产期,孕妇血浆D-二聚体水平呈进行性升高(P<0.05);妊娠早期、中期至晚期,孕妇血浆PT呈进行性缩短(P<0.05),妊娠晚期和临产期孕妇血浆PT无统计学差异(P>0.05);妊娠早期、中期、晚期至临产期,孕妇血浆TT无明显变化(P>0.05);妊娠早期、中期、晚期至临产期,孕妇血浆APTT呈缩短趋势,其中妊娠早期与妊娠中期相比有明显变化(P<0.01),妊娠中期、晚期和临产期相比无统计学差异(P>0.05);妊娠早期、中期、晚期至临产期,孕妇血浆FIB水平呈升高趋势,其中妊娠早期与中期相比有统计学差异(P<0.05),妊娠中期和晚期相比无统计学差异(P>0.05),妊娠晚期和临产期相比有统计学差异(P<0.01)。结论:动态监测妊娠期血浆D-D和凝血四项的变化情况对于预防产中、产后异常出血,弥漫性血管内凝血(DIC)及血栓性疾病等产科并发症具有重要临床意义。     

联合检测血尿酸、血钙、血浆白蛋白预测子痫前期的价值

目的探讨一种易于临床推广的联合预测子痫前期的方法。方法选取2014年1月-2016年6月在扬州市妇幼保健院产科门诊正规产前检查至住院分娩的单胎妊娠孕妇,诊断为子痫前期的患者82例为子痫前期组,其中重度子痫前期患者58例,轻度子痫前期患者24例;随机选取正常妊娠孕妇68例为对照组。两组孕妇均无糖尿病、心脏病、慢性肾炎、免疫系统疾病等妊娠并发症及合并症,比较两组孕妇各项指标的差异。结果子痫前期组孕妇血钙、血浆白蛋白浓度均低于对照组孕妇,血尿酸浓度明显高于对照组孕妇,差异有统计学意义(P0.05)。58例重度子痫前期孕妇中同时出现两项指标异常的22例,占37.93%;三项异常的29例,占50.00%。24例轻度子痫前期孕妇中同时出现两项指标异常的10例,占41.67%;三项异常的5例,占20.83%。68例对照组孕妇中同时出现两项指标异常的19例,占27.94%;三项异常的3例,占4.41%。对照组与轻、重度子痫前期组比较差异有统计学意义(P0.05)。单项指标血钙、血尿酸、血浆白蛋白预测子痫前期的灵敏度分别为42.7%、60.7%、65.4%,特异度分别为61.4%、64.7%、32.4%。三项联合预测时灵敏度为93.1%,特异度为86.7%,比单一预测的阳性预测值高。结论血钙、血浆白蛋白、血尿酸可作为子痫前期的有效预测指标,但联合检测可明显提高子痫前期的预测率。     

孕妇外周血浆中高甲基化RASSF-1A基因水平与自然流产的关系研究

目的通过检测孕早期发生先兆流产孕妇血浆中高甲基化RASSF-1A水平,并随访早期妊娠结局,评估利用孕妇血浆中高甲基化RASSF-1A预测孕早期出现先兆流产的孕妇发生自然流产的临床价值。方法该研究是一项前瞻性研究,最终共有孕早期(6～11.6周)孕妇1767名,根据妊娠结局分为三组:自然流产组(A组)、先兆流产但妊娠结局正常组(B组)、正常对照组(C组)。高甲基化RASSF-1A基因用来代表胎儿DNA,应用实时定量PCR方法检测上述各实验组孕妇血浆胎儿DNA的含量。结果正常孕妇在孕早期血浆中的高甲基化RASSF-1A水平随着孕周的增长而增高;自然流产组孕妇血浆高甲基化RASSF-1A的中位数倍值是正常对照组的4.64倍,有统计学差异(P<0.01),而在有先兆流产但妊娠结局正常组与正常对照组之间无统计学差异(P>0.05);若用高甲基化RASSF-1A的4.92MoMs来预测自然流产,灵敏度为98.2%,假阳性率为1.8%,特异度为91.2%。结论对于发生先兆流产的孕妇,尤其在孕早期,孕妇血浆中的甲基化RASSF-1具有预测自然流产的临床价值,有望成为临床上预测有先兆流产症状的孕妇孕早期发生自然流产新的生物学指标。     

妊娠相关血浆蛋白A与异常妊娠的相关性研究

目的 确定孕妇早孕各孕周的妊娠相关血桨蛋白A的正常值,分析与异常妊振的关系.方法 用酶联免疫吸附试验测定孕妇血清妊娠相关血浆蛋白A的浓度,统计各早孕孕周妊娠相关血浆蛋白A的值.结果 获得孕5-13周妊娠相关血浆蛋白A浓度的中位数.妊娠相关血浆蛋白A低值与异位妊娠、稽留流产有关(Z分别为-7.48、-2.87,均P<0.05).先兆流产预后佳者与正常早孕妊娠相关血浆蛋白A值比较无显著性差异(Z=-0.07,P>0.05).结论 妊娠相关血浆蛋白A的测定值可作为先兆流产、异位妊娠、稽留流产的辅助诊断指标.     

妊高征孕妇血浆纤维结合蛋白的改变

本文对正常晚期妊娠孕妇22例,妊高征晚期妊娠孕妇35例的产前及产后48小时血浆,脐血血浆以及早期妊娠、正常非孕各22例血浆纤维结合蛋白进行了测定。结果表明:早孕与未孕组血浆纤维结合蛋白无显著差异;正常晚期妊娠孕妇的血浆纤维结合蛋白显著高于早孕组,而妊高征孕妇血浆纤维结合蛋白水平显著高于正常晚期妊娠组。妊高征组 轻、中、重三组间无差异,正常晚期妊娠组及妊高征组各自产前与其产后相比,Fn无显著性变化。提示血浆纤维结合蛋白与妊高征的病理生理变化有关。     

妊高征孕妇血浆纤维结合蛋白的改变

本文对正常晚期妊娠孕妇22例，妊高征晚期妊娠孕妇35例的产前及产后48小时血浆，脐血血浆以及早期妊娠、正常非孕各22例血浆纤维结合蛋白进行了测定。结果表明；早孕与未孕组血浆纤维结合蛋白无显著差异；正常晚期妊娠孕妇的血浆纤维结合蛋白显著高于早孕组，两妊高征孕妇血浆纤维结合蛋白水平显著高于正常晚期妊娠组，妊高征组轻、中、童三组间无差异，正常晚期妊娠组及妊高征组各自产前与其产后相比，Fn无显著性变化，提示血浆纤维结合蛋白与妊高征的病理生理变化有关。     

低血浆淀粉酶水平对妊娠期糖尿病的相关影响研究

目的旨在探讨低血浆淀粉酶水平及孕妇代谢指标对妊娠期糖尿病(GDM)的影响。方法将1 706例孕妇按孕周分为早孕、中孕、晚孕3组。收集受试者的空腹血浆样本,测定淀粉酶和其他代谢指标水平。在孕妇妊娠期的第24~28周之间行75克口服葡萄糖耐量试验(OGTT)来确诊是否存在GDM,采用多因素Logistic回归分析研究血浆淀粉酶水平对孕妇GDM患病率的影响。结果不同孕期血浆淀粉酶水平和代谢指标之间存在统计学差异。对于GDM孕妇,空腹血糖(FPG)、1h PG、2h PG、胰岛素抵抗指数稳态模型(HOMA-IR)和血浆淀粉酶水平与无GDM的孕妇相比差异有统计学意义。24~28周孕妇血浆低淀粉酶水平(628例)与FPG、1HPG、HOMA-IR、年龄、代谢指标呈负相关。在年龄、HOMA-IR和FPG的调节下,Logistic回归分析显示,低血浆淀粉酶水平是妊娠24~28周时孕妇发生GDM的影响因素。结论 GDM患者血浆淀粉酶水平较健康孕妇高,提示血浆淀粉酶水平对GDM有一定影响作用。     

妊娠期高血压疾病患者凝血功能指标的检测及其临床意义

目的:分析妊娠期高血压疾病患者凝血功能4项指标改变及检测的临床意义。方法:检测50例正常非孕妇、67例晚期妊娠妇女和70例妊娠期高血压疾病患者血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(Fbg)水平,并进行统计学分析。结果:晚期妊娠妇女的PT、APTT、TT、Fbg与正常非孕妇比较差异有统计学意义,妊娠期高血压疾病患者的PT、APTT、Fbg、TT与晚期妊娠妇女、正常非孕妇比较差异有统计学意义(P<0.05)。结论:妊娠期高血压疾病患者存在明显的高凝状态,对妊娠期高血压疾病患者进行凝血功能指标检测,对妊娠期高血压疾病病情评估和预防D IC的发生有重要意义。     

N末端B型钠尿肽前体水平评价合并心脏病孕妇的心功能研究

目的探讨N末端B型钠尿肽前体(NT-pro BNP)水平与孕妇是否合并心脏病的相关性。方法选取妊娠合并心脏病孕妇74例和同期正常妊娠孕妇80人,两组分别检测晚妊期NT-pro BNP血浆浓度并作比较,其中正常妊娠孕妇组还检测早妊期NT-pro BNP血浆浓度,分别与该组晚妊期结果比较,同时对妊娠合并心脏病孕妇作心功能分级,并与晚妊期血浆NT-pro BNP水平作关联性分析。结果妊娠合并心脏病孕妇NT-pro BNP血浆浓度(中位数为352.50 pg/m L,浓度范围为84.00~3 806.00 pg/m L)明显高于正常妊娠孕妇晚妊期(中位数为58.00 pg/m L,浓度范围为26.00~164.00 pg/m L)(P0.01),其心功能分级越高,NT-pro BNP血浆浓度水平也越高(P0.01);正常妊娠孕妇的晚妊期NT-pro BNP血浆浓度高于早妊期(中位数为49.00 pg/m L,浓度范围为20.00~178.00 pg/m L)(P0.01)。结论 NT-pro BNP血浆浓度水平在评价合并心脏病孕妇心功能受损程度有重要的临床应用价值,妊娠对正常孕妇心功能有一定的影响。     

hs-CRP与CRP预测胎膜早破早产儿宫内感染的价值研究

目的研究和分析超敏C-反应蛋白(hs-CRP)、C-反应蛋白(CRP)预测胎膜早破(PROM)早产儿宫内感染的价值,为PROM早产儿宫内感染的临床诊治工作提供客观依据。方法选取2016年1月-2017年1月期间医院收治的未足月PROM孕妇104例作为病例组,选取健康早产妊娠孕妇50例作为早产妊娠组,选取同期健康足月妊娠孕妇50例作为对照组对三组研究对象入院时、分娩后1d和3d的血清hs-CRP、CRP水平进行检测和比较,对三组新生儿的宫内感染率进行观察和分析。结果分娩前、后各时点,病例组孕妇的血浆hs-CRP、CRP水平均高于早产妊娠组,早产妊娠组孕妇的血浆hs-CRP、CRP水平均高于对照组,发生新生儿宫内感染的病例组孕妇的血浆hs-CRP、CRP水平均高于未发生新生儿宫内感染的病例组孕妇,差异均有统计学意义(P0.05);病例组、对照组、早产妊娠组新生儿宫内感染率分别为55.77%、8.00%和14.00%,病例组新生儿宫内感染率显著高于对照组和早产妊娠组,差异均有统计学意义(P0.05);孕妇入院时血浆hs-CRP、CRP水平在预测RPOM早产儿宫内感染中的AUC分别为0.740和0.744,当应用两种指标进行联合检测时,AUC提升至0.828,联合检测在预测PROM早产儿宫内感染中灵敏度显著高于单独检测血浆hs-CRP或CRP水平(P0.05),而三种方法的特异度差异无统计学意义。结论 PROM早产儿宫内感染率较高,发生新生儿宫内感染的孕妇可表现为外周血hs-CRP、CRP水平的升高,联合检测这两项指标可辅助预测PROM早产儿宫内感染的发生。     

学龄前儿童不同水平铁营养状况的铁剂试验治疗效果

对114例学龄前儿童进行铁剂试验性治疗二个月。治疗前后用Hb、SI、TS、FEP、FEP/Hb和SF等参数评价了铁营养状态,结果表明,治疗前4岁～组的铁营养状态优于1岁～组。治疗后两组的铁营养状况有了非常显著的改善,铁的参数都达到了同样水平。本研究提示学龄前儿童Hb<12g/dl和/或FEP/Hb>3μg/g应进行铁缺乏症的防治。     

妊娠期缺铁性贫血的预防

对３９名健康孕妇从妊中期开始进行血红蛋白（Ｈｂ）、血清铁蛋白（ＳＦ）、血铁饱和度（ＴＳ）、红细胞内游离原卟啉（ＦＥＰ）与Ｈｂ比值动态观察。对照组：孕期未服铁剂。铁剂组：妊中期取血后每日服用硫酸亚铁３００ｍｇ。各观察对象于１８－２２周、２８－３２周、３８－４０周取静脉血。结果显示：妊娠期Ｈｂ、ＳＦ、ＴＳ下降，ＦＥＰ／Ｈｂ上升，缺铁症发生率增高，妊中期开始补铁对预防贫血有效。     

Modifications of hemato-biological parameters in pregnant women in a migrating population in northern Cameroon: prevalence of anemia, iron and folates deficiencies

The wholesale displacement of a population can have nutritional consequences for the migrants. With this in mind, the prevalences of anemia and of iron and folic acid deficiencies were studied in a group of 90 pregnant women living in northeast Benoue, an area situated in northern Cameroon where a development project was initiated in 1973. This project aimed at moving a population from the extreme northern highlands to the fertile valley of the Benoue. The following hemato-biological parameters were measured: hemoglobin, hematocrit, mean cell hemoglobin concentration, plasma iron, transferrin saturation, serum concentrations of folates, prealbumin, transferrin, protides and their fractions. The investigation showed that anemia, as well as iron and folic acid deficiencies, were rare when using World Health Organization criteria. The anemia prevalence, judged on a hemoglobin level of less than 11 g per 100 ml, is 8%, iron deficiency prevalence is 10% (plasma iron level below 50 micrograms per 100 ml), and folic acid deficiency prevalence is 3% (serum folic acid level below 3 ng per ml). However, 40% of the pregnant women had a level of transferrin saturation below 15%. In non deficient subjects, we observed a decrease between the first and second trimesters of pregnancy in hemato-biological parameters linked to anemia or to nutritional status (hemoglobin, hematocrit, plasma iron, transferrin saturation, prealbumin). The nutritional conditions in the area appeared sufficient to prevent deficiencies which are frequently observed in pregnant women in Africa.     

Iron and zinc status of patients with chronic renal failure who are not on dialysis.

OBJECTIVE: The purpose of this study was to assess the zinc and iron status in patients with chronic renal failure (CRF) who were not receiving dialysis. DESIGN: Cross-sectional study. SETTING: Outclinic patients of the Nephrology Division at Federal University of S?o Paulo. PATIENTS: This study was performed on 29 stable patients with CRF who were not receiving dialysis. MAIN OUTCOME MEASURE: The parameters for determining iron and zinc status were transferrin saturation, zinc protoporphyrin, serum ferritin, hematocrit, serum iron, total iron binding capacity, erythrocyte, and plasma zinc levels (measured by atomic absorption spectrophotometry). RESULTS: The serum ferritin level was reduced to 85.5 +/- 67.1 ng/mL and the zinc protoporphyrin level was high (68 +/- 32.9 micromol/mol heme), serum transferrin saturation was 19.9% +/- 7.85%, mean serum iron level was 66.6 +/- 26.3 microg/dL, and mean total iron binding capacity was 336 +/- 45.7 microg/dL. Absolute iron deficiency was found in 34.5% of the patients. Zinc level in erythrocytes was high (50.0 +/- 7.2 microg/g hemoglobin), whereas plasma zinc was at a borderline level (74 +/- 17.7 microg/dL) when compared with normal values. There were significant correlations among plasma zinc and serum iron and transferrin saturation, zinc erythrocyte, and parameters of iron. CONCLUSION: These results show that absolute iron deficiency can occur in patients who are not receiving dialysis and that there is an abnormal distribution of zinc levels in these patients. Moreover, a possible relationship between iron deficiency and zinc distribution was observed.     

Iron nutrition does not account for the hemoglobin differences between blacks and whites.

Many researchers have reported lower hemoglobin concentrations in blacks than in whites, but the reason for this difference is unknown. Data for 2515 persons (in 3-12 y and 18-45 y age groups) from the Second National Health and Nutrition Examination Survey (NHANES II) were evaluated to investigate the roles of iron intake and biochemical iron status indicators in explaining black and white differences in hemoglobin concentration. Dietary iron intake was estimated from one 24-h food recall, and hemoglobin, serum ferritin, transferrin saturation and erythrocyte protoporphyrin were measured by standard laboratory methods. Hemoglobin levels were substantially lower in black children (120.3 g/L) than in white children (126.8 g/L). Hemoglobin concentrations were also lower in black women (128.4 g/L) than in white women (133.9 g/L), and in black men (144.8 g/L) than in white men (153.2 g/L). Blacks had lower hemoglobin concentration than whites at most levels of dietary iron intake, serum ferritin, transferrin saturation and erythrocyte protoporphyrin. Despite their lower hemoglobin levels, blacks had higher serum ferritin levels than whites. These results suggest that the difference in hemoglobin concentrations between blacks and whites in the United States is the result of factors other than iron intake and iron status. More specific investigations of both the genetic and environmental determinants of iron utilization in blacks are needed.     

Assessing iron status of a population.

Reliable methods for assessing the iron status of a population are essential for developing effective public health measures to combat iron deficiency. The hemoglobin concentration, transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin are all useful but they vary widely in their specificity and sensitivity for detecting iron deficiency. In applying these laboratory parameters, the usual approach in nutritional surveys is to determine the percentage of values outside the normal range. As an alternative, a model is presented here that uses these measurements to estimate the distribution of iron stores in a population. This approach may be particularly useful for evaluating the effectiveness of iron supplementation and fortification programs.     

Vitamin-mineral supplement use: association with dietary intake and iron status of adults

Although vitamin-mineral supplement use is increasing in the United States, few researchers have examined whether supplement users have better nutritional status than do nonusers. Data from 10,515 persons examined in the second National Health and Nutrition Examination Survey (NHANES II) were used to compare mean dietary intakes of several nutrients and food groups, hemoglobin, mean corpuscular volume, transferrin saturation, erythrocyte protoporphyrin, and serum ferritin between regular supplement users and nonusers aged 16 to 74 years. Prevalences of impaired iron status also were compared between user groups. Users consumed more vitamin C and ate fruits and vegetables more frequently than did nonusers in all age/sex groups. No significant differences in mean iron status indicators were observed except in the 65 to 74 year age/sex groups: transferrin saturation among men and mean corpuscular volume, erythrocyte protoporphyrin, and serum ferritin among women. In each case, users had higher values than nonusers in this age group. Prevalences of impaired iron status did not differ between users and nonusers in any age/sex group. In general, iron status was not associated with supplement use.     

Nutritional anaemia in pregnant Beninese women: consequences on the haematological profile of the newborn

An assessment of iron and folic acid status, blood thick film and haemoglobin (Hb) electrophoresis was performed on 126 pregnant women (and their newborn infants) and in ninety-five menstruating women in Cotonou (Benin). Anaemia (according to the World Health Organization (1972] was observed in 55% of pregnant women and in 39% of menstruating women. Fe-deficiency was defined as a low serum ferritin concentration (12 micrograms/l or less), combined with a low transferrin saturation (less than 16%) or a high erythrocyte protoporphyrin level (more than 3 micrograms/g Hb), or both. A moderate elevation in the serum ferritin concentration (between 13 and 50 micrograms/l), associated with a low transferrin saturation or a high erythrocyte protoporphyrin level, or both, indicated Fe-deficiency in an inflammatory context. Fe-deficiency was present in 73% of pregnant women and in 41% of menstruating women. Folate deficiency (defined as erythrocyte folate below 160 micrograms/l) was observed in 45% of pregnant women. In pregnant women, anaemia was associated with Fe-deficiency in 83% of cases and with folate deficiency in 48% of cases. Haemoglobinopathies were mainly heterozygous and did not seem to contribute significantly to anaemia. Intensity of malaria was not related to Hb level, but Plasmodium falciparum was found in 99% of subjects. Hb concentration and mean corpuscular volume were significantly lower in babies born of Fe-deficient mothers than in babies born of Fe-sufficient mothers. Hb concentration in newborn infants was positively correlated with maternal serum ferritin.     

Influence of inflammation on laboratory indicators of iron deficiency in the elderly

Hemoglobin, serum iron, transferrin, erythrocyte protoporphyrin and serum ferritin concentrations were measured in 151 elderly institutionalized women. One hundred-fifteen subjects presented an inflammatory process identified by at least one abnormal value for serum concentration of orosomucoid, C-reactive Protein and sedimentation rate. Thirty-six subjects did not present any biological evidence of inflammatory process. Anemia (according to WHO references) was present in 4 (11%) women without and in 37 (32%) women with inflammation. Hemoglobin and serum iron were negatively correlated with the different markers of inflammation, while erythrocyte protoporphyrin and serum ferritin were positively correlated with them. Total iron-binding capacity may be considered as the iron parameter the least affected by the inflammatory process. In women without inflammation, iron deficiency was defined as a combination of low transferrin saturation and a high erythrocyte protoporphyrin concentration. In women with inflammation, iron deficiency was defined as the same association combined with a high total iron-binding capacity. According to these definitions, iron deficiency was present in 11% of elderly women without inflammation and in 16% with biochemical evidence of an inflammatory process, respectively.     

Food stamps and the iron status of the U.S. elderly poor

With the use of data from NHANES I and II, the iron status of poor elderly persons was examined by comparing it with that of nonpoor elderly persons. Within the poor group, the iron status of Food Stamp Program participants was compared with that of nonparticipants. The poor were those below the poverty line; the nonpoor were those with incomes at least twice the poverty line. The indicators of iron status were: hemoglobin, hematocrit, free erythrocyte protoporphyrin, transferrin saturation, total iron-binding capacity, serum iron, and iron intake. Iron status was examined by analyses of variance. The effects associated with sex, race, age, geographic region, and other potentially confounding factors were included in the model. In both surveys, there were interactions with race. That is, the poor whites had lower transferrin saturation and iron intake means than the nonpoor whites, while the Food Stamp Program participants were no different from the nonparticipants in transferrin saturation. Within the nonwhites, the poor had a lower hemoglobin mean than the nonpoor, and the program participants had a lower hemoglobin mean than the nonparticipants. Therefore, the Food Stamp Program was not consistently associated with better iron nutrition of the elderly poor in NHANES I and II.