重度子痫前期并发不良结局149例危险因素分析

Objective To explore clinical features of severe preeclampsia patients with adverse outcome, and the risk factors of adverse outcomes. Methods From Jan. 2008 to Dec. 2009 149 severepreeclampsia impatients who occurred adverse outcome enrolled as case,and 278 severe preeclampsia impatientswithout adverse outcome at the same period enrolled as control. The clinical features between the two groups were compared and the risk factors were investigated. Results No significant differences were found between the two groups in maternal age,times of previous prenancies. The gestation ages at the onset of preeclampsia and at delivery in the cases were less than controls(P ＜ 0. 05). There was significant difference in irregular antenatal checks between the two groups(x2 = 8. 515, P ＜ 0. 05). Proterinuria and the level of oedema in cases were higher than controls( P ＜ 0. 05). Fetal growth restriction (FGR) occurred more frequently in the cases (P ＜0. 05). Indirect bilirubin, total bilirubin, glutamic oxalacetic transaminase, glutamic pyruvic transaminase, uric acid, creatinine, white blood cell, thrombin time, D-dimeride of cases were higher than those of controls(Ps ＜0. 05). Albumin, platelet and profibrin of cases were lower than those of controls(Ps ＜ 0. 05 ＝. Multivariate logistic analysis showed that the gestation ages at the onset of preeclampsia, regular antenatal checks were significantly associated with adverse outcome(OR = 0. 899, P ＜ 0. 001; OR = 0. 600, P = 0. 022, respectively ＝Indirect bilirubin and D-dimeride were significantly associated with preeclampsia complications(OR = 1. 533,P =0. 010; OR = 1.001, P = 0. 003, respectively). Mean arterial pressure and creatinine were significantly associated with eyeground changes(respectively OR = 1. 030,P = 0. 048; OR = 1. 025, P = 0. 022, respectively).Regular antenatal checks was associated with dead fetus(OR = 0. 317, P = 0. 046). No significant differenceswere found between the two group in uterine-incision delivery(P ＞ 0. 05). Incidence rate of low birth weight infants and postpartum hemorrhage of cases were higher than controls and Apgar score was lower in cases than controls( all P ＜0. 05＝. Conclusion The gestation ages at the onset of preeclampsia,regular antenatal checks,fetal distress were risk factors for preeclampsia adverse outcome. Patients with.high indirect bilirubin and Ddimeride are more likely to suffer adverse pregnancy outcomes.     

子痫前期患者外周血中抗血管紧张素Ⅱ受体1型自身抗体的表达

目的 通过检测抗血管紧张素Ⅱ受体1型自身抗体(AT1-AA)在子痫前期患者外周血中的表达,探讨其在子痫前期发病中的病理生理机制.方法 选择子痫前期患者30例,正常晚期妊娠患者20例,未孕健康妇女20例.以合成的抗血管紧张素Ⅱ受体为抗原,采用间接SA-ELISA法检测外周血AT1-AA的表达.结果 子痫前期组外周血AT1-AA的阳性率为(65.0±4.7)%,明显高于正常晚期妊娠对照组(26.0±2.8)%和未孕健康妇女对照组(7.8±2.2)%,差异均有统计学意义(t值分别为24.97、38.56,P均＜0.01).正常晚期妊娠对照组的阳性率与未孕健康妇女对照组比较差异也有统计学意义(t=4.58,P＜0.05).结论 子痫前期患者外周血中的抗AT 1-AA高于正常孕妇和未孕健康妇女,提示AT1-AA在子痫前期发病中其重要作用;正常孕妇血清中抗AT1-AA的阳性率也明显高于同龄未孕健康妇女,提示孕期有免疫机制的参与.

Abstract：

Objective To investigate the role of subtype 1 autoantibody against angiotensin Ⅱ receptor in the pathogenesis of preeclampsia by detecting its expression in the peripheral blood of preeclampsia patients,Methods Thirty patients with preeclampsia were assigned to preeclampsia group. Twenty normal pregnant women at the late stage and twenty non-pregnant healthy women as controls were investigated. The level of type 1 antoantibody against angiotensin Ⅱ in the peripheral blood was detected by indirect SA-ELISA assay with the produced ATR-1 as the antigen. Results The level of subtype 1 antoantibody against angiotensin Ⅱ (65 ±4. 7) % in the peripheral blood of preeclampsia patients is significantly higher than that of normal late pregnant (26 ±2. 8)% and non-pregnant women(7.8 ±2. 2)% groups (t1 =24. 97 ;t2 =38.56;P ＜0. 01 for both) ;The angiotensin Ⅱ receptor subtype 1 autoantibody in the group of normal late pregnancy (26 ± 2. 8 )% was significantly higher than that of healthy non-pregnant women group ( 7. 8 ± 2. 2 ) % ( t = 4. 58, P ＜ 0. 05 ).Conclusion Compared with the normal pregnant women and the healthy non-pregant women, the autoantibody against AT1 receptor in sera of preeclamptic patients is elevated ata high frequency. These results suggest that overproduction of AT1-AA may play an important role during the development of preeclamptic patients. AT1-AA is a novel risk factor in pregnant women. Immune mechanisms may be involved in the process of pregnancy.     

卵巢子宫内膜异位症患者异位和在位内膜中缺氧诱导因子-1α的表达及其临床意义

Objective To investigate the significance of hypoxia inducible factor-1(HIF-1) expression in ovarian endometriosis (Oems). Methods Elivision Tm plus Immunohistochemical and Stereology methods were used to detect HIF-1 expression in 30 cases of ectopic endometrium, 30 cases of eutopic endometrium in ovarian endometriosis and 30 cases of endometrium in ovarian teratoma as the normal control. Quantitative images analysis was performed with the aid of computer to collect and analyze the mean optical density (MOD) of HIF-1 expression. Results The MOD values of HIF-1 in ectopic and eutopic endometrium of Oems and the normal control were 0. 077 ± 0. 014, 0. 070 ± 0. 013 and 0. 061 ± 0. 007 respectively, which showed significantly differences between each other groups(F = 37. 738, P ＜ 0. 01 ＝. HIF-1 expression in proliferative phase (0.076 ±0.007) of eutopic endometrium of Oems was significantly higher than that in secretary phase (0. 059 ±0. 014) (t = 6. 918 ,P ＜0. 01 ＝; which was also significantly higher than that of the normal control in the same phase (0.060±0.007) (t=-12.724,P ＜0.01 ＝.Conclusion HIF-1 may play an important role in the pathogenesis and development of Oems.     

GSTA1基因多态性对环磷酰胺辅助化疗的乳腺癌患者预后的影响

Objective To investigate the association between the genetic polymorphisms in GSTA1 and the clinical outcome of breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy. Methods A total of 137 breast cancer patients receiving cyclophosphamide-based adjuvant chemotherapy were recruited ( 124 cases with infiltrative ductal carcinoma, 5 cases with infiltrative lobular carcinoma and 8 cases with other histological types). PCR-LDR method was used to detect the genotypes of GSTA1. Survival curves were generated by the Kaplan-Meier method, and verified by the log-rank test. Cox proportional hazards regression analysis was used to estimate the prognostic factors in multivariate analysis. Results Of the 137 breast cancer patients, the genotypic frequencies of the GSTA1 * A/* A,* A/* B and * B/* B were 67.2% ( 92/137 ), 31.4% ( 43/137 ) and 1.5% ( 2/137 ), respectively. No significant differences were found between the genotypic frequencies and groups categorization according to age, stage, lymph node metastasis, ER or PR status (x2 = 0. 722,1. 967, 3. 303, 0. 226 and 0. 709, all P ＞0. 05 ) ;through Fisher exact test, also no significant differences were found between the genotypic frequencies and group categorization according to tumor size, histological types and grading ( all P ＞ 0. 05 ) . The recurrence rates in patients with GSTA1 * A/* A and * A/* B or * B/* B genotypes were 47. 8% (44/92) and 31.1% ( 14/45 ), respectively, and the mortality rates were 22. 8% ( 21/92 ) and 17. 8% ( 8/45 ),respectively. Patients with GSTA1 * A/* B and * B/* B genotypes were significantly associated with reduced hazard of relapse (x2 =18.723, P＜0. 01)and mortality (x2 =7.352, P＜0.01), compared to cases with the common * A/* A genotypes, according to Kaplan-Meier survival analysis and log-rank test. Moreover,Cox multivariate analysis showed that GSTA1 polymorphisms appeared to be an independent risk factor for recurrence-free survival ( OR =0. 222, 95% CI:0. 108-0. 458, P ＜0. 01 ) and overall survival ( OR =0. 362,95% CI:0. 145-0. 902, P ＜ 0. 05 ). Conclusion These data indicate that GSTA1 polymorphism may be a potential prognostic factor for recurrence-free survival and overall survival in breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy.     

危重症专科小组运作在呼吸道护理管理中的应用及效果

Objective To investigate the role and effect of critical cases specialist group' s operation mode on the nursing quality of respiratory tract. Methods Totally 106 tracheal intubation patients were selected for experiments. 57 cases that use specialist group's operation mode are in experimental group;and others are in control group, which don' t use specialist group' s operation mode. For experimental group, critical cases specialist group was established to organize regular patient rounds, instruct consultations, formulate work direction and nursing quality standards and evaluation indexes;the critical cases of patients with nursing quality were evaluated with three-tier process monitoring;while control group were treated with traditional head nurse rounds guidance, nurses supervision inspection second-level monitoring. This research chose the accident rate of ventilator-associated pneumonia and respiratory care to be one index of the nursing quality for critical cases.Results Ventilator related pneumonia (VAP) and take off tube incidence reduced significantly, the differences were statistically significant (7. 70% vs 20.04%, χ2 = 4. 51, P ＜ 0. 05;10. 52% vs 26.53 %, χ2 = 5.69, P ＜0. 05). The nursing problems and nursing complaints solved by nurses were more than the control group(P ＜0. 05);Doctors' and patients' satisfaction with nursing care were also improved (P ＜0. 05). Conclusions Critical cases specialist group' s operation mode can improve the professional skill of nurses for critical cases;formulate nursing management of clinical critical cases respiratory nursing;improve the nursing quality of respiratory tract.     

GSTA1基因多态性对环磷酰胺辅助化疗的乳腺癌患者预后的影响

Objective To investigate the association between the genetic polymorphisms in GSTA1 and the clinical outcome of breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy. Methods A total of 137 breast cancer patients receiving cyclophosphamide-based adjuvant chemotherapy were recruited ( 124 cases with infiltrative ductal carcinoma, 5 cases with infiltrative lobular carcinoma and 8 cases with other histological types). PCR-LDR method was used to detect the genotypes of GSTA1. Survival curves were generated by the Kaplan-Meier method, and verified by the log-rank test. Cox proportional hazards regression analysis was used to estimate the prognostic factors in multivariate analysis. Results Of the 137 breast cancer patients, the genotypic frequencies of the GSTA1 * A/* A,* A/* B and * B/* B were 67.2% ( 92/137 ), 31.4% ( 43/137 ) and 1.5% ( 2/137 ), respectively. No significant differences were found between the genotypic frequencies and groups categorization according to age, stage, lymph node metastasis, ER or PR status (x2 = 0. 722,1. 967, 3. 303, 0. 226 and 0. 709, all P ＞0. 05 ) ;through Fisher exact test, also no significant differences were found between the genotypic frequencies and group categorization according to tumor size, histological types and grading ( all P ＞ 0. 05 ) . The recurrence rates in patients with GSTA1 * A/* A and * A/* B or * B/* B genotypes were 47. 8% (44/92) and 31.1% ( 14/45 ), respectively, and the mortality rates were 22. 8% ( 21/92 ) and 17. 8% ( 8/45 ),respectively. Patients with GSTA1 * A/* B and * B/* B genotypes were significantly associated with reduced hazard of relapse (x2 =18.723, P＜0. 01)and mortality (x2 =7.352, P＜0.01), compared to cases with the common * A/* A genotypes, according to Kaplan-Meier survival analysis and log-rank test. Moreover,Cox multivariate analysis showed that GSTA1 polymorphisms appeared to be an independent risk factor for recurrence-free survival ( OR =0. 222, 95% CI:0. 108-0. 458, P ＜0. 01 ) and overall survival ( OR =0. 362,95% CI:0. 145-0. 902, P ＜ 0. 05 ). Conclusion These data indicate that GSTA1 polymorphism may be a potential prognostic factor for recurrence-free survival and overall survival in breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy.     

小儿麻醉临床分析研究

Objective To investigate the ketamine and propofol anesthesia for pediatric clinical effect.Methods From january 2009 to February 2010 in our hospital 80 cases surgery children were randomly divided into two groups of 37 cases of ketamine anesthesia using ketamine alone, 43 cases combined with propofol ketamine anesthesia to observe the postoperative incidence of adverse reactions, and postoperative recovery time,for statistical analysis. Results The preoperative and postoperative changes in HR and RR were better than the ketamine group, the difference was statistically significant, P＜ 0. 05; 9.3% adverse reaction rate in combined group was 24. 3% lower than the ketamine group,There were significant differences between groups, P ＜0. 05;recovery time in children of combimed group were less than ketamine group, the difference was also statistically significant, P＜ 0.05. Conclusion Ketamine and propofol anesthesia for children is better than a single ketamine anesthesia, should be widely applied.     

结合珠蛋白基因多态性与急性冠脉综合征的相关性研究

Objective To assess the association of Haptoglobin(Hp) polymorphism with acute coronary syndrome(ACS) in Chinese. Method A total of 112 patients with ACS including 57 patients with acute myocardial infarction and 55 patients with unstable angina pectoris confirmed with angiography and 121healthy controls were recruited in this study. Polymerase chain reaction (PCR) method was utilized to genotype Hpl and Hp2 alleles and genotype frequencies in cases and controls were compared. All polymorphisms were test of Hardy-Weinberg equilibrium in both groups separately. The differences of genotypes and alleles between two groups were analyzed with x2 test. The association between Hp polymorphism and the risk of ACS was estimated by odds ratio (OR) and their 95% confidence intervals (95% CI), and the comprehensive evaluation of the factors associated with ACS were determined by using multivariate logistic regression analysis. P ＜0.05 was considered to be statistically significant. Results The frequency of Hp2-2 genotype was significantly higher in ACSs than in controls (0. 571 vs. 0. 355, P = 0. 001; OR = 2. 419, 95% CI:1. 427 ～4. 100), multivariate Logistic regression analysis indicates that Hp2-2 genotype is an independent risk factor to ACS (P = 0.002; OR = 2.557,95% CI: 1. 392 - 4.637). Similarly, the Hp2 allele frequency in ACS groups was significantly higher than that in the control subjects (0. 759 vs. 0. 616, P =0.001; OR = 1. 965,95% CI 1. 316 ～2. 934). Conclusion The Hp2-2 genotype is associated with ACS in Chinese. Hp2-2 genotype may be an independent risk factor to ACS, and Hp2 allele may be a genetic susceptibility factor to ACS in Chinese.     

进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

卵巢子宫内膜异位症患者异位和在位内膜中缺氧诱导因子-1α的表达及其临床意义

目的 探讨缺氧诱导因子-1α(HIF-1α)在卵巢子宫内膜异位症组织中表达的意义.方法 应用Elivision Tm plus免疫组化方法分别检测30例卵巢子宫内膜异位症异位、在位内膜和非子宫内膜异位症(Ems)子宫内膜组织(对照组)中的HIF-1α,并应用计算机图像分析系统对结果进行体视学指标平均吸光度的检测.结果 卵巢子宫内膜异位症组异位内膜、在位内膜及对照组中HIF-1α的平均吸光度分别为(0.077±0.014)、(0.070±0.013)及(0.061±0.007),3组比较差异有统计学意义(F=37.738,P＜0.01＝.HIF-1α蛋白在卵巢子宫内膜异位症组在位内膜增生期的表达(0.076±0.007)高于分泌期(0.059±0.014)(t=6.918,P＜0.01＝,高于对照组同期水平(0.060±0.007)(t=12.724,P＜0.01＝.结论 HIF-1可能与卵巢子宫内膜异位症的发生、发展密切相关.

Abstract：

Objective To investigate the significance of hypoxia inducible factor-1(HIF-1) expression in ovarian endometriosis (Oems). Methods Elivision Tm plus Immunohistochemical and Stereology methods were used to detect HIF-1 expression in 30 cases of ectopic endometrium, 30 cases of eutopic endometrium in ovarian endometriosis and 30 cases of endometrium in ovarian teratoma as the normal control. Quantitative images analysis was performed with the aid of computer to collect and analyze the mean optical density (MOD) of HIF-1 expression. Results The MOD values of HIF-1 in ectopic and eutopic endometrium of Oems and the normal control were 0. 077 ± 0. 014, 0. 070 ± 0. 013 and 0. 061 ± 0. 007 respectively, which showed significantly differences between each other groups(F = 37. 738, P ＜ 0. 01 ＝. HIF-1 expression in proliferative phase (0.076 ±0.007) of eutopic endometrium of Oems was significantly higher than that in secretary phase (0. 059 ±0. 014) (t = 6. 918 ,P ＜0. 01 ＝; which was also significantly higher than that of the normal control in the same phase (0.060±0.007) (t=-12.724,P ＜0.01 ＝.Conclusion HIF-1 may play an important role in the pathogenesis and development of Oems.     

重度子痫前期孕妇不良妊娠结局的危险因素分析

目的 探讨重度子痫前期孕妇发生不良妊娠结局的相关危险因素.方法 回顾性分析2012年6月至2013年6月在汕头大学医学院第一附属医院住院分娩的重度子痫前期孕妇122例临床资料,按妊娠结局分为不良妊娠结局组27例和良好妊娠结局95例.结果 ①一般资料：两组孕妇妊娠终止孕周及入院时舒张压比较,差异有统计学意义（P＜0.05）.②相关实验室检查结果比较：不良妊娠结局组尿蛋白定量明显高于良好妊娠结局组,差异有统计学意义（P＜0.05）.不良妊娠结局组的血小板计数明显低于良好妊娠结局组,而红细胞压积却明显低于良好妊娠结局组,差异均有统计学意义（P＜0.05）.不良妊娠结局组的丙氨酸氨基转移酶（ALT）,血尿素氮（BUN）的水平均明显高于良好妊娠结局组,差异有统计学意义（P＜0.05）.③出现不良妊娠结局的危险因素分析：孕妇入院时舒张压越高（OR值2.13）,终止妊娠时孕周越早（OR值0.42）,血小板计数越低（OR值0.78）,与不良妊娠结局的相关.结论 重度子痫前期孕妇入院时舒张压,终止妊娠时孕周,血小板计数是判定出现不良妊娠结局的高危因素,可以指导临床医生适时终止妊娠.     

趋化因子受体4和血管内皮生长因子在肾癌中的表达及其临床意义

目的 探讨趋化因子受体4(CXCR4)和血管内皮生长因子(VEGF)在肾癌的发生、发展中的作用及临床意义.方法 采用免疫组织化学技术SP法检测CXCR4和VEGF在56例肾癌标本(包括20例伴有淋巴结转移的肾癌组织及肾周转移的淋巴结)、10例癌旁正常组织中的表达.结果 56例肾细胞癌组织中CXCR4、VEGF的表达阳性率分别为66.1%(37/56),73.2%(41/56),明显高于正常肾组织的表达阳性率20.0%(2/10)、30.0%(3/10),两者间差异有统计学意义(P＜0.05＝.肾癌组织中CXCR4和VEGF的表达呈正相关(r=0.315,P＜0.05＝,CXCR4和VEGF的表达与肾细胞癌的分期(χ2=9.520,P=0.023;χ2=9.072,P=0.027),肿瘤的侵袭转移(χ2=4.972,P=0.026;χ2=3.910,P=0.034)及微血管密度(P＜0.05＝有关,与患者的性别(χ2=0.020,P=0.887;χ2=0.001,P=0.716)、肿瘤的大小(χ2=0.003,P=0.995;χ2=0.108,P=0.990)、病理类型(χ2=1.960,P=0.900;χ2=0.112,P=0.994)无关.结论 CXCR4和VEGF在肾癌中呈高表达并且表达呈正相关,与肾癌的发展转移及预后密切相关.可以作为判断肾癌的侵袭转移及预后的重要指标,并给肾癌的治疗提供前景.

Abstract：

Objective To study the role and clinical significance of chemokine receptor-4 (CXCR4) and vascular endothelial growth factor (VEGF) in the occurrence and development of renal cell carcinoma. Methods Expression of CXCR4 and VEGF were detected by SP immunohistochemical technique in 56 cases of kidney carcinoma tissues (including 20 cases of lymph node metastasis), 10 normal tissues nearby kidney cancer. Results The positive rates of CXCR4 and VEGF were 66. 1% (37/56) and 73. 2% (41/56),which were significantly higher than those in normal tissues( 20. 0% (2/10) and 30. 0% (3/10), respectively) (P ＜ 0. 05 ＝. The expression of CXCR4 protein was significantly positively correlated with that of VEGF protein (r = 0. 315 ,P ＜ 0.05 ＝ in renal cell carcinoma. The expression of CXCR4 and VEGF was closely related to stages of tumor ( χ2 = 9. 520, P = 0. 023; χ2 = 9. 072, P = 0. 027 ), lymphatic metastasis, degree of invasion ( χ2 =4. 972, P = 0. 026; χ2 = 3.910, P = 0. 034 ), and microvessel density ( MVD) ( P ＜ 0. 05 ＝. However, they were not related to sex ( χ2 = 0. 020, P= 0. 887; χ2 = 0. 001, P = 0. 716 ), tumor size ( χ2 = 0. 003, P = 0. 995; χ2 =0. 108, P = 0. 990) and pathologic types ( χ2 = 1. 960, P = 0. 900; χ2 = 0. 112, P = 0. 994). Conclusion There is a significant positive correlation between high expressions of CXCR4 and VEGF proteins in renal cell carcinoma,the high expressions of CXCR4 and VEGF proteins may be related to the metastasis and prognosis of renal cell carcinoma,thus they could be used as important indicators in judging the metastasis prognosis of renal cell carcinoma,and offer prospects for the treatment of renal cell carcinona.     

早发型子痫前期与妊娠结局的关系及相关因素分析

目的 探讨早发型（妊娠＜34周）子痫前期与患者妊娠结局的关系以及明确发生早发型子痫前期的相关因素。方法 回顾性分析2008年1月至2013年1月在本院妇产科进行分娩的纳入符合研究标准的孕产妇25360例的临床资料,对发生早发型子痫前期的孕妇的相关因素进行分析,并对妊娠结局的影响进行分析。结果 早发型子痫前期的孕妇有96例,占0．37％,其中12例在妊娠34周后分娩。孕妇年龄≥35岁（ P ＝0．006;95％ CI ,1．309～5．135）、初产（ P ≤0．001;95％ CI ,2．525～5．052）、糖尿病（ P ≤0．001;95％ CI ,2．029～8．669）、慢性高血压（ P ≤0．001;95％ CI ,9．112～37．303）、先天性异常（ P ≤0．001;95％C I ,2．632～11．222）是早发型子痫前期的高危因素。早发型子痫前期患者在围产期发生不良结果较非早发型子痫前期患者严重,其中与新生儿病死相关因素包括：胎死、小于胎龄儿、围产期新生儿死亡。结论 依据早发型子痫前期的相关因素以及可能的妊娠结局,可以尽早区别孕产妇情况和预防干预妊娠结局。     

子痫前期并发幽门螺旋杆菌感染患者血清 miR-31-5p表达与不良妊娠结局的相关性研究

目的　探究血清微小核糖核酸 -31-5p（miR-31-5p）表达与子痫前期（ PE）并发幽门螺旋杆菌（ Hp）感染患者不良妊娠结局的相关性。方法　选取 2019年 1月～ 2020年 5月在唐山市妇幼保健院就诊的 204例 PE并发 Hp感染患者作为研究对象，并根据妊娠结局将其分为不良妊娠组（ n=121）和正常妊娠组（ n=83）。用实时荧光定量 PCR法检测 PE确诊时（ T0）、妊娠 28周第 1天（T1）和妊娠 30周第 1天（T2）的血清 miR-31-5p表达量。结果　不良妊娠组的收缩压、舒张压、24 h尿蛋白和剖宫产率分别为 155.64±11.89mmHg，101.25±6.16mmHg，2.69±0.52g/24 h和 85.95%，均高于正常妊娠组（151.75±11.34mmHg，97.93±8.79mmHg，2.06±0.29g/24 h和 65.06%)；分娩孕周为 34.79±2.06周，低于正常妊娠组（ 37.94±0.97周），差异均有统计学意义（ t/χ2=2.344～ 14.631，均 P<0.05）。不良妊娠组的血清 T0-miR-31-5p，T1-miR-31-5p和 T2-miR-31-5p相对表达量分别为 2.42±0.39，2.20±0.42和 2.10±0.25，均高于正常妊娠组（2.11±0.32，     

肿瘤外科ICU室上性心律失常的发生率及危险因素分析

目的 探讨肿瘤外科ICU室上性心律失常(SVAs)的发生率及危险因素.方法 回顾分析我院ICU 2008年11月至2009年10月间收治570例患者的临床资料,对SVAs可能的影响因素进行单因素和多因素Logistic分析.结果 13例有心房颤动病史的患者被除外,入选557例.SVAs发生率为12.93%(72/557).多因素分析显示年龄(OR=1.066,95%CI:I.034～1.099,P＜0.001)、冠心病病史(OR=2.644,95%CI:1.459～4.790,P＜0.05)、转入时确诊为脓毒症(OR=2.374,95%CI:1.098～5.135,P＜0.05)和胸部外科手术操作(OR=2.322,95%CI:1.061～5.084,P＜0.05)是SVAs发生的独立危险因素.SVAs患者与非SVAs组住ICU时间[2(1～77)、3(1～40)d,Z=-3.505,P＜0.001]和APACHEⅡ评分[9(0～37)、11(3～38)分,Z=-3.332,P=0.001],差异有统计学意义.SVAs组死亡9例(12.5%),非SVAs组死亡19例(3.9%),病死率差异有统计学意义(x2=9.673,P=0.002).结论 肿瘤外科ICU患者术后SVAs的发生率较高,年龄、冠心病病史、转入ICU时确诊有脓毒症和胸部外科手术操作是术后SVAs发生的独立危险因素.SVAs增加患者住ICU时间,是反映患者病情严重性的一种标志.

Abstract：

Objective To evaluate the incidence and to investigate risk factors of supraventricular arrhythmia (SVAs) in postoperative cancer patients in intensive care unit ( ICU ). Methods Data of 570 patients consecutively admitted to oncologic surgical ICU of Cancer Hospital of Chinese Academy of Medical Sciences from Nov. 2008 to Oct. 2009 were retrospectively collected. Univariate and multivariate logistic analysis were conducted for potential factors that influenced SAVs. Results Thirteen patients with a history of atrial fibrillation (AF) were excluded and 557 patients were eligible for the study. SVAs occurred in 72 patients ( 12. 93% ). Multivariate analysis showed four independent predictors of SVAs including age ( OR = 1. 066,95%CI: 1. 034 - 1. 099,P ＜0. 001 ) ,a history of coronary heart diseases ( OR = 2. 644,95% CI: 1. 459 - 4. 790,P ＜ 0. 05), sepsis ( OR = 2. 374,95% CI: 1. 098 - 5. 135, P ＜ 0. 05 ) and intra-thoracic procedure ( OR =2. 322,95 % CI: 1.061 - 5.084, P ＜ 0. 05 ) . ICU length of stay, severity ( APACHE Ⅱ scores in SVAs patients) were significantly greater in patients who were not affected by SVAs ( ICU stay: [2 ( 1 ～ 77 )]vs [3 ( 1 ～ 40 )]days,P ＜ 0. 001; APACHE Ⅱ score: [9 (0 ～ 37 )] vs [11 (3 ～ 38 )], P = 0. 001 ). Nine cases died in SVAs patients ( 12. 5% ) and 19 died in the non-SVAs patients (3.9%), with significant difference between the two groups( x2 = 9. 673, P = 0. 002). Conclusion In oncologic surgical ICU, the incidence of SVAs is high. Age,history of coronary heart diseases, sepsis and intra-thoracic procedure were independent rsik factors of SVAs. SVAs prolong ICU length of stay. SVAs is a marker of critical illness severity.     

GSTA1基因多态性对环磷酰胺辅助化疗的乳腺癌患者预后的影响

目的 探讨GSTA1基因多态性与接受CTX类药物辅助化疗乳腺癌患者预后的关系.方法 对采用CTX类药物为主的方案进行辅助化疗的137例确诊乳腺癌患者(浸润性导管癌患者124例,浸润性小叶癌患者5例,其他类型癌症患者8例),用PCR-LDR检测其GSTA1基因多态性,Kaplan-Meier法绘制生存曲线,log-rank法比较不同基因型组间生存差异,并用Cox比例风险回归模型进行预后影响因素的多因素分析.结果 137例乳腺癌患者中,GSTA1*A/*A、*A/*B和-B/*B基因型频率分别为67.2%(92/137)、31.4%(43/137)和1.5%(2/137).乳腺癌患者的GSTA1基因型频率在按年龄、临床分期、淋巴结转移、雌、孕激素受体状态等临床病理特征分组的分布差异均无统计学意义(x2值分别为0.722、1.967、3.303、0.226、0.709,P均＞0.05);经Fisher精确概率分析,肿瘤大小、病理组织类型、病理分级的差异均无统计学意义(P均＞0.05).携带GSTA1-A/*A基因型和*A/*B或*B/-B基因型的乳腺癌患者复发率分别为47.8%(44/92)和31.1%(14/45),死亡率分别为22.8%(21/92)和17.8%(8/45).Kaplan-Meier生存曲线和log-rank分析显示,携带GSTA1*A/*B+*B/*B基因型乳腺癌患者的无复发生存率和总生存率均高于携带GSTA1*A/*A基因型患者,且差异均有统计学意义(x2值分别为18.723、7.352,P均＜0.01).经Cox多因素分析,GSTA1基因多态性是影响乳腺癌患者无复发生存[OR=0.222,95%CI:0.108～0.458,P＜0.01]和总生存[OR=0.362,95%CI:0.145～0.902,P＜0.05]的独立因素.结论 GSTA1基因多态性是乳腺癌患者CTX药物辅助化疗无复发生存和总生存的预测标志.

Abstract：

Objective To investigate the association between the genetic polymorphisms in GSTA1 and the clinical outcome of breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy. Methods A total of 137 breast cancer patients receiving cyclophosphamide-based adjuvant chemotherapy were recruited ( 124 cases with infiltrative ductal carcinoma, 5 cases with infiltrative lobular carcinoma and 8 cases with other histological types). PCR-LDR method was used to detect the genotypes of GSTA1. Survival curves were generated by the Kaplan-Meier method, and verified by the log-rank test. Cox proportional hazards regression analysis was used to estimate the prognostic factors in multivariate analysis. Results Of the 137 breast cancer patients, the genotypic frequencies of the GSTA1 * A/* A,* A/* B and * B/* B were 67.2% ( 92/137 ), 31.4% ( 43/137 ) and 1.5% ( 2/137 ), respectively. No significant differences were found between the genotypic frequencies and groups categorization according to age, stage, lymph node metastasis, ER or PR status (x2 = 0. 722,1. 967, 3. 303, 0. 226 and 0. 709, all P ＞0. 05 ) ;through Fisher exact test, also no significant differences were found between the genotypic frequencies and group categorization according to tumor size, histological types and grading ( all P ＞ 0. 05 ) . The recurrence rates in patients with GSTA1 * A/* A and * A/* B or * B/* B genotypes were 47. 8% (44/92) and 31.1% ( 14/45 ), respectively, and the mortality rates were 22. 8% ( 21/92 ) and 17. 8% ( 8/45 ),respectively. Patients with GSTA1 * A/* B and * B/* B genotypes were significantly associated with reduced hazard of relapse (x2 =18.723, P＜0. 01)and mortality (x2 =7.352, P＜0.01), compared to cases with the common * A/* A genotypes, according to Kaplan-Meier survival analysis and log-rank test. Moreover,Cox multivariate analysis showed that GSTA1 polymorphisms appeared to be an independent risk factor for recurrence-free survival ( OR =0. 222, 95% CI:0. 108-0. 458, P ＜0. 01 ) and overall survival ( OR =0. 362,95% CI:0. 145-0. 902, P ＜ 0. 05 ). Conclusion These data indicate that GSTA1 polymorphism may be a potential prognostic factor for recurrence-free survival and overall survival in breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy.     

Maternal plasma concentrations of insulinlike growth factor-1 and insulinlike growth factor-binding protein-1 in early pregnancy and subsequent risk of preeclampsia

OBJECTIVES: We investigated the relationship between maternal plasma free insulinlike growth factor-1 (IGF-1) and insulinlike growth factor-binding protein-1 (IGFBP-1) concentrations and risk of preeclampsia. DESIGN AND METHODS: Maternal blood samples were collected at 13 weeks' gestation on average. From the cohort, we selected 53 women who developed preeclampsia and 477 who remained normotensive. Free IGF-1 and IGFBP-1 concentrations were measured using immunoassays. Logistic regression procedures were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Women who developed preeclampsia had 18% and 27% lower concentrations of free IGF-1 and IGFBP-1, respectively, than controls (P < 0.05). There was a 57% reduced risk of preeclampsia among women with free IGF-1 concentrations of >or= 0.81 ng/mL (OR = 0.43, 95% CI 0.23-0.83) and a 43% reduced risk among women with IGFBP-1 concentrations of >or= 72.36 ng/mL (OR = 0.53, 95% CI 0.23-1.21). CONCLUSIONS: Alterations of free IGF-1 and IGFBP-1 concentrations in maternal plasma during early pregnancy are associated with risk of preeclampsia. These associations may help to further elucidate the pathologic processes of preeclampsia.     

Concentrations of estrogens in patients with preeclampsia

The role of estrogens in the pathophysiology of preeclampsia remains to be determined. The aim of our study was to compare serum concentrations of 17 beta-estradiol and estriol in women with preeclampsia to normotensive pregnant controls. Serum concentrations of estrogens were measured in women with mild (n = 24) and severe (n = 24) preeclampsia as well as is normotensive pregnant controls (n = 24). Patients were matched for gestational age. Pregnancies complicated by early onset severe preeclampsia are associated with increased rates of maternal and fetal morbidity. Subsequently, we created further subgroups before and after 34 weeks of gestation (34 + 0). Serum estrogen concentrations were determined by standard ELISA technique. Compared to normotensive controls, the differences between the overall median serum concentrations of 17 beta-estradiol in women with mild (3811 v. 3730 pg/ml, P = 0.9) and severe (3811 v. 3630 pg/ml, P = 0.1) preeclampsia were statistically not significant. The differences between the overall median serum concentrations of estroil in controls and in patients with mild (121 v. 76 ng/ml, P = 0.6) and severe (121 v. 79 ng/ml, P = 0.4) preeclampsia were similar. The differences between the median concentrations of 17 beta-estradiol in patient with early onset severe preeclampsia compared to patients with mild preeclampsia (3061 v. 3715 pg/ml, P = 0.004) and controls (3061 v. 3807 pg/ml, P = 0.006) were statistically significant. In addition, the differences between the median concentrations of estriol in women with early onset severe preeclampsia compared to controls were statistically significant (20 v. 92 ng/ml, P = 0.02). The differences between the median concentrations of estrogens in those with late onset severe preeclampsia compared to women with mild preeclampsia were not significant. We found significantly lower concentrations of estrogens in women with early onset severe preeclampsia.