中晚期孕妇血清亮氨酸氨基肽酶水平及其临床意义

目的 探讨中晚期孕妇血清亮氨酸氨基肽酶(LAP)的变化水平及其临床意义.方法 采用速率法分别检测175例中期妊娠(162例为正常妊娠)妇女、302例晚期妊娠(215例为正常妊娠)妇女及100例健康未孕妇女的血清LAP水平.结果 正常中期妊娠组血清LAP活性为(140.43±64.39)U/L,正常晚期妊娠组为(234.72±93.53)U/L,对照组为(72.62±15.31)U/L,前两组的LAP活性显著高于对照组(P＜0.05).当妊娠合并肝内胆汁淤积(ICP)时,均较相应正常妊娠组LAP活性显著增高.结论 正常妊娠随着孕周的增加,血清LAP活性随之升高,但如合并ICP时升高更为显著.妊娠高血压综合征时LAP轻微升高,早产时略有降低.LAP水平的变化可作为妊娠合并ICP及孕妇和胎儿健康情况动态监测的一项有效指标.     

异常妊娠孕妇血清亮氨酸氨基肽酶活性检测的价值

目的探讨孕妇血清亮氨酸氨基肽酶(LAP)检测在异常妊娠中的临床价值。方法分别检测早期妊娠(4~13周,其中宫外孕34例、正常妊娠34例)、中期妊娠(13~28周,其中先兆流产32例、正常妊娠51例)、晚期妊娠(28~41周,其中子痫前期39例、肝内胆汁淤积症30例、多胎妊娠30例、正常妊娠54例)妇女血清LAP、碱性磷酸酶(ALP)和丙氨酸氨基转移酶(ALT)活性并做比较。结果早期妊娠中宫外孕组LAP活性明显低于正常妊娠组(P0.05),ALP和ALT活性2组间差异无统计学意义(P0.05)。中期妊娠中先兆流产组血清LAP、ALP、ALT与正常妊娠组比较差异均无统计学意义(P0.05)。晚期妊娠中子痫前期组LAP活性虽高于正常妊娠组,但差异无统计学意义(P0.05),而肝内胆汁淤积症组和多胎妊娠组LAP、ALP和ALT活性均明显高于正常妊娠组(P0.05)。结论连续测定LAP活性可监测妊娠过程中有无异常,对监测胎盘功能及妊娠并发症具有一定的意义。     

应用ROC曲线分析几项生化指标在妊娠期肝内胆汁淤积症诊断中的价值

目的分析血清碱性磷酸酶（ALP）、总胆红素（TBIL）、亮氨酸氨基肽酶（LAP）等生化指标在妊娠期肝内胆汁淤积症（ICP）诊断中的临床应用价值。方法收集440例妊娠中晚期孕妇（住院和门诊）的血样，采用速率法检测ALP，TBIL，LAP等生化指标的活性，以甘胆酸（CG）为标准，应用ROC曲线进行分析比较。结果ICP组的各项生化指标值明显高于正常组妊娠（P〈0.05），中孕组各项指标的ROC曲线下面积（AUC）分别为：ALP0．812，LAP0．730，TBIL0．597；晚孕组的为：ALP0．763，LAP0．702，TBIL0．593。ALP，TBIL及LAP与CG均有相关性（P均〈0．05）。结论妊娠中晚期妇女血ALP与LAP活性水平升高是反映肝内胆汁淤积的良好指标，检测方法较CG测定简便、快捷，在各级医院易于推广应用。     

亮氨酸氨基肽酶在HBV慢性肝病鉴别诊断中的意义

目的检测HBV慢性肝病患者血清中的亮氨酸氨基肽酶（leucine aminopeptidase，LAP）活性变化，探讨其临床意义。方法采用速率法检测HBV慢性肝病患者血清LAP的活性,选择110例健康献血员做对照，对118例HBV慢性肝病患者（慢性肝炎组、代偿期肝炎肝硬化组、失代偿期肝炎肝硬化组）血清中LAP活性进行了测定。结果在HBV慢性肝病组中失代偿期肝炎肝硬化组患者血清中LAP活性升高最明显，与对照组和其他肝病组比较均有显著性差异（P〈0．01）：代偿期肝炎肝硬化组LAP活性与慢性肝炎组比较有差异（P〈0．05），与对照组比较有显著性差异（P〈0．01）；慢性肝炎组与对照组比较有差异（P〈0．0S）。结论LAP活性在HBV慢性肝病中普遍升高，但失代偿期肝炎肝硬化患者最高，此可作为HBV慢性肝病鉴别诊断的一项初步指标。     

亮氨酸氨基肽酶在HBV慢性肝病鉴别诊断中的意义

目的检测HBV慢性肝病患者血清中的亮氨酸氨基肽酶（leucine aminopeptidase，LAP）活性变化，探讨其临床意义。方法采用速率法检测HBV慢性肝病患者血清LAP的活性,选择110例健康献血员做对照，对118例HBV慢性肝病患者（慢性肝炎组、代偿期肝炎肝硬化组、失代偿期肝炎肝硬化组）血清中LAP活性进行了测定。结果在HBV慢性肝病组中失代偿期肝炎肝硬化组患者血清中LAP活性升高最明显，与对照组和其他肝病组比较均有显著性差异（P〈0．01）：代偿期肝炎肝硬化组LAP活性与慢性肝炎组比较有差异（P〈0．05），与对照组比较有显著性差异（P〈0．01）；慢性肝炎组与对照组比较有差异（P〈0．0S）。结论LAP活性在HBV慢性肝病中普遍升高，但失代偿期肝炎肝硬化患者最高，此可作为HBV慢性肝病鉴别诊断的一项初步指标。     

尿NAG和LAP对糖尿病早期肾损害的诊断价值

目的检测糖尿病无肾损害组和糖尿病合并肾损害组患者尿N-乙酰-β-D氨基葡萄糖苷酶（NAG）、亮氨酸氨基肽酶（LAP）的活性，探讨尿NAG、LAP对糖尿病早期肾损害的诊断价值。方法58例糖尿病患者随机分为两组：37例糖尿病无肾损害组和21例糖尿病有肾损害组，采用速率法检测糖尿病患者尿NAG、LAP的活性。结果糖尿病无肾损害组和肾损害组尿NAG、LAP的活性高于对照组（P〈0．05）；糖尿病肾损害组高于糖尿病无肾损害组（P〈0．05）。结论检测尿NAG、LAP的活性对糖尿病早期肾损害的诊断具有价值。     

血清丙氨酸氨基肽酶和亮氨酸氨基肽酶的临床应用

目的：探讨血清丙氨酸氨基肽酶（AAP）和亮氨酸氨基肽酶（LAP）在肝胆疾病诊断中的应用价值。方法：采用速率法同时检测159例肝胆疾病患者血清AAP、LAP活性。结果：各种肝胆疾病患者血清AAP、LAP活性多有不同程度升高，升高幅度依次为：急性胆道疾病＞原发性肝癌＞急性黄疸性肝炎＞肝硬化＞转移性肝癌＞慢性乙型肝炎，两者显著相关，相关系数r为0．9762，P＜0．01。与常见的三种肝酶ALT、ALP、GGT相比，AAP、LAP与ALP、GGT呈正相关，与ALT没有相关关系。结论：AAP和LAP在肝胆疾病诊断中的临床意义十分相似，为鉴别肝胆疾病类型提供了新的、有效的诊断依据。     

尿亮氨酸氨基肽酶测定在泌尿系感染的鉴别价值

目的探讨测定尿液亮氨酸氨基肽酶(Leucine aminopepridase,LAP)水平,在肾脏炎症与下尿路感染的鉴别价值.方法采用连续监测法和速率法检测泌尿系感染者的尿LAP及尿肌酐(Cr)水平,并用U/g.Cr的单位表示酶活性单位.通过ROC曲线特性分析尿LAP在泌尿系感染鉴别肾脏炎症时的临界值.结果①肾脏炎症组尿LAP水平显著高于对照组(P＜0.01);下尿路感染患者尿LAP水平与对照组相比无显著性差异(P＞0.05);肾脏炎症组尿LAP水平显著高于下尿路感染组(P＜0.01).结论检测泌尿系感染患者尿LAP水平,对肾脏炎症和下尿路感染的定位鉴别诊断,有一定的诊断价值.     

CDFI检测异位妊娠子宫血循环阻力指数的临床价值

目的：探讨异位妊娠子宫血循环的特征性改变。方法：应用CDFI和PD检测了26例异位妊娠的子宫动脉、螺旋动脉和滋养动脉血流的RI值，并与52例正常早孕、完全性流产病例作了对照分析。结果：异位妊娠组子宫动脉平均RI值高于对照组（P＜0．001）；而异位妊娠组子宫螺旋动脉CDFI阳性率则明显低于对照组（P＜0．05，P＜0．01）；异位妊娠组附件区滋养动脉血流的检出率为61．5％、特异性100％。结论：CDFI和PD各项指标结合停经史和β-HCG对异位妊娠的诊断与鉴别诊断有重要的临床价值。     

氨甲喋呤联合米非司酮治疗异位妊娠临床疗效观察

目的：观察氨甲喋呤（MTX）联合米非司酮（Ru486）治疗异位妊娠疗效及疗效与血β－HCG滴度的关系。方法：将62例异位妊娠患者随机分成2组,MTX＋Ru486组：MTX单次肌内注射50mg/m^2后,空腹口服Ru48650mg,每天2次,总共3d;MTX组：单次肌内注射50mg/m^2,两组均不用四氢叶酸解毒方案治疗,定期监测血β－HCG滴度直至正常。结果：MTX＋Ru486组治愈率90．31％,血β－HCG＜6000IU／L,治愈率100％,MTX组治疗愈率80．24％,血β－HCG＜6000IU／L,治愈率90．25％,差异有显著意义,P＜0．01。结论：MTX＋Ru486组治疗异位妊娠疗效好,尤以血β－HCG＜6000IU／L为最佳。     

Placental and non-placental leucine aminopeptidases during normal pregnancy.

1. A simple and rapid method discriminating between placental and non-placental leucine aminopeptidases (LAP) existing in pregnancy serum is described, which includes technics of heat inactivation at 60 degrees for 30 minutes and inhibition by 0.02 M L-methionine. 2. Serial determinations of serum total, heat-stable and L-methionine-insensitive LAP activities during normal pregnancy were carried out. 3. The results were ascertained by disc electrophoresis and it was found that the heat-stable enzyme corresponds to normal serum LAP; the L-methionine-insensitive enzyme to pregnancy serum LAP of placental origin; the sum of these two to total serum LAP.     

Heterotopic pregnancy after in vitro fertilization

Maternal mortality related to ruptured ectopic pregnancy remains elevated. A case is presented of heterotopic pregnancy in a patient whose pregnancy was assisted with in vitro fertilization. The patient's diagnosis was delayed, potentially because of lack of tachycardia associated with the hypotension. The clinical presentation of heterotopic pregnancy is similar to that of ectopic pregnancy. The risk factors for heterotopic pregnancy are the same as those for ectopic pregnancy, with the addition of in vitro fertilization, which increases the risk substantially.     

Two Cases of Heterotopic Pregnancy

We present 2 recent cases of heterotopic pregnancy in which bedside sonography performed by the treating emergency physician was used to identify the heterotopic pregnancy and facilitate prompt gynecologic intervention. The cases, the sonographic approach to the diagnosis of heterotopic pregnancy, and a review of the literature are presented.     

探讨超声诊断非辅助生殖技术所致的宫内外同时妊娠的临床价值

目的：探讨超声诊断非辅助生殖技术所致的宫内外同时妊娠的临床价值。方法：对16例非辅助生殖技术所致的宫内外同时妊娠患者经腹及经阴道超声检查结果以及临床资料进行回顾性分析,并随访宫内妊娠结局以及手术病理检查结果。结果：通过经腹壁及经阴道超声联合应用,结合病史及临床症状,14例首诊高度怀疑并提示宫内宫外同时妊娠,超声仅发现宫内孕囊及附件区包块,但无法确认包块是宫外孕或黄体破裂者1例,经后穹窿穿刺出不凝血而高度怀疑;附件包块漏诊1例,1周后腹痛复查时证实。上述16例患者均由手术病理证实,经腹壁及经引道超声检查两者联合应用,宫内外同时妊娠诊断符合率达87.50%。其中仅4例宫内继续妊娠,2例得以足月生产,另外2例分别于16周4天和18周1天流产。结论：经腹和经阴道超声联合应用是提高宫内外同时妊娠诊断率的有效方法,同时结合病史及临床症状、仔细全面的超声检查、超声图像的认真分析,可有效减少宫内外同时妊娠的误、漏诊。早期的诊断对选择合适的治疗方案具有十分重大的临床意义。     

Triplet heterotopic pregnancy after gonadotropin stimulation and intrauterine insemination diagnosed at laparoscopy: a case report

Heterotopic pregnancy has been traditionally considered a rare event; however, with the use of assisted reproductive technology, the incidence of heterotopic pregnancies is increasing. Diagnosing a heterotopic pregnancy can be challenging. This report describes a 30-year-old female at 11 weeks' gestation with an intrauterine twin pregnancy after gonadotropin stimulation and intrauterine insemination who presented complaining of left lower quadrant abdominal pain with constipation and cramps. The patient was empirically treated for diverticulitis but failed to respond to therapy. A heterotopic triplet pregnancy was ultimately diagnosed at laparoscopy. Heterotopic pregnancy must be considered in the differential diagnosis of abdominal pain in the first trimester, especially in patients who conceived by means of assisted reproductive technology. Surgical treatment is the most frequently used method of treatment.     

体外受精-胚胎移植后宫内外同时妊娠1例并文献复习

目的：探讨IVF-ET后宫内外同时妊娠的诊断及治疗。方法：对我院收治的1例宫内外同时妊娠进行回顾性分析。结果：患者IVF-ET术后宫内外同时妊娠，开腹手术证实为陈旧性宫外孕，虽经积极治疗，但孕5个月因绒毛膜羊膜炎流产。结论：宫内外同时妊娠罕见，容易误诊。对于辅助生育过程中宫内发现妊娠囊者，应警惕同时合并宫外孕的可能性。     

Heterotopic pregnancy diagnosed by emergency ultrasound

We present a case of heterotopic pregnancy rapidly diagnosed by an emergency physician. To the best of our knowledge, this is the first report of an emergency physician using bedside ultrasound to diagnose an ectopic pregnancy present simultaneously with an intrauterine pregnancy. Other unique features of this case include the diagnosis being made on initial evaluation and the patient's lack of risk factors for heterotopic pregnancy. A review of the cases of heterotopic pregnancy reported in the emergency medicine literature, the rising prevalence of the disease, and factors that may facilitate in making the diagnosis are discussed as well.     

Heterotopic gestation: another possibility for the emergency bedside ultrasonographer to consider

Emergency bedside ultrasonography has become an important tool in differentiating an intrauterine from an ectopic pregnancy. As the odds of a heterotopic pregnancy were thought to be minute, some ultrasonographers and Emergency Physicians certified in bedside ultrasonography have taught that an intrauterine gestation with fetal heart tones clinches the diagnosis of intrauterine pregnancy. However, with the current rise in heterotopic gestations, this standard of care should be re-evaluated. If emergency bedside ultrasonography reveals an intrauterine gestation in the presence of either a moderate amount of free fluid in the pelvis or a co-existent ovarian cyst, one must consider and search for a heterotopic pregnancy.     

Heterotopic pregnancy: simultaneous intrauterine and ectopic pregnancy following IVF treatment with the birth of a healthy child

Although spontaneous simultaneous intrauterine and ectopic pregnancy was an extremely rare event in the past, it is increasingly being diagnosed since the rate of assisted reproduction technique (ART) gestations increased. Due to the serious consequences, delayed diagnosis should be prevented in order to salvage the viable intrauterine fetus and avoid maternal morbidity and mortality. This case report demonstrates that the pitfalls of the diagnosis of heterotopic pregnancy make early diagnosis difficult and the prevention of heterotopic pregnancies by single embryo transfer should be continuously discussed. The role of high resolution ultrasound scans and the importance of close monitoring of early pregnancies following ART are emphasized because early diagnosis of heterotopic pregnancy results in a similar perinatal outcome as singleton pregnancies.     

Heterotopic pregnancy: report of three cases

OBJECTIVE: Heterotopic pregnancy, defined as concomitant intrauterine and ectopic pregnancy, is a rare event. Assisted reproductive technologies have led to an increase in the number of heterotopic pregnancies. MATERIALS AND METHOD: From 1997 to 1999 three cases of heterotopic pregnancies were referred to the gynecological unit of the hospital of St. P?lten. The condition was diagnosed at 7, 8 and 12 weeks of gestation, respectively. Two patients had undergone assisted reproductive technologies and former pelvic surgery for tubal pregnancy. Two patients had intrauterine singleton pregnancies and one patient had an intrauterine twin pregnancy. In all cases the ectopic site presented as a ruptured tubal pregnancy and the treatment consisted of laparoscopic salpingectomy. RESULTS: In all patients the postoperative course was uneventful and the intrauterine pregnancy progressed. In one case recurrent preterm labor led to vaginal delivery at 33 weeks of pregnancy. In the case of twin pregnancy, a planned cesarean section was performed at 37 weeks of gestation. One patient delivered at term. All newborns were healthy. CONCLUSION: Knowledge of heterotopic pregnancy and understanding the epidemiological risk factors underlying this condition are important for early diagnosis with the aim of improving therapy and clinical outcome.