216例系统性红斑狼疮患者不良妊娠结局危险因素分析

目的探讨系统性红斑狼疮(SLE)合并妊娠患者不良妊娠结局的危险因素。方法回顾性分析2013年4月至2017年4月就诊于郑州大学第一附属医院的SLE合并妊娠患者的病例资料,采用logistic回归模型进行单因素及多因素不良妊娠结局的危险因素分析。结果纳入216例SLE患者的223次妊娠结果,其中妊娠期SLE活动者130次(58.29%),其流产、胎死宫内、新生儿早产、低出生体质量儿的发生率及新生儿NICU转入率高于疾病稳定者(P<0.001)。妊娠期SLE活动为妊娠丢失(OR=12.626,95%CI:2.431～65.581,P=0.003)、新生儿早产(OR=7.467,95%CI:2.819～19.766,P<0.001)和低出生体质量儿(OR=4.359, 95%CI:1.361～13.965,P=0.013)发生的独立危险因素。子痫前期为新生儿早产(OR=3.697,95%CI:1.120～12.200,P=0.032)和低出生体质量儿(OR=16.185,95%CI:1.895～138.232,P=0.011)发生的独立危险因素。除SLE活动外,妊娠丢失的危险因素还包括妊娠期新发SLE(OR=4.466,95%CI:1.588～12.554,P=0.005)和产妇外周血白细胞水平下降(OR=23.158,95%CI:1.952～274.685,P=0.013)。血清白蛋白水平升高为妊娠期SLE活动(OR=0.875,95%CI:0.775～0.987,P=0.030)及新生儿早产(OR=0.883,95%CI:0.798～0.977,P=0.016)的保护因素。结论 SLE合并妊娠患者疾病活动度高,引起不良妊娠结局的发生率高,妊娠期新发SLE为疾病活动的独立危险因素。临床中应早期识别新发SLE及SLE活动的危险因素并积极治疗,从而改善妊娠结局。     

新生儿窒息的相关危险因素分析

目的：探讨新生儿窒息的相关危险因素。方法：回顾性分析2021年1-9月在南昌市第一医院出生的新生儿1 024例的临床资料,分析新生儿窒息发生的相关危险因素。结果：新生儿窒息发生率为5.08%(52/1 024);单因素分析显示,巨大儿、早产、孕妇年龄、分娩次数、产前胎盘早剥、脐带绕颈、胎儿宫内窘迫、羊水污染、产程延长与新生儿窒息发生均有关,差异均有统计学意义(P<0.05);新生儿性别、单胎、前置胎盘、孕期胎位不正、分娩方式、臀位助产与新生儿窒息发生均无关,差异均无统计学意义(P>0.05);多因素分析显示,早产[β=0.940,OR=2.559,95%CI(1.300,5.035)]、孕妇年龄≥35岁[β=0.858,OR=2.358,95%CI(1.290,4.310)]、分娩次数<2次[β=1.055,OR=2.872,95%CI(1.459,5.654)]、产前胎盘早剥[β=0.889,OR=2.432,95%CI(1.131,5.229)]、脐带绕颈[β=1.034,OR=2.813,95%CI(1.599,4.950)]、胎儿宫内窘迫[β=0.679,OR...     

孕妇分娩方式的选择及其影响因素分析

目的:了解孕妇分娩方式的选择现状及相关影响因素,为孕妇在围产期保健中采取更适合自己的分娩方式提供理论依据。方法:采用横断面研究,选择在某市妇产医院产科病房住院的孕38周以上的待产孕妇467例进行问卷调查。采用x2检验和Logistic回归分析孕妇分娩方式相关影响因素。结果:467例孕妇中,自然分娩者283例,占60.6%,剖宫产者184例,占39.4%。文化程度低、患有焦虑、孕前贫血是影响孕妇分娩方式选择的独立影响因素。初中及以下者发生剖宫产的危险性分别是本科及以上人群的1.596倍(OR=1.596,95%CI:1.001~2.599);患有焦虑的孕妇选择剖宫产的概率是没有焦虑的孕妇1.797倍(OR=1.797,95%CI:1.104~2.925);孕前贫血的孕妇发生剖宫产的危险性是是未患贫血者的1.833倍(OR=1.833,95%CI:1.088~3.088)。结论:孕妇的剖宫产率较高,文化程度低、患有焦虑、孕前贫血是影响孕妇分娩方式的独立危险因素。提高孕妇健康水平、加强产前相关健康教育和心理疏导对于有效预防、降低孕妇剖宫产率具有重要意义。     

甲状腺自身抗体增加早产风险的荟萃分析

目的探索孕妇甲状腺自身抗体与早产风险的关系。方法检索并纳入相关前瞻性队列研究,利用荟萃分析计算甲状腺自身抗体阳性孕妇早产风险的相对危险度(RR)值及其95%可信区间(CI)。结果纳入9个研究,荟萃分析显示甲状腺自身抗体阳性孕妇发生早产的RR值为1.63(95%CI 1.16².27,P=0.003)。亚组分析显示,在对照组甲状腺功能正常的亚组和未排除甲状腺功能异常者的亚组中,甲状腺自身抗体均增加早产风险。结论甲状腺自身抗体增加早产风险。     

剖宫产分娩与新生儿疾病发生关联的研究

目的 探讨剖宫产分娩与新生儿疾病发生是否存在关联,为预防新生儿疾病的发生和降低剖宫产率提供依据。方法 通过病历管理系统,选择2004年1月—2013年12月在温州医科大学附属第一医院产科住院分娩的产妇及其新生儿为研究对象,采用病例对照的研究方法,以患有某种新生儿疾病的新生儿为病例组,不患有该种疾病的新生儿为对照组,比较两组剖宫产率是否存在差异。分析时采用多因素Logistic回归分析调整产妇年龄、新生儿性别、剖宫产指征等因素对两者关联的影响。结果 59.3%（2 035/3 432）的产妇分娩方式为剖宫产,54.7%（1 876例）的产妇具有剖宫产指征;40.7%（1 397例）的产妇为阴道分娩。阴道分娩者和剖宫产者年龄、入院待产时间、是否实施抢救、剖宫产指征、住院时间、分娩总费用、分娩护理费用比较,差异均有统计学意义（P＜0.01）;两者新生儿性别比较,差异无统计学意义（P=0.05）。Logistic回归分析结果显示,新生儿肺部疾病〔OR=1.48,95%CI（1.03,2.11）,P=0.03〕、新生儿窒息〔OR=0.37,95%CI（0.29,0.47）,P＜0.01〕、低体质量儿〔OR=1.56,95%CI（1.09,2.23）,P=0.02〕、早产儿〔OR=2.21,95%CI（1.97,2.61）,P＜0.01〕和低体质量早产儿〔OR=3.00,95%CI（1.98,4.56）,P＜0.01〕与剖宫产分娩存在关联,而新生儿消化系统疾病〔OR=1.64,95%CI（0.83,3.24）,P=0.16〕和新生儿败血症〔OR=0.69,95%CI（0.91,3.69）,P=0.28〕与剖宫产分娩无关。结论 剖宫产分娩可能增加新生儿罹患呼吸系统疾病的风险,降低新生儿窒息的发生,而与消化系统疾病发生无关。低体质量儿、早产儿和低体质量早产儿更容易选择剖宫产,增加剖宫产率。     

IVF-ET与自然妊娠后妊娠期糖尿病孕妇的妊娠结局分析

目的 分析体外受精-胚胎移植(IVF-ET)与自然妊娠后妊娠期糖尿病(GDM)孕妇的妊娠结局差异。方法 回顾性分析2019年10月至2020年10月在广东医科大学顺德妇女儿童医院住院分娩的GDM孕妇的临床资料,按照基线资料进行1∶3倾向性得分匹配,最后筛选出135例接受IVF-ET的孕妇作为观察组,377例自然妊娠的孕妇作为对照组,分析两组妊娠结局差异。结果 观察组产后出血、剖宫产、双胞胎、贫血、早产、低体重儿、新生儿呼吸窘迫综合征、新生儿生长受限、新生儿黄疸、新生儿肺炎、新生儿脑白质损伤、新生儿贫血、新生儿凝血功能异常的发生率高于对照组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,观察组出现产后出血的危险系数是对照组的5.000倍(95%CI:1.660～15.056),出现剖宫产的危险系数是对照组的2.349倍(95%CI:1.483～3.720),出现双胞胎的危险系数是对照组的10.077倍(95%CI:4.716～21.531),出现新生儿脑白质损伤的危险系数是对照组的2.344倍(95%CI:1.003～5.477)。结论 对于IVF-ET后发...     

妊娠期糖尿病孕妇早产与足月分娩临床特征差异性分析

目的 探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇早产及足月分娩的临床特征差异以及妊娠期糖尿病孕妇早产危险因素.方法 选择2008年1月～2010年12月在南方医科大学附属花都区人民医院、南方医院住院并分娩的GDM孕产妇238例,其中发生早产65例(GDM早产组),足月分娩173例(GDM足月组),采用单因素及多因素回归方法 分析GDM孕妇早产危险因素.结果 (1)单因素回归分析提示既往早产史、IVF-ET、双胎及多胎妊娠、年龄、体质指数、收缩压、糖化血红蛋白、24h尿蛋白定量、以及子痫前期、胎膜早破、胎盘早剥、胎儿窘迫等妊娠期并发症是GDM早产发生的危险因素(P＜0.05);(2)多因素回归分析结果 显示,既往早产病史(OR=2.318,95%CI为1.096～12.596,P=0.035)、子痫前期(OR=3.597,95%CI为2.308～19.167,P=0.000)、胎膜早破(OR=2.839,95%CI为1.254～6.692,P=0.000)是GDM孕妇早产发生的独立危险因素.结论 GDM早产组和GDM足月分娩组在临床特征和妊娠并发症发生率上存在一定差异性.既往早产病史、子痫前期、胎膜早破是GDM孕妇早产发生的独立危险因素.加强产前检查和孕期保健、积极筛查GDM、对GDM孕妇采取有效措施控制血糖、尽早发现相关妊娠期并发症是减少GDM早产的有效手段.     

双胎妊娠的地中海贫血孕妇的临床特点

目的总结双胎妊娠的地中海贫血孕妇的临床特点。方法回顾性分析50例双胎妊娠的地中海贫血孕妇(观察组)和200例单胎妊娠的地中海贫血孕妇(对照组)的临床资料。比较两组孕妇的一般资料、孕中晚期血红蛋白及铁蛋白水平、妊娠并发症发生情况及妊娠结局。结果与对照组比较,观察组孕妇孕前体重指数、使用辅助生殖技术比例及初产妇比例更高,孕中晚期血红蛋白水平、分娩孕周和新生儿出生体重更低,妊娠期糖尿病和妊娠高血压综合征的发生率、早产率、剖宫产率更高,产后出血量更多(均P<0.05)。结论与单胎妊娠者比较,双胎妊娠的地中海贫血孕妇采用辅助生殖技术受孕更常见,且更易出现妊娠期贫血、妊娠期高血压疾病、产后出血量多、早产和新生儿低出生体重等情况。     

孕妇体重指数变化对剖宫产的影响

目的探讨孕妇体重指数变化对剖宫产的影响。方法对2年来笔者所在医院产检并分娩的441例初产妇妊娠初期体重指数、妊娠37周后体重指数、新生儿体重及剖宫产指征,应用t检验、χ~2检验及Logistic回归分析评估其与剖宫产的关系。结果在496例产妇中,共有441例用于统计分析,剖宫产192例,剖宫产率43.5%。与非剖宫产组相比,剖宫产组孕期体重指数增量6构成比较高(20.3%vs 9.6%,χ~2=10.086,P=0.000),巨大儿构成比较高(26.6%vs 1.6%,χ~2=10.086,P=0.000)。Logistic回归分析显示,经巨大儿及社会因素校正后,孕期体重指数增量6是剖宫产的危险因素(RR=6.017,95%CI为6.883～12.555,P=0.000)。结论初产妇孕期体重指数增量6与剖宫产有关。     

剖宫产瘢痕妊娠患者侧支动脉的形成及其危险因素分析

目的：探讨剖宫产瘢痕妊娠行子宫动脉栓塞术时发现侧支动脉形成的概率及其危险因素。方法：分析2009年1月至2014年6月在中南大学湘雅三医院进行子宫动脉栓塞术的剖宫产瘢痕妊娠患者资料,并根据有无侧支动脉的形成将患者分成有侧支动脉组(34例)及无侧支动脉组(对照组,110例)。记录可能引起侧支动脉形成的各项参数,分别用t检验、χ2检验及Fisher精确检验法进行单因素分析,对P<0.20的参数进行logistic多因素分析,计算其相对危险度(RR)及95%可信区间(95%CI)。结果：有侧支动脉形成的剖宫产瘢痕妊娠患者的发病率为23.4%。单因素及logistic多因素回归分析表明：胎盘前置(RR=78.556,95%CI：2.869~2 150.651,P=0.010)、盆腔炎症(RR=6.633,95% CI：1.595~27.592,P=0.009)、人流手术史(RR=18.381,95%CI：1.683~200.752,P=0.017)及子宫肌瘤或腺肌症(RR=12.580,95%CI：1.004~157.550, P=0.050)与剖宫产瘢痕妊娠侧支动脉的形成密切相关。结论：前置胎盘、盆腔炎症、人流手术史以及子宫肌瘤或腺肌症是剖宫产瘢痕妊娠患者侧支动脉形成的危险因素。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.