早发型重度子痫前期期待治疗的研究进展

探讨早发型重度子痫前期期待治疗的对象选择及治疗方法。期待治疗可恰当延长孕龄，减少因胎不成熟导致的围生儿死亡，同时避免孕产妇终末脏器不可逆损害，降低孕产妇病死率与婴幼儿死亡率及病残率。     

早发型与晚发型重度子痫前期的临床分析与比较

目的 分析并比较早发型与晚发型重度子痫前期的临床资料.方法 按孕周将87例重度子痫前期患者分为2组,≤34周为早发组,36例;>34周的晚发组51例.比较两组孕妇基本情况,实验室检查结果,母儿并发症及妊娠结局等.结果 早发型与晚发型重度子痫前期孕妇定期正规孕检比例、学历层次比较、收缩压、舒张压、24h尿蛋白定量、血小板数量及新生儿死亡比例,组间比较差异有统计学意义(P<0.05).两组孕妇年龄、血红蛋白数量、胎儿窘迫及胎死宫内比例比较差异无统计学意义(P>0.05).结论 早发型重度子痫前期较之晚发型发病早,病情重,母婴预后差,应引起产科工作者的重视.     

低分子肝素治疗重度子痫前期患者外周血vWF、AT的变化

目的探讨低分子肝素能否改变重度子痫前期患者血浆中vWF含量,AT的活性水平,为低分子肝素用于重度子痫前期的治疗提供新的理论基础。方法选择2010年3月1日～2010年11月30日在天津医科大学宝坻临床学院、天津医科大学总医院分娩的重度子痫前期病人39例为研究组。根据入院顺序随机分成2组,传统治疗组20人,给予传统常规的治疗。低分子肝素治疗组19人,在传统常规治疗的基础上给予低分子肝素钙0.4m1,每天一次,皮下注射,两组分别于入院时及治疗3～5天后抽取孕妇静脉血,检测血浆vWF：Ag和AT：A及常规凝血试验。结果两组重度子痫前期患者治疗前血浆中vWF：Ag与同期对照组比较明显升高,而AT：A与同期对照组比较明显减少,低分子肝素治疗后血浆中vWF：Ag与治疗前比较明显降低,而AT：A与治疗前比较明显增高,传统方法治疗后血浆vWF：Ag和AT：A与治疗前比较差异无统计学意义。结论低分子肝素结合传统疗法治疗重度子痫前期患者,可改变患者血浆中vWF含量,AT的活性水平。     

早发型重度子痫前期56例母婴结局分析

目的探讨早发型重度子痫前期的发病对妊娠结局的影响。方法回顾分析2005年1月至2009年1月我院妊娠≤34周的早发重度子痫前期病例56例,分析发病孕周、终止妊娠孕周、孕周延长时间、产妇严重并发症发生情况、胎儿及新生儿死亡率。结果 56例中无孕产妇死亡和子痫发生,但产妇妊娠期各种并发证发生率为100%,产后1月围产儿的总死亡率为32.1%。结论早发型重度子痫前期在终止妊娠前短期的保守治疗是安全有效的,但是围产儿死亡率仍相当高。     

早发型重度子痫前期79例临床分析

目的探讨早发型重度子痫前期的治疗及对母儿的影响。方法回顾性分析本院79例早发型重度子痫前期患者的有关临床资料,按发病孕周将其分成三组即A组（孕周〈28周）12例、B组（28周≤孕周〈32周）35例和C组（32周≤孕周〈34周）32例,分析各组孕期治疗期限、孕妇并发症、胎儿和新生儿结局。结果三组保守治疗时间比较,A组与B组、C组与B组之间差异有统计学意义（P〈0.05）,其中B组延长孕龄最长;三组孕妇并发症发生率随发病孕周延长而下降,但三组间比较无显著性差异（P〉0.05）;胎儿及新生儿死亡率比较,C组明显低于A、B组（P〈0.01）,B组低于A组（P〈0.05）。结论早发型重度子痫前期严重影响母儿健康,保守治疗可行,但要严密监测母儿情况,适时终止妊娠,终止妊娠的方式首选剖宫产。     

早发型重度子痫前期发病及临床特点

子痫前期（preeclampsia）是妊娠期特发的常见的并发症,严重威胁母儿健康,尤其是重度子痫子痫前期（severe pre-eclampsia）,是导致孕产妇和围生儿病率及死亡率增加的常见原因之一。有学者将发病于32孕周前或34孕周前的重度子痫前期称为早发型重度子痫前期（early onset severe pre-eclampsia）,在此后发病者称为晚发型重度子痫前期（late onset severe pre-eclampsia）,本文就关于早发型重度子痫前期临床发病特点研究进展作一综述。     

早发型重度子痫前期发病机制及监测的研究新进展

妊娠高血压(pregnancy-induced hypertension syndrome,PIH)是妊娠期常见的特发性疾病,基本病变为全身小血管痉挛及血液动力学改变,严重威胁母婴健康,尤其是早发型重度子痫前期(early onset severe preeclampsia,ES-PE),发病早,程度严重,能引发机体各终末器官的损害[1]。近年随着分子生物学的进展,ES-PE的发病机制日益受到重视,目前认为ES-PE发病涉及到胎盘因素、血管内皮损伤和活性物质失衡、系统炎症反应、免疫及其他因素等。     

早发型重度子痫前期56例母婴结局分析

目的 探讨早发型重度子痫前期的发病对妊娠结局的影响.方法 回顾分析2005年1月至2009年1月我院妊娠≤34周的早发重度子痫前期病例56例,分析发病孕用、终止妊娠孕周、孕周延长时间、产妇严重并发症发生情况、胎儿及新生儿死亡率.结果 56例中无孕产妇死亡和子痫发生,但产妇妊娠期各种并发证发生率为100%,产后1月国产儿的总死亡率为32.1%.结论 平发型重度子痫前期在终止妊娠前短期的保守治疗是安全有效的,但是围产儿死亡率仍相当高.     

低分子肝素钙对重度子痫前期患者血脂的影响及疗效的探讨

目的探讨低分子肝素钙治疗重度予痫前期的疗效及治疗期间母儿各项指标的变化。方法选取2009年6月～2011年6月在我院住院的重度子痫前期患者92例,随机分为观察组50例,对照组42例。观察两组血脂代谢水平及相关临床指标的变化。结果观察组较对照组(均经治疗后)血脂水平(血清甘油三脂TG、总胆固醇TC、低密度脂蛋白LDL-c、载脂蛋白B(apoB))有明显下降,尿量增加,尿蛋白总量减少,脐动脉血流S/D比值下降,胎儿窘迫、新生儿窒息率下降,两组产后出血量无明显差异。结论低分子肝素钙治疗重度予痫前期患者,可显著改善治疗效果;低分子肝素钙对母儿安全。     

早发型重度子痫前期的临床分析

目的 探讨早发型重度子痫前期对围生期母婴预后的影响.方法 对2003年2月至2006年2月3年中84例早发型重度子痫前期病例进行分析根据其发病孕周分为3组,即A组（孕周＜28w）,B组（28孕周≤孕周＜32孕w）,C组（32孕周≤孕周＜34孕w）.观察发病情况、病情特点及母婴并发症.结果 早发型重度子痫前期3组患者并发症发生率无统计学意义;3组间新生儿窒息率和围产儿死亡率均随孕周延长而下降,且3组间差异均有统计学意义（P＜0.05）;B组期待治疗时间均明显长于其他两组（P＜0.05）.各组患者的分娩方式均以剖宫产为主.结论 早发型重度子痫前期有较高的母婴病死率,是重度子痫前期的一种特殊类型,在期待治疗过程中,应严密监护母婴情况,适时终止妊娠,终止妊娠方式首选剖宫产.     

A low molecular weight heparin in hemodialysis

Summary The purpose of our study was to check whether the dosage recommended for the low molecular weight heparin tested here, i.e., 50% of the corresponding unfractionated heparin dose, is adequate to prevent clot formation in the extracorporeal system. Sixteen dialysis treatments of 4–5 h were given to each of six chronic dialysis patients. In dialyses 1, 2, 15 and 16 unfractionated heparin (initial dose 35 IU/kg, continuous dose 20 IU/kg/h) was given, and in dialyses 3–14 low molecular weight heparin (initial dose 17.5 anti-Xa U/kg, continuous dose 10 anti-X U/kg/h). At these dose levels of low molecular weight heparin, clot formation occurred in the extracorporeal system in five of the six patients, despite the fact that the plasma anti-Xa level of 0.5 U/ml recommended by the manufacturer had been attained. For this reason the continuous dose of low molecular weight heparin had to be raised to approx. 80% of the corresponding continuous dose of unfractionated heparin. A plasma anti-Xa level of 0.7 U/ml is necessary to prevent extracorporeal clot formation.Abbreviations anti-Xa U Anti-factor Xa unit - aPTT Activated partial thromboplastin time - AT III Antithrombin III - IU International unit - LMWH Low molecular weight heparin - UFH Unfractionated heparin     

Clinical cure of severe, early onset preeclampsia with low molecular weight heparin therapy in primigravida with hyperreactio luteinalis and thrombophilia

Inherited thrombophilias, suggested to be risk factors for ovarian hyperstimulation syndrome and known to be associated with venous thromboembolism during pregnancy, may also increase the risk for preeclampsia (PE). We describe the case of a 29-year-old woman with primary infertility with no history of thrombosis, hypertension or renal disorders. In her first pregnancy, achieved by frozen embryo transfer, she developed severe early-onset (23rd gestational week) PE with heavy proteinuria, and at the same time was found to have enlarged ovaries with hyperreactio luteinalis. After admission we found that she was a heterozygotic carrier of the factor V Leiden mutation. After administering low molecular weight heparin (LMWH) therapy, her blood pressure normalized, proteinuria diminished and her d-dimer values returned to that of a normal pregnant level. The fetus grew normally. Her ovaries normalized during the pregnancy, as determined by ultrasound examinations. At term she delivered spontaneously a normal weight, healthy girl. Previously, only prophylactic LMWH, in subsequent pregnancy, have been administered in patients with thrombophilia and a history of severe PE. We describe a case of spontaneous hyperreactio luteinalis, where the clinical characteristics of PE improved after beginning LMWH therapy in severe, very early onset PE. Inherited thrombophilia, spontaneous hyperreactio luteinalis and PE may be associated phenomena.     

In vivo treatment of rats with unfractionated heparin (UFH) or low molecular weight heparin (LMWH) does not affect experimentally induced colon carcinoma metastasis

Recent randomized trials have suggested that treatment with low molecular weight heparin (LMWH) improves survival of cancer patients with venous thromboembolism, as compared to treatment with unfractionated heparin (UFH). Experimental studies have shown that UFH has activities besides its anticoagulant function which may affect progression of malignancy, including stimulation of new blood vessel formation. In contrast, LMWH has been suggested to inhibit angiogenesis. In the present study, we compared quantitatively the effects of treatment with UFH, LMWH or placebo on the development of experimentally induced colon carcinoma metastases in rat liver and on tumor-associated angiogenesis. It is shown that UFH and LMWH in therapeutic dosages neither affect development of metastases nor tumor blood vessel formation in this animal model. These results indicate that heparins do not affect colon cancer metastasis in liver. Further studies in other animal models are required to establish the mechanisms by which heparins potentially affect cancer.     

Successful pregnancy with low molecular weight heparin in two women with recurrent miscarriage of unknown etiology

We report here two cases of recurrent miscarriages that were successfully treated with continuous intravenous administration of low molecular weight heparin (LMWH). One patient experienced 11 spontaneous abortions, and the other eight abortions. Previous treatments including prednisone, aspirin and mononuclear-cell immunization were all unsuccessful. They were negative for anticardiolipin antibodies and lupus anticoagulant, and had no inherited thrombophilic disorder. Intravenous administration of LMWH, 4800 units of dalteparin, was started as soon as the conception was confirmed, and was continued until 34 weeks of gestation. They were delivered of live born infants.     

硫酸镁和低分子肝素联合应用对海马迟发性神经元坏死的保护作用

目的 研究硫酸镁和低分子肝素在短暂局灶性脑缺血再灌注后海马迟发性神经元坏死中的保护作用。方法 新西兰大白兔夹闭单侧颈总动脉制成模型，缺血30min再灌注72h后通过HE染色进行组织观察，同时检测血清中IL-8的含量，探讨硫酸镁和低分子肝素对保护脑的作用机制。结果 硫酸镁联合低分子肝素治疗组迟发性神经元坏死程度显著低于盐水治疗组，低分子肝素能降低缺血再灌注后血清中的IL-8含量。结论 IL-8做为一种急性炎症的趋化因子，在脑缺血时升高，可作为脑缺血炎症期或再灌注损伤重要的观察指标之一。硫酸镁没有抗炎作用，单用硫酸镁或低分子肝素的治疗效果。没有联合应用的治疗效果显著。     

Inhibitory effects of low molecular weight heparin on mediator release by mast cells: preferential inhibition of cytokine production and mast cell-dependent cutaneous inflammation

There has been substantial evidence that suggests that heparin may modulate various aspects of immune function and inflammation in addition to its well known anticoagulant activity. In this regard heparin was found to suppress cell-mediated immune responses or asthmatic reactions to allergen challenge. In the present study we analyse the effects of low molecular weight heparin (LMWH) on mast cell degranulation and cytokine production in vitro and on the elicitation of IgE-mediated mast cell-dependent late cutaneous allergic inflammation in vivo. We have established that LMWH preferentially inhibited tumour necrosis factor-alpha (TNF-α) and IL-4 production without having any significant effect on mast cell degranulation. These effects have been observed in mast cells derived from three different origins that were activated by either immunological or non-immunological stimuli. We have shown that there is inhibition of TNF-α production (and not neutralization of activity), as elimination of the drug after a short preincubation and addition of LMWH to rTNF-α had no effect on TNF-α-mediated cytotoxic activity. These results were also confirmed by ELISA. In vivo, s.c. injection of the LMWH inhibited the leucocyte infiltration associated with the late cutaneous response which followed passive cutaneous anaphylaxis (PCA) reaction, without affecting mast cell numbers or degranulation. These data suggest that LMWH may have an inhibitory role in mast cell-mediated allergic inflammation, and thus might be considered as a possible therapeutic modality.     

低分子肝素钙预防腰椎退行性疾病术后深静脉血栓形成的有效性和安全性

目的探讨低分子肝素钙预防腰椎退行性疾病术后深静脉血栓形成(DVT)的有效性和安全性。方法回顾性分析广安市广安区人民医院68例腰椎退行性疾病患者的临床资料,术后均采用抗凝预防血栓形成,按照术后预防DVT所采用方式的不同分为对照组和低分子肝素钙组。分析比较2组患者术后引流量、切口愈合情况、DVT发生率、皮下瘀斑情况、血小板数值、凝血功能、D-二聚体。结果术后2组患者引流量、切口愈合情况、皮下瘀斑情况、凝血功能相关指标比较,差异无统计学意义(P>0.05)。术前和术后1、10 d 2组患者血小板数量的变化差异无统计学意义(P>0.05)。DVT发生率2组患者比较差异有统计学意义(P<0.05)。术前及术后1 d 2组患者D-二聚体比较,差异无统计学意义(P>0.05);术后10 d,对照组患者D-二聚体显著增加,2组比较差异有统计学意义(P<0.05)。结论腰椎退行性疾病术后使用低分子肝素钙进行抗凝,可以显著降低DVT的发生率,具有良好的安全性。     

低分子肝素对URSA患者外周血免疫细胞的影响

目的探讨低分子肝素对不明原因复发性流产（URSA）患者外周血免疫细胞的影响。方法研究组包括28例URSA患者,予低分子肝素（Fraxiparine 0.4-0.6ml/d或Enoxaparin 0.4-0.6ml/d iH）治疗至妊娠12w,于治疗前、3w后采用流式细胞术检测患者外周血中淋巴细胞亚群及血常规;15例未接受低分子肝素治疗的URSA患者为对照组,于首次就诊（血HCG确认妊娠）及2~3w后（流产清宫前）检测以上项目。结果研究组保胎成功率为86%,明显高于对照组33%（P〈0.05）;使用低分子肝素后USRA患者外周血中总T细胞数比例为（66.9±5.6）%,较使用前（61.2±7.4）%升高（P〈0.05）;NK细胞比例为（16.6±4.4）%,较使用前（19.4±7.3%）下降（P〈0.05）,中性粒细胞比例为（67.1±7.9）%,红细胞压积为（36.1±3.9）%,较使用前（70.7±7.8%）、（33.8±7.8%）均下降（P〈0.05）。结论低分子肝素对URSA有显著治疗效果,其作用机理除抗凝外,还可能直接降调URSA外周血中的NK细胞及中性粒细胞。     

Protective effect of ultra low molecular weight heparin on glutamate-induced apoptosis in cortical cells

PURPOSE: To investigate the effect of ultra low molecular weight heparin (ULMWH) on glutamate induced apoptosis in rat cortical cells and to explore the possible mechanisms. MATERIALS AND METHODS: Cell viability was measured using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Apoptosis was first analyzed with Hoechst 33258 and then confirmed by DNA fragmentation. The concentration of free intracellular calcium ([Ca(2+)](i)) was determined with fura-2/AM fluorometry. The expression of Bcl-2 family protein and caspase-3 were evaluated with Western blot. RESULTS: Typical apoptotic morphological change in rat cortical cells treated with 100 micromol/L glutamate for 24h was detected by Hoechst 33258 staining, which was then confirmed by the DNA ladder of agarose gel electrophoresis. The apoptotic rate of the glutamate treated cells was up to 33.21%, and 24 h of treatment with glutamate increased [Ca(2+)](i), down-regulated Bcl-2 expression, up-regulated Bax expression, and increased caspase-3 activation in rat cortical cells. Our research demonstrated that ULMWH pretreatment can prevent the glutamate-induced apoptosis, attenuate the increase of [Ca(2+)](i) not only in medium containing Ca(2+) but also in Ca(2+)-free medium, up-regulate the expression of Bcl-2, down-regulate the expression of Bax, and decrease caspase-3 activation. CONCLUSION: ULMWH has neuroprotective capacity to antagonize glutamate-induced apoptosis in cortical cells, through decrease of Ca(2+) release and modulation of apoptotic processes.