子痫前期孕妇血清和胎盘组织脂联素的表达及意义

目的 分析子痫前期孕妇血清和胎盘组织脂联素的表达及意义.方法 采用酶联免疫吸附法检测52例无妊娠并发症孕妇（对照组）、58例轻度子痫前期孕妇（轻度子痫前期组）、55例重度子痫前期孕妇（重度子痫前期组）血清脂联素,并计算稳态模型评估法胰岛素抵抗指数（HOMA-IR）;采用免疫组织化学SP法检测三组孕妇胎盘组织脂联素表达情况.结果 重度子痫前期组空腹血糖明显高于对照组和轻度子痫前期组[（5.56±1.37） mmol/L比（4.55±0.51）,（4.68±0.66） mmol/L],轻度子痫前期组、重度子痫前期组空腹胰岛素及HOMA-IR均高于对照组[（14.19±3.42）,（14.90±6.64） mU/L比（9.87±1.75） mU/L,1.04±0.37,1.18±0.56比0.67±0.21],重度子痫前期组血清脂联素明显高于对照组和轻度子痫前期组[（15.79±4.86） mg/L比（11.47± 3.50）,（11.92±2.96） mg/L],差异均有统计学意义（P＜0.05）.三组胎盘组织脂联素水平比较差异均无统计学意义（P＞0.05）.血清脂联素水平与HOMA-IR及胎盘组织脂联素表达无相关性（P＞0.05）.结论 重度子痫前期孕妇血清脂联素、HOMA-IR明显增高,血清脂联素升高可能是子痫前期孕妇的一种适当的反馈性调节.     

Utilization of iron from an animal-based iron source is greater than that of ferrous sulfate in pregnant and nonpregnant women

Heme iron absorption during pregnancy and the role of hepcidin in regulating dietary heme iron absorption remains largely unexplored. The objective of this research was to examine relative differences in heme (animal based) and nonheme (ferrous sulfate) iron utilization. This study was undertaken in 18 pregnant (ages 16-32 y; wk 32-35 of gestation) and 11 nonpregnant women (ages 18-27 y). Women were randomly assigned to receive both an animal-based heme meal (intrinsically labeled (58)Fe pork) and labeled ferrous sulfate ((57)Fe) fed on alternate days. Blood samples obtained 2 wk postdosing were used to assess iron status indicators and serum hepcidin and iron utilization based on RBC incorporation of iron isotopes. Heme iron utilization was significantly greater than nonheme iron utilization in the pregnant (47.7 ± 14.4 vs. 40.4 ± 13.2%) and nonpregnant women (50.1 ± 14.8 vs. 15.3 ± 9.7%). Among pregnant women, utilization of nonheme iron was associated with iron status, as assessed by the serum transferrin receptor concentration (P = 0.003; r(2) = 0.43). In contrast, heme iron utilization was not influenced by maternal iron status. In the group as a whole, women with undetectable serum hepcidin had greater nonheme iron utilization compared with women with detectable serum hepcidin (P = 0.02; n = 29); however, there were no significant differences in heme iron utilization. Our study suggests that iron utilization from an animal-based food provides a highly bioavailable source of dietary iron for pregnant and nonpregnant women that is not as sensitive to hepcidin concentrations or iron stores compared with ferrous sulfate.     

妊娠糖尿病相关不良妊娠结局的危险因素分析

目的 评估不同糖耐量状态孕妇临床特征、胰岛素敏感性及胰岛β细胞功能,探讨妊娠糖尿病相关不良妊娠结局的危险因素.方法 回顾性分析2009年1月至2012年6月在北京协和医院定期产前随诊并住院分娩的360名50 g葡萄糖负荷试验阳性孕妇的临床资料.360例孕妇均进一步行100 g口服葡萄糖耐量试验（OGTT）,根据血糖值分为妊娠糖尿病（GDM）组83例、糖耐量异常（IGT）组75例、糖耐量正常（NGT）组202例,各组孕妇监测血糖谱均控制在孕妇达标范围.比较3组孕妇一般临床资料和生化指标、胰岛素抵抗指数、胰岛素敏感性指数、胰岛β细胞功能指数、第一时相和第二时相胰岛素分泌指数、胰岛素分泌敏感性指数,比较3组孕妇妊娠结局,分析预测GDM相关不良妊娠结局的危险因素.结果 与NGT组比较,GDM组年龄[（33.1±3.7）岁比（31.7±3.4）岁,P=0.008]、孕早期收缩压[（115.8±9.7）mmHg比（111.4±13.5） mmHg（1 mmHg=0.133kPa）,P=0.031]及舒张压[（75.4±9.0）mmHg比（71.8±8.8） mmHg,P=0.010]、一级亲属糖尿病家族史阳性率（37.3％比22.3％,P=0.012）、胰岛素治疗阳性率（10.8％比0％,P=0.001）、血清甘油三酯[（2.8±0.9）mmol/L比（2.3±0.9）mmol/L,P=0.001]、游离脂肪酸[（486.7±137.6） μmol/L比（438.1±140.7）μmol/L,P=0.033]、C反应蛋白[（5.7±4.3）mg/L比（3.6±3.0） mg/L,P=0.001]水平均显著升高;GDM组孕前体质量指数（22.6±2.9）kg/m2高于IGT组（21.3±2.7） kg/m2（P=0.049）及NGT组（21.2 ±2.8）kg/m2（P=0.003）.从NGT到IGT再到GDM组,糖化血红蛋白[（5.2±0.3）％比（5.3±0.3）％比（5.4±0.3）％]逐渐升高（P=0.001,P=0.007）,血糖曲线下面积[（20.4±2.0） mmol·h/L比（22.9±1.5） mmol·h/L比（26.9±2.1） mmol·h/L] （P =0.001,P=0.001）、胰岛素曲线下面积[（1.7±0.9）×103 pmol·h/L比（2.1±1.1）× 103 pmol·h/L比（2.7±1.3） ×103 pmol· h/L]逐渐升高（P=0.001,P=0.007）,     

游离脂肪酸与子痫前期的相关性研究

目的:探讨血清游离脂肪酸与子痫前期发病的相关性。方法:选取2010年1月～2011年6月在广东省妇幼保健院产前检查并住院分娩的子痫前期孕妇204例为研究组,同期正常孕妇335例为对照组,对两组的脂代谢参数、糖代谢参数、体脂参数进行横断面研究,并分析子痫前期患者血清游离脂肪酸浓度与孕前体重指数、甘油三酯、空腹血糖、胰岛素抵抗指数等的相关性。结果:子痫前期患者血清游离脂肪酸浓度高于正常妊娠组[(785.4±211.94)μmol/L vs(533.37±280.34)μmol/L,P<0.001],与对照组相比,子痫前期组孕妇具有更高的血甘油三酯[(4.28±1.82)mmol/L vs(2.95±1.05)mmol/L,P<0.001]、空腹血糖[(4.57±0.82)mmol/L vs(4.28±0.63)mmol/L,P<0.05]和胰岛素抵抗指数[(2.29±1.56)mmol/L vs(1.82±1.15)mmol/L,P<0.05],子痫前期组较正常对照组孕前体重指数更高(23.38±2.24 vs20.47±2.63,P<0.05)。子痫前期组游离脂肪酸与血甘油三酯、胰岛素抵抗指数正相关。结论:子痫前期患者游离脂肪酸显著升高,血甘油三酯、胰岛素抵抗指数与血游离脂肪酸水平正相关。游离脂肪酸在子痫前期发病中起重要作用。     

Reduced intellectual development in children with prenatal lead exposure

OBJECTIVE: Low-level postnatal lead exposure is associated with poor intellectual development in children, although effects of prenatal exposure are less well studied. We hypothesized that prenatal lead exposure would have a more powerful and lasting impact on child development than postnatal exposure. DESIGN: We used generalized linear mixed models with random intercept and slope to analyze the pattern of lead effect of the cohort from pregnancy through 10 years of age on child IQ from 6 to 10 years. We statistically evaluated dose-response nonlinearity. PARTICIPANTS: A cohort of 175 children, 150 of whom had complete data for all included covariates, attended the National Institute of Perinatology in Mexico City from 1987 through 2002. EVALUATIONS/MEASUREMENTS: We used the Wechsler Intelligence Scale for Children-Revised, Spanish version, to measure IQ. Blood lead (BPb) was measured by a reference laboratory of the Centers for Disease Control and Prevention (CDC) quality assurance program for BPb. RESULTS: Geometric mean BPb during pregnancy was 8.0 microg/dL (range, 1-33 microg/dL), from 1 through 5 years was 9.8 microg/dL (2.8-36.4 microg/dL), and from 6 through 10 years was 6.2 microg/dL (2.2-18.6 microg/dL). IQ at 6-10 years decreased significantly only with increasing natural-log third-trimester BPb (beta=-3.90; 95% confidence interval, -6.45 to -1.36), controlling for other BPb and covariates. The dose-response BPb-IQ function was log-linear, not linear-linear. CONCLUSIONS: Lead exposure around 28 weeks gestation is a critical period for later child intellectual development, with lasting and possibly permanent effects. There was no evidence of a threshold; the strongest lead effects on IQ occurred within the first few micrograms of BPb. RELEVANCE TO CLINICAL PRACTICE: Current CDC action limits for children applied to pregnant women permit most lead-associated child IQ decreases measured over the studied BPb range.     

子痫前期患者血清及胎盘激活素A水平变化的研究

目的 研究子痫前期患者血清及胎盘激活素A水平的变化及其与病情的关系。方法 采用ELISA检测40例子痫前期患者（子痫前期组，包括20例轻度，20例重度）和40例健康晚孕期妇女（正常妊娠组）的血清激活素A的水平；采用免疫组化方法检测胎盘激活素A的水平。结果 子痫前期组血清、胎盘激活素A水平分别为（32．23±6．11）μg/L、（516．14±5．46）μg/L，明显高于正常妊娠组的（8．04±2．19）μg/L、（275．38±18．12）μg／L（P〈0．01）；其中重度子痫前期患者血清、胎盘激活素A水平较轻度子痫前期患者升高（P〈0．01）；子痫前期组血清、胎盘激活素A水平与24h尿蛋白含量之间呈显著正相关；重度子痫前期伴胎儿生长受限（FGR）者血清胎盘激活素A水平较不伴FCR者差异均无统计学意义（P〉0．05）。结论 子痫前期患者血清、胎盘激活素A水平较健康晚孕期妇女显著升高，且与子痫前期病情进展关系密切。     

妊娠期高血压疾病凝血指标变化

目的 探讨妊娠期高血压疾病患者凝血指标变化的意义.方法 收集66例妊娠期高血压疾病患者(妊娠期高血压组)及70例正常妊娠晚期孕妇(对照组),行血小板计数(PC)、平均血小板体积(MPV)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)检测.结果妊娠期高血压组与对照组比较,PC[(178.32±51.08) × 10~9/L比(186.17±40.02)× 10~9/L]、PT[(10.54±0.54)s比(11.07±0.49)s]、APTT[(26.23±3.12)s比(28.08±4.31)s]显著下降(P<0.05或<0.01);FIB[(5.34±0.68)g/L比(4.02±0.73)g/L]、MPV[(11.10±2.31)fl比(8.95±1.37)fl]、D-D[(0.46±0.27)mg/L比(0.18±0.19)mg/L]显著增加(P<0.01).重度子痫前期患者与轻度子痫前期患者比较,FIB、D-D显著增加(P<0.01).早发型子痫前期患者与晚发型子痫前期患者比较,PT明显缩短(P<0.05),FIB、D-D明显增加(P<0.05或<0.01).结论 妊娠期高血压疾病呈明显高凝状态;早发型子痫前期患者较晚发型子痫前期患者高凝状态和凝血功能障碍更严重.     

Lead exposure among females of childbearing age--United States, 2004

For centuries, exposure to high concentrations of lead has been known to pose health hazards, and evidence is mounting regarding adverse health effects from moderate- and low-level blood lead concentrations. Public health authorities use higher levels to define blood lead levels (BLLs) of concern in nonpregnant females (> or =25 microg/dL) compared with children (> or =10 microg/dL) and a lower level (> or =5 microg/dL) for pregnant females. This difference in levels for nonpregnant and pregnant females has raised concern because of the recognition that a proportion of nonpregnant females with BLLs > or =5 microg/dL will become pregnant and potentially expose their infants to a risk for adverse health effects from lead. Maternal and fetal BLLs are nearly identical because lead crosses the placenta unencumbered. This report summarizes 2004 surveillance data regarding elevated BLLs among females of childbearing age (i.e., aged 16-44 years) in 37 states participating in CDC's Adult Blood Lead Epidemiology and Surveillance (ABLES) program. The results indicated that rates of elevated BLLs ranged from 0.06 per 100,000 females of childbearing age at BLLs of > or =40 microg/dL to 10.9 per 100,000 females at BLLs of > or =5 microg/dL. Primary and secondary prevention of lead exposure among females of childbearing age is needed to avert neurobehavioral and cognitive deficits in their offspring.     

Blood lead concentrations in maternal and cord blood evaluated by two analytic methods

In this study the authors determined the relationship between blood lead concentrations in pregnant women and newborns, using graphite furnace atomic absorption spectrometry (GFAAS) and the LeadCare System (LCS). Fifty-five pregnant women admitted for delivery from June to August 2002 at a hospital in Brazil were included in the study. Blood samples were taken from the women and from umbilical cords to determine serum lead concentrations. Only 3 women had blood lead concentrations > or = 0.48 micromol/L. There were correlations between lead concentrations in women and newborns using either GFAAS (r = 0.83, p < .001) or the LCS (r = 0.75, p < .001). However, there were no statistically significant correlations between the GFAAS and LCS methods, probably because most of the women did not have high concentrations of lead (> or = 0.48 micromol/L). Considering the discrepancy the authors found between the LCS method and the traditional GFAAS method, the authors advise against using the LCS method, especially in populations with levels of lead < or = 0.48 micromol/L.     

Blood Lead Concentration and Thyroid Function during Pregnancy: Results from the Yugoslavia Prospective Study of Environmental Lead Exposure

Background: Although maternal hypothyroidism increases the risk of adverse neonatal and obstetric outcomes as well as lower IQ in children, the environmental determinants of maternal thyroid dysfunction have yet to be fully explored.Objectives: We aimed to examine associations between mid-pregnancy blood lead (BPb) and concomitant measures of thyroid function among participants in the Yugoslavia Prospective Study of Environmental Lead Exposure.Methods: As part of a population-based prospective study of two towns in Kosovo—one with high levels of environmental lead and one with low—women were recruited during the second trimester of pregnancy, at which time blood samples and questionnaire data were collected. We measured concentrations of BPb, free thyroxine (FT₄), thyroid-stimulating hormone (TSH), and thyroid peroxidase antibodies (TPOAb) in archived serum samples.Results: Compared with women from the unexposed town, women from the exposed town had lower mean FT₄ (0.91 ± 0.17 vs. 1.03 ± 0.16 ng/dL), higher mean TPOAb (15.45 ± 33.08 vs. 5.12 ± 6.38 IU/mL), and higher mean BPb (20.00 ± 6.99 vs. 5.57 ± 2.01 μg/dL). No differences in TSH levels were found. After adjustment for potential confounders, for each natural log unit increase in BPb, FT₄ decreased by 0.074 ng/dL (95% CI: –0.10, –0.046 ng/dL), and the odds ratio for testing positive to TPOAb was 2.41 (95% CI: 1.53, 3.82). We found no association between BPb and TSH.Conclusions: Prolonged lead exposure may contribute to maternal thyroid dysfunction by stimulating autoimmunity to the thyroid gland.Citation: Kahn LG, Liu X, Rajovic B, Popovac D, Oberfield S, Graziano JH, Factor-Litvak P. 2014. Blood lead concentration and thyroid function during pregnancy: results from the Yugoslavia Prospective Study of Environmental Lead Exposure. Environ Health Perspect 122:1134–1140; http://dx.doi.org/10.1289/ehp.1307669     

冠心病患者载脂蛋白A V与脂联素关系研究

目的 探讨冠心病患者血清载脂蛋白(Apo)AV与脂联素之间的关系.方法 检测59例冠心病患者(冠心病组)和40例对照者(对照组)的血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、ApoA I、ApoB,同时采用酶联免疫吸附法测定血清ApoAV和脂联素水平.结果 冠心病组血清TG显著高于对照组[(1.79±1.28)mmol/L比(1.27±0.79)mmol/L],HDL-C显著低于对照组[(1.17±0.25)mmol/L比(1.29±0.26)mmol/L],ApoAV显著低于对照组[(186.71±78.20)μg/L比(250.29±110.38)μg/L],脂联素亦显著低于对照组[(3.81±0.15)mg,L比(5.33±0.37)mg/L],P<0.05或<0.01.ApoAV与TG呈负相关 r=-0.208,P=0.040),与HDL-C(r=0.241,P=0.016)、脂联素(r=0.238,P=0.018)呈正相关.结论 冠心病患者血清ApoAV和脂联素水平降低,TG水平增高.ApoAV与脂联素共同影响动脉粥样硬化的发展.     

Lead exposure in highway toll-booth workers

Biomarkers of lead exposure (blood lead, BPb) and effect (erythrocyte protoporhyrin, EP, and activity of delta-aminolevulinic acid dehydratase, ALAD) were measured in 68 male toll-booth operators (aged 22-60 years) on the Zagreb-Karlovac motorway. Average values (arithmetic mean +/- standard deviation) were: 61.8 +/- 29.3 micrograms/L for BPb, 0.70 +/- 0.20 mumol/L erythrocytes for EP, and 50.6 +/- 9.8 U/L erythrocytes for ALAD. All were within the normal range determined for general population (BPb < 150 micrograms/L, EP < 1.62 mumol/L erythrocytes, and ALAD > 35 U/L erythrocytes). A significant positive correlation was found between BPb and EP (r = 0.367, P < 0.01) and an inverse correlation between BPb and ALAD (r = -0.271, P < 0.05) and for EP and ALAD (r = -0.381, P < 0.01). Significant correlations were found between BPb or ALAD and smoking index (r = 0.486, P < 0.01, and r = -0.322, P < 0.01, respectively), whereas BPb also significantly correlated with blood gamma-glutamyl transferase (GGT) activity, which may indicate hepatotoxic effect of alcohol consumption (r = 0.334, P < 0.01). Among standard spirometric tests, BPb inversely correlated with FEV1 (r = -0.251, P < 0.05) and Tiffenau index (r = -0.280, P < 0.05), whereas ALAD positively correlated with FEF75-85 (r = 0.261, P < 0.05) and Tiffenau index (r = 0.314, P < 0.01). Among standard hematologic tests, BPb positively correlated with MCV (r = 0.282, P < 0.05), EP inversely correlated with erythrocyte count (r = -0.253, P < 0.05), and ALAD positively correlated with MCHC (r = 0.306, P < 0.05) and inversely with MCV (r = -0.250, P < 0.05). Although PbB values in these workers are within occupational exposure limits, they are higher than in corresponding occupations in developed countries. This may be explained by greater exposure to lead in ambient air, tobacco (through mainstream and sidestream smoking) and alcohol in this population.     

No relationship between pregnancy complications and variations in blood glucose levels among nondiabetic women

Research using high-risk pregnant women suggests that postprandial blood glucose levels at the high end of normal are associated with greater risk of adverse pregnancy outcomes than low-normal levels. The objective of this study was to determine the relationships between pregnancy complications and glucose levels in low-risk pregnant women. Based on 2-hour postprandial glucose testing at 27 to 33 weeks, 337 women with normal reproductive histories were divided into three groups: group A, glucose less than 5.6 mmol/L (100 mg/dL), group B, 5.6 to 6.6 mmol/L (100 to 119 mg/dL), and group C, 6.7 to 9.1 mmol/L (120 to 164 mg/dL). Women with glucose levels greater than or equal to 9.2 mmol/L (165 mg/dL) were excluded. The groups were compared to detect differences in rates of various maternal outcomes (preeclampsia, cesarean delivery, forceps delivery) and neonatal outcomes (macrosomia, Apgar scores, prematurity, fetal death, infant death, congenital anomalies). No significant differences were found. These data indicate that variations in maternal glucose tolerance (within the normal range) are not associated with adverse outcomes in normal pregnant women.     

妊娠期糖尿病孕妇个体化管理和营养治疗效果研究

目的：研究个体化管理和营养治疗对妊娠期糖尿病（ GDM）孕妇的治疗效果。方法选取2012年7至12月确诊为GDM的孕妇90例和同期血糖正常的孕妇92例为研究对象,通过个体化管理和营养治疗后,比较GDM孕妇和对照组孕妇血糖、妊娠并发症和新生儿并发症的发生率。结果治疗前GDM组孕妇空腹及餐后1h和2h 血糖分别为（5．25±0．44） mmol/L,（8．30±0．89）mmol/L和（7．75±1．51）mmol/L;治疗后分别为（4．78±0．30）mmol/L,（7．22±0．46）mmol/L和（6．44±0．59） mmol/L,较治疗前均有明显降低,差异有统计学意义（t值分别为8．286、10．204和7．604,均P＜0．05）。治疗前后,GDM组孕妇HbA1c值分别为（4．91±0．58）％和（4．69±0．83）％,差异有统计学意义（t＝2．044,P＜0．05）。个体化营养治疗后,GDM组和对照组孕妇空腹及餐后1h和2h血糖分别为（4．78±0．30）mmol/L,（7．22±0．46）mmol/L,（6．44±0．59）mmol/L和（4．80±0．32） mmol/L,（7．16±0．42）mmol/L,（6．29±0．44）mmol/L;差异均无统计学意义（t值分别为-0．419、0．962和1．967,均P＞0．05）。两组孕妇剖宫产率、早产率及胎膜早破的发生率差异也均无统计学意义（χ^2值分别为0．194、0．122和0．000,均P＞0．05）,两组巨大儿的出生率差异无统计学意义（Fisher确切概率法得出P＝0．275）。结论个体化管理和营养治疗可有效降低GDM孕妇的血糖,并减少母婴并发症的发生。     

营养干预结合有氧运动对非酒精性脂肪肝患者血清脂联素的影响

目的探讨营养干预结合有氧运动对非酒精性脂肪肝(NAFL)患者血清脂联素水平和胰岛素抵抗的影响.方法以2008年4月至2009年8月聊城市人民医院查体中心和肝病门诊确诊的32例NAFL患者为NAFL组,同期健康查体人员31例为对照组.对NAFL组进行营养干预并实施有氧运动方案,检测两组干预前后体重指数(BMI)、血清脂联素、空腹血糖(FBG)、空腹胰岛素(FINS)及血脂水平变化,计算胰岛素抵抗指数(HOMA-IR),比较组间差异、干预前后差异以及血清脂联素与各指标的相关性.结果 子预前NAFL组的BMI[(29.84±3.16) kg/m2比( 22.22±1.81)kg/m2,P=0.000]、总胆固醇(TC)[(5.09±0.86) mmol/L比(4.38±0.85) mmol/L,P=0.002]、甘油三酯(TG) [(1.99-0.86) mmol/L比(1.10±0.38) mmol/L,P=0.000]、FBG [(6.02±0.63) mmol/L比(5.02±0.71) mmol/L,P=0.000]、FINS[(13.73±3.24)mU/L比(9.55±1.99) mU/L,P=0.000]、HOMA-IR[(3.74±1.21) mmol/L比(2.08±0.27) mmol/L,P=0.000]水平均显著高于正常对照组,脂联素水平明显低于对照组[(4.89±1.81) ug/L比(12.97±3.15) ug/L,P=0.000].NAFL组干预后BMI[(26.65±2.39) kg/m2比(29.84±3.16) kg/m2,P =0.000]、FBG[(5.61±0.47) mmol/L比(6.02±0.63) mmol/L,P=0.004]和FINS[(11.12±2.01) mU/L比(13.73±3.24) mU/L,P=0.000]水平显著低于干预前,脂联素水平显著高于干预前[(6.54±2.12)ug/L比(4.89±1.81) ug/L,P=0.001].脂联素与BMI、FBG、FINS、HOMA-IR和TG呈显著负相关(P值分别为0.004、0.000、0.000、0.000、0.010),与高密度脂蛋白呈显著正相关(P =0.026),与TC无相关性(P =0.101).结论营养干预结合有氧运动可提高NAFL患者的血清脂联素水平,调节血糖血脂水平,改善胰岛素抵抗.     

妊娠合并临床甲状腺功能减退症患者控制与否对母婴结局的影响

目的探讨妊娠合并临床甲状腺功能减退症（甲减）病情控制与否对母婴结局的影响,为临床提供诊治依据。方法对本院168例合并临床或亚临床甲减的孕妇进行临床观察,其中甲减控制组9例,甲减未控制组29例,亚临床甲减组130例,并与正常孕妇组180例对照比较,分析各组孕妇妊娠结局和新生儿出生情况。结果与对照组相比,甲减控制组妊娠晚期游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）、促甲状腺激素（TSH）水平差异无统计学意义[（3．68±1．11）pmol／LVS（3．19±0．33）pmol／L,（15．48±4．14）pmol／LVS（13．95±1．68）pmol／L,1．87mU／LV81．76mU／L,P〉0．05]。甲减未控制组妊娠中、晚期血清FT3、FT4水平降低,TSH水平升高[（2．71±0．80）pmol／Lvs（3．14±0．34）pmol／L,（10．94±2．68）pmol／LVS（14．25±2．01）pmol／L,5．62mU／LVS2．28mU／L,（2．34±0．70）pmol／LVS（3．19±0．33）pmol／L,（10．16±1．65）pmol／LVS（13．95±1．68）pmol／L,7．13mU／LVS1．76mU／L,t=2．754～9．15,P〈0．01],亚临床甲减组血清TSH水平升高（4．67mU／LVS2．28mU／L,5．25mU／LVS1．76mU／L,t=18．28,18．57,P〈0．01）。甲减控制组孕妇未发生围生儿不良结局,而甲减未控制组孕妇围生儿不良结局、产科并发症的发生率高于对照组（17．2％VS2．8％,37．9％V85．6％,x2=11．47,28．97,P〈0．01）。亚临床甲减组产科并发症的发生率较对照组升高（40．0％VS5．6％,x2=52．97,P〈0．01）。结论妊娠合并临床或亚临床甲减均可影响母婴结局,尤以临床甲减未控制者对母婴结局影响较大,甲减孕妇病情控制可改善母婴预后。     

妊娠期糖尿病孕妇血清载脂蛋白M与胰岛素和瘦素的关系

目的探讨妊娠期糖尿病（GDM）孕妇血清载脂蛋白M（ApoM）与胰岛素和瘦素之间的关系。方法GDM孕中期组（孕24—28周）87例、孕晚期组（分娩前1周）122例,对照组为同孕期正常孕妇,检测血清中载脂蛋白M（ApoM）、胰岛素、瘦素的表达水平,分析指标间的相关性。结果孕中期GDM孕妇ApoM表达水平（0．029±0．010）g／L显著低于同孕期正常对照组（0．036±0．013）g／L（t=-4．168,P=00001）,孕晚期GDM孕妇ApoM表达水平（0．028±0．010）g／L显著高于同孕期正常对照组（0．023±0．008）g／L（t=3．529,P=0．0005）。孕中期GDM组的胰岛素表达水平、胰岛素抵抗指数均高于同孕期正常对照组[胰岛素表达水平：12．975（7．968～22．237）比6．885（4．805—10．015）μg/L,Z=-5．618,P=0．000;胰岛素抵抗指数2．808（1．705～5．158）比1．336（0．897—1．925）,Z=-6．305,P=0．000],瘦素水平[0．026（0．015～0．044）比0．024（0．014—0．036）ng／L]两组比较差异无统计学意义（Z=-0．927,P=0．354）;孕晚期GDM组和同孕期正常对照组比较,胰岛素表达水平[9．5（5．645～13．265）比9．82（6．708—15．885）μg/L,Z=0．971,P=0．332]、胰岛素抵抗指数[1．637（0．977～2．471）比1．781（1．121—2．686）,Z=0．904,P=0．366]和瘦素[0．025（0．015—0．044）比0．029（0．015～0．043）ng／L,Z=0．494,P=0．621]差异均无统计学意义。采用多因素非条件Logistic回归分析显示,ApoM表达水平是GDM的独立危险因素。结论妊娠期糖尿病孕妇血清ApoM表达异常,ApoM可能与GDM的发生有一定的关系,但胰岛素和瘦素与ApoM之间无相关性。     

Semen quality and reproductive endocrine function in relation to biomarkers of lead, cadmium, zinc, and copper in men

Blood lead (BPb), activity of delta-aminolevulinic acid dehydratase (ALAD), erythrocyte protoporphyrin (EP), blood cadmium (BCd), serum zinc (SZn), seminal fluid zinc (SfZn), serum copper (SCu), and parameters of semen quality and of reproductive endocrine function were measured in 149 healthy male industrial workers 20-43 years of age. The group contained 98 subjects with slight to moderate occupational exposure to Pb and 51 reference subjects. All of the subjects lived in Zagreb, Croatia. Significant (p < 0.05) correlations of BPb, ALAD, and/or EP with reproductive parameters indicated a Pb-related decrease in sperm density, in counts of total, motile, and viable sperm, in the percentage and count of progressively motile sperm, in parameters of prostate secretory function (SfZn, acid phosphatase, and citric acid in seminal fluid), and an increase in abnormal sperm head morphology, serum testosterone, and estradiol. These associations were confirmed by results of multiple regression, which also showed significant (p < 0. 05) influence of BCd, SZn, SCu, smoking habits, alcohol consumption, or age on certain reproductive parameters. These effects were mainly of lower rank and intensity as compared to Pb-related reproductive effects, whereas BCd contributed to a decrease in sperm motility and an increase in abnormal sperm morphology and serum testosterone. No significant Pb- or Cd-related influence was found on levels of the lactate dehydrogenase isoenzyme LDH-C(4) and fructose in seminal fluid or on follicle-stimulating hormone, luteinizing hormone, and prolactin in serum. The seminal fluid concentrations of Pb (SfPb) and Cd (SfCd) were measured in 118 of the 149 subjects, and a highly significant (p < 0.0001) correlation was found between BPb and SfPb levels (r = 0.571) and between BCd and SfCd levels (r = 0.490). The overall study results indicate that even moderate exposures to Pb (BPb < 400 microg/L) and Cd (BCd < 10 microg/L) can significantly reduce human semen quality without conclusive evidence of impairment of male reproductive endocrine function.     

子痫前期患者血清内脏脂肪素水平的变化及意义

目的 探讨子痫前期(PE)患者血清内脏脂肪素(VF)水平的变化及意义.方法 选取PE患者81例,其中轻度PE 39例(轻度PE组),重度PE 42例(重度PE组),另选择45例健康孕妇作为对照组.检测各组孕妇空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)及三酰甘油(TG)水平,采用稳态模型评估胰岛素抵抗指数(HOMA-IR).采用ELISA法检测血清VF水平.结果 三组FPG、FINS、HOMA-IR比较差异无统计学意义(P>0.05);重度PE组TG、TC高于对照组和轻度PE组(P<0.05).重度PE组血清VF水平为(22.45±4.18)μg/L,显著高于对照组[(14.52±3.25)μg/L]和轻度PE组[(18.75±3.96)μg/L](P<0.05).PE患者血清VF水平与FPG、FINS水平无相关性(r=0.21、0.24,P>0.05);PE患者血清VF水平与HOMA-IR、TC及TG呈正相关(r=0.42、0.36、0.41,P<0.05).结论 PE患者血清VF水平增加,VF水平与PE的严重程度、胰岛素抵抗和脂质代谢有关.     

Clinician follow-up of children screened for lead poisoning.

OBJECTIVES: This study assessed clinicians' compliance with Centers for Disease Control and Prevention recommendations for follow-up of children with blood lead (BPb) levels of 0.48 mumol/L (10 micrograms/dL) or higher. METHODS: Clinicians' success at follow-up was determined for 3 BPb ranges: > or = 0.97 mumol/L, 0.73 through 0.92 mumol/L, and 0.48 through 0.68 mumol/L (> or = 20 micrograms/dL, 15-19 micrograms/dL, and 10-14 micrograms/dL, respectively). RESULTS: A total of 410 children with elevated BPb levels were followed over a 12-month period; within 4 months, 71% of those with initial levels of 0.97 mumol/L or greater were retested and 57% and 34% of children with initial BPb levels of 0.73 through 0.92 mumol/L and 0.48 through 0.68 mumol/L, respectively, were retested. CONCLUSIONS: Follow-up of children with elevated BPb levels is inadequate within an urban ambulatory care network.