妊高征患者胎盘病理改变及与母血脐血一氧化氮水平关系的分析

妊高征 (ＰＩＨ)是目前造成孕产妇死亡的主要妊娠并发症。其发生发展与内皮舒张因子一氧化氮 (ＮＯ)有密切关系 ,ＮＯ水平的改变可能与胎盘的病理改变有关[1] ,但是 ,目前对ＮＯ水平与胎盘病理改变间的因果关系尚未完全阐明。本研究旨在探讨ＰＩＨ时胎盘病理改变与母血及脐血ＮＯ水平的关系。1　资料和方法1.1　研究对象　选择 1998年 10月至 1999年 10月住院确诊为妊高征的晚期妊娠妇女 38例 (ＰＩＨ组 ) ,随机选择同期住院的正常晚期妊娠妇女 32例 (对照组 ) ,两组均为初产妇 ,无其它妊娠并发症与合并症 ,年龄 2 2～ 2 8岁 ,平均年龄2 5岁…     

妊高征患者产前母血及新生儿脐血瘦素水平的检测及意义

目的 探讨妊高征患者产前母血及其新生儿脐血瘦素水平和临床意义。方法 2000年2月至2002年10月间采用放射免疫法测定96例妊高征、150例正常妊娠妇女在分娩前的母血及其新生儿的脐血瘦素水平。结果 中、重度妊高征组的母血、脐血瘦素水平均升高明显；妊高征组的收缩压、舒张压及平均动脉压与母血瘦素水平的相关程度明显高于正常妊娠组；轻、中度妊高征组及正常妊娠组脐血瘦素水平与新生儿出生体重、体重指数呈显著性正相关。结论 母血瘦素水平可能成为中、重度妊高征的观察、诊断指标之一。脐血瘦素水平可能成为正常妊娠，轻、中度妊高征的胎儿宫内生长发育状况的评估指标之一。     

硝酸甘油对妊高征患者血中一氧化氮及内皮素的影响

目的：观察一氧化氮（ｎｉｔｒｉｃｏｘｉｄｅ,ＮＯ）供体硝酸甘油对妊高征患者血中ＮＯ及内皮素（ｅｎｄｏｔｈｅｌｉｎ,ＥＴ）的影响,为使用硝酸甘油治疗妊高征提供理论依据。方法：于用药前、后３０分钟分别抽取患者肘静脉血。以Ｇｒｉｅｓｓ反应测定血清中ＮＯ的代谢产物及放射免疫法测定血浆中内皮素的含量,同时监测心功能参数。结果：妊高征病人使用硝酸甘油后,血中ＮＯ代谢产物明显增多（Ｐ＜０．０５）,ＥＴ明显下降（Ｐ＜０．０５）ＥＴ与ＮＯ代谢产物的比值明显下降（Ｐ＜０．０５）。结论：硝酸甘油不仅可增加血中ＮＯ含量,而且可减少血中ＥＴ含量,纠正ＥＴ／ＮＯ的比例失衡,改善心功能,纠正妊高征的病理生理改变,可作为临床治疗妊高征的药物。     

脐血流A/B值对重症妊高征围产儿监测的意义及处理

４４例重度ＰＩＨ患者，按围产儿预后分为正常组和异常组，后者包括死胎、新生儿死亡及新生儿出生后１分钟Ａｐｇａｒ＜５分者，两组孕妇年龄、ＰＩＨ的临床表现大致相同，而围产儿预后与分娩孕周及出生体重关系密切（Ｐ＜０．０１），与ＰＩＨ发病孕周也有关（Ｐ＜０．０５）。脐血流测定结果表明：①Ａ／Ｂ≥３者２５例，占总数的５６．８％，其中异常组１８例，并全部呈异常高值。②２５例ＳＧＡ中２２例Ａ／Ｂ值≥３；如按Ａ／Ｂ≥３估计ＩＵＧＲ，其阳性预测值为８８．０％（２２／２５）；阴性预测值为８４．２％（１６／１９）。③脐血流Ａ／Ｂ值与孕妇发生ＰＩＨ的孕周及围产儿死亡率有关，＜２４周发病组，１０例Ａ／Ｂ值均＞４，围产儿死亡８／１０例（８０％）；而＞３２周发病组，１０例Ａ／Ｂ均＜３，新生儿全部存活。④ＡＥＤＶ者１０例，该１０例妊高征均发生于＜３２周组，围产儿死亡９／１０例（９０．０％）。     

妊高征患者封闭抗体对配偶T淋巴细胞分化抗原CD3、CD4、CD8的影响

目的　通过测定妊娠高血压综合征 (妊高征 )患者血清封闭抗体对配偶T淋巴细胞的封闭效率来探讨妊高征发病的免疫学机制。　方法　正常孕妇组 82例 ,其中早孕组 16例 ,中孕组32例 ,晚孕组 34例 ;妊高征组 15例 (孕晚期 )。将孕妇血清与配偶T淋巴细胞作用后加入荧光标记的CD3、CD4、CD8单克隆抗体。以流式细胞仪测定所有研究对象的血清封闭抗体对配偶T淋巴细胞分化抗原CD3、CD4、CD8的封闭效率。　结果　正常孕妇组 ,早孕妇女对配偶T淋巴细胞CD3、CD4、CD8的封闭效率分别为 (4.14± 1.0 2、2 .0 2± 0 .2 4、2 .37± 1.0 5 ) % ,高于中孕期 (- 0 .2 9± 0 .13、1.0 3± 0 .2 7和 0 .6 5± 0 .2 3) % (P均 <0 .0 5 ) ;而晚孕期妇女血清对配偶T淋巴细胞CD3、CD4、CD8的封闭效率最低 (- 1.33± 1.4 7、0 .15± 0 .0 1和 - 1.0 4± 0 .37) %。妊高征患者血清对配偶CD3、CD4、CD8的封闭效率 (- 4 .16± 1.2 5、- 2 .13± 0 .4 3和 - 3.38± 1.0 6 ) %明显低于正常晚孕妇女 (P<0 .0 1、0 .0 0 5、0 .0 0 5 )。　结论　 (1)封闭抗体随孕周增加而降低 ,到晚孕期达到最低水平。 (2 )正常妊娠妇女孕早期血清高水平的封闭抗体 ,保证了胚胎早期的正常发育。(3)妊高征患者血清中封闭抗体的减少可能是导致妊高征发病的重     

妊娠高血压综合征孕妇血清一氧化氮与雌三醇水平的相关性研究

目的 :探讨一氧化氮 (NO)含量和雌三醇 (E3 )水平在正常妊娠与妊高征中的相互作用及其与妊高征的关系。方法 :采用硝酸还原酶法与放射免疫测定法 ,测定同期住院的妊高征 5 0例 (PIH组 )及正常晚期妊娠 5 1例 (对照组 )静脉血中的NO代谢产物亚硝酸基 /硝酸基 (NO2 - /NO3 - )及E3 。结果 :PIH组血清NO2 - /NO3 - 含量为 4 5 .92±11.31μmol/L ,对照组为 60 .16± 2 0 .92 μmol/L ;PIH组血清NO2 - /NO3 - 含量明显低于对照组 ,有极显著差异 (P =0 .0 0 0 1)。PIH组E3 水平 (67.2 2± 14.5 3ng/ml)显著低于对照组(81.0 6± 36.5 9ng/ml) ,差异有显著性 (P =0 .0 15 6)。妊高征组及对照组NO含量与E3 水平均呈正相关 (r =0 .5 5 964,P =0 .0 0 0 1;r =0 .5 7349,r =0 .0 0 0 1)。结论 :妊高征患者血清NO含量与E3 水平均降低 ,NO合成障碍可能是妊高征的发病原因之一 ,E3 对NO合成可能起一定作用     

A controlled study of maternal serum concentrations of lipoproteins in pregnancy-induced hypertension

Summary Seventeen women with pregnancy-induced hypertension (PIH) and 17 controls with uncomplicated pregnancy who were matched for maternal and gestational age were investigated for lipid concentrations in whole serum and lipoprotein fractions. The triglyceride level in the low-density lipoprotein fraction was higher in PIH patients than in controls (P<0.03). The differences between values of other parameters did not attain the level of statistical significance, although the tendency of the results was consistent with findings reported in other studies. The differences observed were small and the data exhibited wide variation. Therefore, it appears unlikely that serum lipid and lipoprotein concentrations could gain major clinical importance as diagnostic parameters in PIH.     

The relationship between neck circumference and pregnancy-induced hypertension in the third trimester pregnant women

Objective: The purpose of this study was to evaluate the relationship between neck circumference (NC) and pregnancy-induced hypertension (PIH) in the third trimester pregnant women. Methods: The study included 126 women who were in the third trimester pregnancy. All subjects completed a standard sleep questionnaire, anthropometric measurements and ultrasonic testing. Results: Pregnant women with NC ≥34.7?cm had significantly higher frequency of PIH than pregnant women with NC <34.7?cm (35.6% versus 2.5%, χ^2?=?25.863, p?=?0.000). Conclusions: The increase of NC was independent risk factor for PIH in the third trimester pregnant women.     

妊高征患者丙二醛、超氧化物歧化酶活性的变化及其临床意义

目的：探讨妊娠高血压综合征（PIH）患者外周静脉血清、新生儿脐静脉血清及胎盘组织中丙二醛（MDA）和超氧化物歧化酶（SOD）含量的变化及与PIH发生、发展的关系。方法：以PIH27例为研究组，测定其外周静脉血清，新生儿脐静脉血清及胎盘组织中的MDA和SOD，并比较了分娩前、后的变化，以年龄相近的20例正常孕妇作为对照组。结果：PIH患者的MDA含量按轻、中、重程度不同较正常晚期妊娠者逐渐增高（P＜0．01），二者呈正相关（r＝0．939，r＝0．925，r＝0．961，均P＜0．01）；PIH患者的SOD含量按轻、中、重程度不同较正常孕妇者逐渐降低（P＜0．01），二者呈负相关（r＝－0．925，r＝－0．937，r＝－0．954，均P＜0．01）；PIH患者分娩后MDA含量下降（P＜0．01），而SOD含量升高（P＜0．01）。结论：PIH的发生、发展与体内氧化与抗氧化平衡失调有关。     

Reduced endothelial nitric oxide synthase activity and concentration in fetal umbilical veins from maternal cigarette smokers

OBJECTIVE: This study aimed to investigate the effect of maternal cigarette smoking on endothelial nitric oxide synthase (eNOS) activity and concentration in the fetal umbilical vein, and subsequently, to relate the findings to the size of the newborn. STUDY DESIGN: Forty-four nonsmoking and 30 smoking women were included in the study. Umbilical vein endothelial cells were isolated immediately after delivery. The eNOS activity was determined in the samples by the conversion of (14)C-L-arginine to (14)C-L-citrulline, and the eNOS concentration was determined by a human eNOS immunoassay. RESULTS: Newborns of smokers had a lower weight (P=.014) and a smaller head circumference (P=.002) than those newborns of nonsmokers. The eNOS activity in fetal umbilical veins exposed to maternal smoking was 40% lower (P=.006), and the eNOS concentration 32% lower (P=.053) in newborns of smokers than in nonsmokers. CONCLUSION: The findings suggest that maternal smoking reduces nitric oxide production in the fetal circulation. This may contribute to retarded fetal growth caused by the subsequent endothelial dysfunction with reduction of dilatory capacity of the vessels.     

胎儿宫内生长迟缓孕妇静脉血及其新生儿脐血一氧化氮水平测定的临床意义

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Malon dialdehyde, nitrite and adrenomedullin levels in patients with premenstrual syndrome

Objective To assess the levels of malon dialdehyde (MDA); a lipid peroxide product, total nitrite; a stabile product of nitric oxide (NO), and adrenomedulin (AM), to determine whether their levels are altered in premenstrual syndrome (PMS) and to search for their possible pathophysiological role in this peculiar syndrome. Study design Twenty-one patients aged between 28 and 37 years, who had regular menses for at least six previous cycles, and were in general good health condition, were taken into the study. Blood samples were obtained from each patient at the 3rd and 21st day of their menstrual cycles. AM, nitrite, MDA and estradiol levels have been assessed in these samples for each patient. Results No statistically significant difference in terms of age, parity and body mass index was detected among groups (P > 0.05). Nitric oxide levels were higher on the 3rd day, compared to 21st day in the study group, and this difference was statistically significant (P < 0.05). In the study group, 21st day AM levels were significantly higher when compared to the control group (P < 0.05). Conclusion Even though various stress symptoms are present in PMS, there is no change in the levels of MDA, an oxidative distress indicator but AM and NO may have a pathophysiological role on this enigmatic disease.     

Ca, Mg, Cu and Zn contents of the maternal and umbilical cord serum in pregnancy-induced hypertension

Calcium, magnesium, copper and zinc in the maternal and umbilical cord serum were measured in 106 patients suffering from pregnancy-induced hypertension (PIH) and 106 controls. Mean maternal serum values of Ca, Mg, Cu and Zn in the PIH group were 2.460 mmol/L, 0.839 mmol/L, 35.094 mol/L and 8.408 mumol/L,respectively and were compared with the corresponding Values of 2.765 mmol/L, 0.834 mmol/L, 31.486 mumol/L, and 9.657 mumol/L in the controls. The Ca and Zn levels were lower and Cu higher in the PIH group (P less than 0.05 or P less than 0.01). No significant difference was found in the four elements in umbilical cord serum between the PIH cases and controls, indicating that the fetus can maintain an adequate Ca, Mg, Cu and Zn homeostasis even in pregnancy-induced hypertension. However, PIH cases had a lower Ca level in maternal serum than in umbilical cord serum. This study suggests that maternal serum Ca, Cu and Zn are related to PIH, and Ca might have a causal role in the development of PIH.     

Platelet-binding immunoglobulins in pregnancy-induced hypertension II. Origin of circulating IgG and IgM antiplatelet antibodies in the umbilical cord serum

IgG and IgM have been identified on the surface of maternal platelets in both autoimmune thrombocytopenia (ATP) and pregnancy-induced hypertension (PIH). IgG is also found on the umbilical cord platelets of patients with ATP and PIH, whereas IgM is only found on the umbilical cord platelets of patients with PIH. The possible maternal or fetal origins of these umbilical cord blood immunoglobulins were investigated by immunoblot analysis of antibodies in paired maternal and umbilical cord blood sera of ATP and PIH patients. Maternal sera contained IgG and IgM antibodies which reacted with several platelet proteins, however, a large amount of patient-to-patient variation was observed in the specific antigens that were identified. Analysis of paired maternal and umbilical cord sera from patients with ATP or PIH showed identical patterns of antigen specificity, which suggested that the IgG antibodies in the fetal circulation were of maternal origin. Circulating IgM antibodies were not observed in the umbilical cord sera of ATP patients. The umbilical cord sera of PIH patients, however, contained IgM antibodies that reacted against a variety of platelet antigens. In addition, most umbilical cord sera from PIH patients had identical patterns and relative intensities of reactivity, which differed from the patterns observed in the paired maternal sera. Antiplatelet IgM in the umbilical cord blood of PIH patients, therefore, appears to be a product of the fetal immune system.     

The effect of maternal exercise on umbilical artery blood flow in pregnancy-induced hypertension.

Seventeen in-patients with pregnancy-induced hypertension (PIH) in the last trimester of pregnancy underwent an exercise stress test. The mean exercise intensity achieved was 66% (55-77%) of submaximal exercise. The mean maternal heart rate rose significantly from a mean of 89 beats per minute (64-110 bpm) to a mean of 144 bpm (120-168 bpm) after exercise. The mean systolic blood pressure rose significantly from a mean of 149 mmHg (130-170 mmHg) to a mean of 171 mmHg (150-190 mmHg). The diastolic blood pressure rose from a mean of 102 mmHg (100-110 mmHg) to a mean of 106 mmHg (100-115 mmHg). In patients with systolic blood pressure of 180-190 mmHg, their fetuses had significantly higher systolic/diastolic (S/D) ratios before and after exercise than those with blood pressure of 150-170 mmHg. The PI showed sharp fluctuations but the changes were not significant. The mean S/D and the PI decreased at 2, 4, 6 and 8 minutes of recovery from baseline values at rest. Subsequently it rose significantly to peak at 20 minutes of recovery. No evidence of ill effect from the exercise test was noted on any of the mothers or their fetuses. All pregnancies resulted in a good outcome.