妊娠高血压综合征患者婴幼儿的智力发育随访研究

目的　随访 1 56例妊娠高血压综合征 (简称妊高征 )患者所生婴幼儿的智力、体格发育的状况 ,探讨促进妊高征患者婴幼儿智力发育措施 ,为今后妊高征婴幼儿管理提供依据。　方法　对妊高征患者婴幼儿和同期正常妊娠婴幼儿出生后 1、2、3岁时 ,用“儿 -心、精神发育量表”随访婴幼儿智力及体格发育状况。结果　妊高征组婴幼儿智力及体格发育 (身高、体重 )与正常妊娠组比较 ,差异有非常显著性 ( P<0 .0 1 )。重度妊高征患者新生儿 Apgar评分 5min低于 7分的 2 4例中 ,婴幼儿至 3岁时有 6例智力、体格发育差。　结论　防治妊高征患者新生儿窒息、加强重度窒息儿的监护、治疗 ,根据致婴幼儿智力落后的因素进行教育 ,是促进妊高征患者婴幼儿智力、体格发育 ,减少发生后遗症的重要措施。     

缺氧诱导因子HIF-1α、HIF-2α在妊娠高血压综合征胎盘组织中的表达

目的:探讨缺氧诱导因子HIF-1α,HIF-2α在妊娠高血压综合征(妊高征)中的作用。方法:采用免疫组化法对30例妊高征患者和30例正常妊娠孕妇胎盘组织进行检测。结果:妊高征患者胎盘组织中HIF-1α显著高于正常对照组(P<0.05),中度、重度妊高征组HIF-1α与正常对照组相比差异均有显著性(P<0.05),中度组高于轻度组(P<0.01),重度组高于中度组(P<0.01);虽两组胎盘组织中HIF-2α表达程度显著高于HIF-1α(P<0.01),但两组的HIF-2α表达差异无显著性(P>0.05);妊高征各组HIF-2α表达与正常对照组相比差异无显著性(P>0.05),妊高征各组间比较差异也无显著性(P>0.05)。结论:HIF-1α参与了妊高征缺氧的病理生理改变,而且与病情严重程度有一定关系。     

妊娠高血压综合征患者血浆止凝血分子标志物水平变化的意义

目的探讨妊娠高血压综合征(妊高征)患者血浆止凝血分子标志物水平变化的意义.方法对45例妊高征孕妇(妊高征组,其中轻度20例、中度15例、重度10例)及20例正常孕妇(正常妊娠组)分娩前后的血浆止凝血分子标志物进行检测.其中,采用酶联免疫吸附试验(ELISA)检测两组孕妇分娩前后的P-选择素、凝血酶原片段1+2(F1+2)、D-二聚体、纤溶酶抗纤溶酶复合物(PAP);采用发色底物法检测两组孕妇分娩前后的抗凝血酶活性.结果 (1)P-选择素妊高征组中、重度孕妇分娩前分别为(66±24)μg/L、(80±30)μg/L,正常妊娠组为(49±15)μg/L,两组比较,差异有显著性(P<0.05).分娩后妊高征组重度孕妇为(65±34)μg/L,正常妊娠组为(40±12)μg/L,两组比较,差异有显著性(P<0.05).(2)F1+2妊高征组轻、中、重度孕妇分娩前分别为(2.2±0.2)nmol/L、(2.3±0.4)nmol/L、(2.2±0.2)nmol/L,均明显高于正常妊娠组的(1.2±0.3)nmol/L,两组比较,差异有显著性(P<0.05).(3)D-二聚体妊高征组轻、中、重度孕妇分别为(0.7±0.1)mg/L、(0.7±0.3)mg/L、(0.8±0.2)mg/L,正常妊娠组为(0.4±0.1)mg/L,妊高征组显著高于正常妊娠组(P<0.05),且妊高征组重度孕妇D-二聚体水平高于中度及轻度孕妇.(4)PAP妊高征组轻、中、重度孕妇分娩前分别为(0.7±0.4)mg/L、(0.8±0.4)mg/L、(0.8±0.4)mg/L,均高于正常妊娠组的(0.7±0.3)mg/L(P<0.05),且妊高征组轻、中、重孕妇PAP的升高水平与疾病的严重程度呈正相关(P<0.05).两组孕妇分娩后PAP水平比较,差异无显著性(P>0.05).(5)抗凝血酶活性正常妊娠组为(108±17)%,而在妊高征组则显著降低,其中重度孕妇为(44±37)%、中度孕妇为(64±25)%、轻度孕妇为(83±39)%,两组比较,差异有极显著性(P<0.01).妊高征组中、重度孕妇又显著低于轻度孕妇(P<0.01).结论 P-选择素及 F1+2可用于高危妊娠的筛查,D-二聚体可作为妊高征孕妇早期DIC的监测,抗凝血酶活性是反映妊高征疾病严重程度的有效指标.以上这些止凝血分子标志物可作为妊高征患者血栓前状态的监测指标.     

妊高征孕妇甲状腺功能的研究

本文对30例正常未孕妇女,33例正常足月妊娠孕妇及28例妊高征孕妇采用双抗体PEG法测定血清T_3、T_4、TSH浓度,结果表明正常足月妊娠孕妇血清T_3浓度较正常未孕妇女显著增高(P<0.001),妊高征孕妇血清T_3浓度较正常孕妇显著降低(P<0.001),妊高征孕妇血清TSH浓度较正常孕妇显著增高(P<0.001),三组妇女血清T_4浓度差异不显著。同时妊高征妇女分娩小于胎龄儿者低T_3综合征发生率明显增高(P<0.05);轻、中度与重度妊高征孕妇血清T_4、T_3、TSH浓度比较无显著差异。提示妊高征孕妇甲状腺功能发生变化,推测妊高征孕妇IUGR及胎儿宫内窘迫发生率与血清T_3及TSH浓度有一定关系。     

妊娠高血压综合征患者胎盘组织中血管内皮生长因子的表达

目的　探讨血管内皮生长因子（VEGF）在妊娠高血压综合征（妊高征）患者胎盘组织中的表达及对妊高征患者胎盘滋养细胞功能和绒毛毛细血管网形成的影响。方法　采用免疫组织化学SP法检测21例正常孕妇（对照组）,60例妊高征患者（妊高征组,其中轻、中、重度妊高征患者各20例）胎盘组织VEGF的表达强度。结果　VEGF主要表达于胎盘绒毛滋养细胞;中度及重度妊高征患者胎盘绒毛滋养细胞VEGF表达强度均明显低于对照组及轻度妊高征患者(P＜0.05),而轻度妊高征患者与对照组比较,差异无显著性(P＞0.05),各组间蜕膜组织VEGF表达强度差异无显著性(P＞0.05)。　结论　VEGF在胎盘中主要由绒毛滋养细胞分泌,妊高征患者VEGF分泌减少,可能是引起局部胎盘绒毛及血管病变的原因之一。     

妊高征孕妇血清中可溶性Fas的变化

目的探讨中度、重度妊高征血清中可溶性Fas的变化及意义.方法采用ELISA方法测定23例重度妊高征患者和12例中度妊高征患者血清可溶性Fas抗原(sFas)水平,并与同期23例年龄相仿的健康足月妊娠者相比较.结果中度、重度妊高征组和正常妊娠组血清sFas含量分别为(1024±302)ng/L、(713±256)ng/L和(673±214)ng/L;重度妊高征组血清sFas含量明显高于正常妊娠组(P<0.01),也明显高于中度妊高征组(P<0.01);正常妊娠组和中度妊高征组血清sFas含量比较差异无显著性(P>0.05).结论重度妊高征母体血清sFas升高,提示存在Fas/FasL介导的淋巴细胞激活诱导的细胞死亡(activation-induced cell death,AICD)的改变,导致母体对胚胎的免疫排斥增强和细胞免疫不适当激活.     

中西医结合疗法治疗智力低下幼儿30例疗效观察

目的观察穴位注射疗法结合智能训练治疗智力低下幼儿的疗效。方法 90例智力低下幼儿中轻、中、重度智力低下各30例。按不同病情程度分为对照组、肌肉注射组、穴位注射组3组各30例,每组均有轻、中、重度智力低下患儿各10例。对照组给予家庭智能训练;肌肉注射组给予智能训练及单唾液酸四己糖神经节苷酯2mL肌肉注射治疗;穴位注射组给予智能训练及单唾液酸四己糖神经节苷酯2mL穴位注射治疗。疗程为3个月。按照Gesell发育量表于治疗前后分别测定各组的发育商(DQ)。治疗后进行各组有效率比较及各组组间、组内DQ值比较。结果治疗后穴位注射组疗效好于肌肉注射组与对照组,差异有统计学意义(P0.0167),对照组与肌肉注射组疗效相当,差异无统计学意义(P0.0167)。肌肉注射组和穴位注射组轻、中、重度DQ差值均高于对照组,差异有统计学意义(P0.01);穴位注射组轻、中、重度DQ差值均高于肌肉注射组,差异有统计学意义(P0.05)。各组轻、中、重度间DQ差值比较差异有统计学意义(P0.05,0.01)。经两两比较后,除对照组中-重度和肌肉注射组轻-中度间DQ差值比较差异无统计学意义(P0.05)外,其余比较差异均有统计学意义(P0.05,0.01)。结论在治疗智力低下幼儿时,尤其轻中度智力低下的幼儿应早期采用中西医结合的治疗方法。     

血管内皮生长因子与妊娠高血压综合征发病及一氧化氮的关系

目的　探讨血管内皮生长因子（VEGF）在妊娠高血压综合征（妊高征）发病中的作用,及其与一氧化氮（NO）的关系。方法　选择妊高征患者(妊高征组)41例,其中轻度妊高征12例,中度妊高征13例,重度妊高征16例;选择同期正常晚期妊娠妇女20例为对照组。采用酶联免疫吸附法测定两组孕妇血清VEGF水平,用硝酸盐还原酶法测定两组胎盘组织NO浓度变化。结果　（1）妊高征组血清VEGF水平明显低于对照组,轻度妊高征患者血清VEGF水平与对照组比较,差异无显著性,中、重度妊高征患者血清VEGF水平分别为（23.1±4.1）ng/L、（14.8±3.9）ng/L,明显低于对照组。（2）妊高征组胎盘组织中NO浓度较对照组明显降低,轻度妊高征患者胎盘组织NO浓度与对照组比较,差异无显著性,中、重度妊高征患者胎盘组织NO浓度分别为（9.1±2.1）μmol/g、(5.6±1.8)μmol/g,均明显低于对照组。（3）血清VEGF水平与胎盘组织NO浓度呈显著正相关（r=0.65,P<0.01）。结论　妊高征患者血清中VEGF水平降低,胎盘组织中NO浓度下降,可能在妊高征的发病中起一定作用。     

米索前列醇引产在早期重度妊高征中的应用

目的观察米索前列醇用于早期发生的重度妊高征终止妊娠的安全性和可行性.方法选择伴有各种严重并发症且发病较早,需要终止妊娠的重度妊高征8例(孕周26～32+5),同期正常足月需引产者13例为对照组.米索前列醇50μg阴道给药,依据宫缩情况3～4h重复给药.监测血压、心率、体温、诱发宫缩时间、用药至临产时间及产程.结果两组用药前后血压、心率、体温变化均无统计学差异(P＞0.05),两组均荻引产成功,妊高征组用药总量及给药次数明显高于对照组(P＜0.001),但临床经过平稳,无副反应.结论米索前列醇用于早期重度妊高征的终止妊娠,尤其是对不期待活产的病例,具有一定的安全性和可行性.     

妊高征血清尿酸变化及临床意义

目的 :探讨妊高征患者妊娠期血清尿酸变化对预测母儿预后的意义。方法 :对 6 5 80例正常孕妇于孕 2 6～ 2 7周检测血清尿酸值 ,对其中发生妊高征的 187例患者于分娩前 1周复测尿酸值。结果 :孕 2 6～ 2 7周 ,中、重度妊高征组比轻度妊高征、正常妊娠及正常非孕组尿酸值升高 ,差异有显著性 (P<0 .0 5 )。轻、中、重度妊高征两两比较 ,尿酸值差异有显著性 (P<0 .0 5、P<0 .0 1) ,各组分娩前 1周的尿酸含量比孕 2 6～ 2 7周高 (P<0 .0 1)。分娩前 1周 ,正常妊娠比正常非孕、重度妊高征比轻度及中度妊高征尿酸含量高 (P<0 .0 5 ,P<0 .0 1) ;重度妊高征中 ,尿酸升高组眼底异常 ,2 4小时尿蛋白≥ 5 g的发生率比尿酸正常组高 ,肝功能异常、肾功能异常、心电图异常的发生率与尿酸正常组比较 ,差异无显著性(P>0 .0 5 )。肾功能衰竭、心力衰竭、眼底出血、HEL L P综合征、胎盘早剥、DIC、抽搐等严重并发症的发生率 ,两组无显著性差异 (P>0 .0 5 )。重度妊高征中 ,尿酸升高组围产儿预后不良的发生率比尿酸正常组高 (P<0 .0 1)。结论 :尿酸升高与妊高征病情及围产儿预后密切相关 ,比其他监测指标更能预测围产儿的预后 ,动态监测尿酸变化 ,根据尿酸水平进行处理 ,具有十分重要的意义     

妊高征患者血浆中末端补体复合物的测定及其意义

目的 探讨末端补体复合物在妊高征发病中的作用及其与血管内皮细胞损伤的关系。方法 采用酶联免疫吸附试验（ＥＬＩＳＡ）检测４７例妊高征患者,１５例有妊高征高危因素者和４０例正常孕妇血浆中ＳＣ５ｂ－９含量,同时测定循环免疫复合物,纤维结合蛋白含量。     

妊高征与新生儿视网膜出血关系探讨

目的:探讨妊娠高血压综合征(简称妊高征)与新生儿视网膜出血(retina hemorrhage,RH)的关系。方法:对我院467例妊高征患者病例进行回顾性分析。结果:轻度、中度、重度妊高征孕妇分娩的新生儿中分别有14例、21例、26例出现RH;阴道分娩的261例中,新生儿RH 53例(20.3%),剖宫产的206例中,新生儿RH 8例(3.9%)。结论:新生儿RH程度与妊高征的严重程度有关;剖宫产新生儿视网膜出血明显低于阴道分娩。     

Moderate antenatal anxiety symptoms and birth outcomes of boys and girls

Abstract

Women’s antenatal anxiety, especially if paired with significant life stressors or comorbid physical or mental health disorders, can predict adverse birth outcomes, defined in terms of birth weight, gestational age at birth and obstetric complications. Here, we tested for an impact of moderate anxiety symptoms on these outcomes because many women experience these kinds of symptoms during pregnancy, and even subtle differences in birth outcomes can have significant effects on children’s development. We also tested for moderation of anxiety effects by infant gender. The sample comprised 219 women with anxiety symptoms ranging from none to moderate levels on the Beck Anxiety Inventory. Multivariate models estimated main effects of Group (no/minimal versus moderate symptoms) and interactions between Group and infant Gender. Results indicate that moderate anxiety predicted more obstetric complications, particularly among mothers of daughters. Results also demonstrate a Group?×?Gender interaction on BW, indicating that sons of anxious mothers weighed more than sons of controls; whereas, daughters of anxious mothers weighed less than daughters of controls. These findings show that moderate anxiety symptoms may affect some birth outcomes, and differently for males and females.     

妊娠高血压综合征患者血浆神经肽Y水平变化的相关性研究

目的　探讨妊娠高血压综合征(妊高征)患者血浆神经肽Y(NPY)水平的变化及其与妊高征发病的关系。方法　采用放射免疫分析法测定了30例妊高征患者(妊高征组)产前及产后、23例正常妊娠妇女(正常妊娠组)和20例正常育龄未孕妇女(正常非孕组)血浆NPY水平。结果　妊高征组产前血浆NPY水平［(164.16±68.32)ng/L］明显高于正常非孕组［(86.60±20.65)ng/L］和正常妊娠组［(82.42±12.46)ng/L］(P<0.01)。妊高征组轻、中、重患者之间,产前血浆NPY水平有显著差异,分别为(88.66±25.69)ng/L、(145.15±18.72)ng/L、(235.05±33.60)ng/L(P<0.01)。妊高征组中、重度患者产前与产后血浆NPY水平分别为(80.04±28.70)ng/L及(130.43±37.38)ng/L,两者比较,差异有显著性(P<0.01);重度患者产后NPY水平仍明显高于正常妊娠组(P<0.01)。结论　妊高征患者血浆NPY水平增高,NPY参与了妊高征的发生和发展。     

Association between fetal growth restriction and polymorphisms at sites -1 and +3 of pituitary growth hormone: a case-control study

Background

No previous studies have examined the effect of pregnancy-induced hypertension (PIH) on early infant growth. The objective was to study infant growth patterns of babies born to mothers with PIH at 28 and 42 days postpartum.

Methods: Design

We conducted a population-based retrospective cohort study of 16,936 pregnancies delivered between January 1, 1989 through December 31, 1990 in Suzhou, China. PIH was classified as gestational hypertension, preeclampsia and severe preeclampsia. Infant Growth Percentage (IGP) was calculated as the weight gain from birth to infant weight at 28 or 42 days postpartum divided by the birth weight. Univariate analysis and multivariate linear regression were performed to compare the infant weight as well as IGP at 28 and 42 days postpartum between various types of PIH and the normotensive group.

Results

Infant weights at 28 and 42 days postpartum were significantly lower in severe preeclampsia (e.g., 4679.9 g at 42 days) and preeclampsia (e.g., 4763.8 g at 42 days) groups than in the normotensive group (e.g., 4869.1 g at 42 days, p < 0.01). However, there were no differences in IGP between groups. After stratifying by intrauterine growth restriction (IUGR) status, if babies were not intrauterine growth restricted, none of the PIH types showed a significantly lower weight at 28 and 42 days postpartum and their IGPs were similar to those of the reference group. When babies were growth restricted, all PIH groups showed significantly lower weights but higher IGP at 28 and 42 days postpartum as compared to the normotensive group.

Conclusion

Infants born to mothers with PIH but without IUGR have normal early infant growth. IUGR secondary to PIH is associated with significant catch-up growth at 28 and 42 days postpartum.     

Increased incidence of bronchopulmonary dysplasia in preterm infants exposed to preeclampsia

Objective: The aims of the study were to determine the effect of preeclampsia on bronchopulmonary dysplasia (BPD) development in preterm infants and to investigate the possible association between BPD severity and preeclampsia. Methods: The study group involved preterm infants (≤32 gestational week) born to a preeclamptic mother with no co-existing medical condition, whereas the comparison group involved preterm infants born to a normotensive mother. BPD was defined as requirement for supplemental oxygen for the first 28 days of life and classified as mild, moderate and severe. Results: There were a total of 117 and 215 premature infants that were born to a preeclamptic mother and a normotensive mother, respectively. The incidence of BPD in preterm infants born to preeclamptic mothers (38.5%) was significantly higher than those born to normotensive mothers (19.5%). Frequencies of moderate and severe BPD were significantly higher in the infants born to preeclamptic mothers. Moderate and severe BPD was also significantly higher in infants born to a mother with severe preeclampsia compared with a mother with mild preeclampsia. In logistic regression model, preeclampsia was found to be predictive of BPD. Conclusions: Preeclampsia was found to be an important risk factor for BPD development in preterm infants. The incidence of both moderate and severe BPD was significantly higher in infants born to preeclamptic mothers. These findings might be associated with altered angiogenesis in the preeclamptic mother which might be shared by the fetus.     

妊高征患者血液中内皮细胞因子的表达

目的　探讨妊高征患者血液中内皮细胞因子的表达与妊高征发病和病情严重程度的关系。方法　1999年 1月至 2 0 0 1年 4月采用放射免疫法检测 6 5例不同组别的研究对象血浆中内皮细胞因子水平。结果　内皮素 1(ET 1)在重度妊高征组中显著升高 ,血管内皮生长因子 (VEGF)在各组间无差异 ,神经肽Y(NPY)在妊高征各组中较正常组升高 ,中、重度妊高征组降钙素基因肽 (CGRP)较正常组为低 ,胰岛素样生长因子 (IGF 1)在重度妊高征组显著低于正常组 ,胰岛素样生长因子结合蛋白 (IGFBP 3)水平在各组间差异无显著性意义。各细胞因子间关联性分析发现ET 1与VEGF、NPY及CGRP相关联 (r分别为 - 0 2 87P <0 0 5 ,0 2 6 5P <0 0 5 ,0 5 4 4P <0 0 1)。结论　ET 1和IGF 1在妊高征的发病机制中起重要的作用。ET 1与NPY呈正相关 ,提示妊高征的病理过程与ET 1及NPY等缩血管神经肽有关     

妊高征患者外周血清及单核细胞内镁,钙含量测定

目的：探讨镁、钙代谢在妊高征病理生理变化中的作用。方法：采用原子吸收分光光度测定法（火焰原子化法），测定了２６例妊高征患者（妊高征组）产前外周血清及单核细胞内镁、钙含量，以２７例同期住院的正常晚期妊娠妇女作对照（对照组）。结果：妊高征组与对照组比较：（１）妊高征组外周血清镁、钙含量显著降低（Ｐ＜０．０１及Ｐ＜０．０５）；（２）中、重度妊高征患者外周血单核细胞内镁含量显著降低（Ｐ＜０．００１及Ｐ＜０．０１）；（３）中、重度妊高征患者外周血中单核细胞内的钙含量显著降低（Ｐ＜０．０１及Ｐ＜０．０５）。结论：镁、钙含量降低可能在妊高征病理生理变化中起重要作用。     

妊高征患者血小板蛋白激酶C活性变化的研究

目的探讨血小板蛋白激酶Ｃ（ＰＫＣ）比活变化与妊高征发生和发展的关系。方法用底物蛋白磷酸化法检测１８例妊高征患者（妊高征组）,２０例健康孕妇（正常妊娠组）及２０例健康育龄妇女（对照组）血小板质膜和胞液的ＰＫＣ比活。结果正常妊娠组血小板质膜和胞液的ＰＫＣ比活显著低于对照组（Ｐ＜０．０１）;妊高征组血小板质膜和胞液的ＰＫＣ比活高于正常妊娠组（Ｐ＜０．０５）。中、轻度妊高征患者仅血小板质膜ＰＫＣ比活明显高于正常妊娠组（Ｐ＜０．０１）,胞液的ＰＫＣ比活与正常妊娠组比较,则差异无显著性（Ｐ＞０．０５）。而重度妊高征患者血小板质膜和胞液的ＰＫＣ比活均高于正常妊娠组（Ｐ＜０．０１,Ｐ＜０．０５）,且重度妊高征患者血小板胞液ＰＫＣ比活高于中、轻度妊高征患者（Ｐ＜０．０５）,而质膜ＰＫＣ比活比较,则差异无显著性（Ｐ＞０．０５）。结论血小板ＰＫＣ比活变化与妊高征发生和发展有关。     

Outcome of infants delivered between 24 and 28 weeks' gestation in women with severe pre-eclampsia.

OBJECTIVE: To determine whether there are differences in neonatal outcome between infants born to mothers with severe pre-eclampsia and those born to normotensive mothers with preterm labor and intact membranes between 24 and 28 weeks' gestation. MATERIALS AND METHODS: Over a 4-year period between 1991 and 1995, neonates of women with severe pre-eclampsia delivering between 24 and 28 weeks were matched for maternal age, antenatally assigned gestational age and mode of delivery to normotensive women delivering during the same period. RESULTS: Fifty-eight women with severe pre-eclampsia were matched to 58 normotensive controls who delivered as a result of preterm labor. Antenatal steroids were used more often in pre-eclamptic women (75% vs. 47%, p < 0.01). The mean birth weight of pre-eclamptic neonates was significantly lower than that of controls, 767 g vs. 989 g, respectively. Other neonatal complications were similar for both groups. Neonates of pre-eclamptics required longer ventilator support (21 vs. 16 median days, p = 0.03). Neonatal survival was similar for both groups (72% and 79% for pre-eclamptics and normotensives, respectively). CONCLUSIONS: Neonates born to patients with severe pre-eclampsia have similar survival but a lower birth weight and require longer ventilator support than neonates born to women with preterm labor.