子宫内膜癌患者血清中HE4、YKL-40的表达及临床意义

目的:探讨血清人附睾蛋白4(HE4)、甲壳质酶蛋白40(YKL-40)在子宫内膜癌的表达及临床意义。方法:用酶联免疫吸附试验检测健康妇女、子宫内膜增生及子宫内膜癌患者血清中HE4、YKL-40的水平。结果:(1)健康妇女、子宫内膜增生患者及子宫内膜癌患者术前血清中HE4表达中位数分别为15.75、30.12、105.67pmol/L;YKL-40的表达中位数分别为39.6、42.8、100.5μg/L;子宫内膜癌组HE4、YKL-40的表达水平均高于前两组,差异有统计学意义(P<0.05),前两组的差异无统计学意义;子宫内膜癌患者术后血清中HE4、YKL-40中位数分别为23.52pmol/L、30.9μg/L,明显低于术前(P<0.05);(2)子宫内膜癌患者术前血清HE4浓度、YKL-40浓度与FIGO分期呈正相关关系。结论:子宫内膜癌血清HE4、YKL-40水平升高,可作为子宫内膜癌血清学标记物,是子宫内膜癌的早期辅助诊断、疗效评估、随访检测的客观指标,可用于指导临床的综合治疗。     

上皮性卵巢肿瘤患者血清中YKL-40、HE4的表达及临床意义

目的:探讨血清甲壳质酶蛋白40(YKL-40)、人附睾蛋白4(HE4)在上皮性卵巢肿瘤的表达及临床意义。方法:用酶联免疫吸附试验,检测健康妇女、上皮性良性卵巢肿瘤、交界性卵巢肿瘤及卵巢癌患者血清中YKL-40、HE4的水平。结果:(1)健康妇女、上皮性良性卵巢肿瘤、交界性卵巢肿瘤及卵巢癌患者术前血清中,YKL-40表达中位数分别为35.56、41.42、44.34和130.25μg/L;HE4的表达中位数分别为41.10、43.98、65.21和260.90pmol/L;在术前卵巢癌组YKL-40、HE4的表达水平均高于前3组,差异有统计学意义(P<0.05),前3组之间差异无统计学意义;卵巢癌患者术后血清中YKL-40、HE4中位数分别为58.57μg/L、124.32pmol/L,术前血清水平明显高于术后(P<0.05);(2)卵巢癌患者术前血清YKL-40浓度与FIGO分期、血清CA125浓度呈正相关(P<0.05);术前血清HE4浓度与病理类型、血清CA125浓度、年龄相关。结论:血清YKL-40、HE4有望成为卵巢癌标志物,用于早期诊断和预后分析。     

肌动蛋白聚合蛋白(fascin)和CD44V6在子宫内膜样腺癌组织中的表达及意义

目的:探讨肌动蛋白聚合蛋白(fascin)和CD44V6在子宫内膜样腺癌中的表达情况及其临床意义。方法:应用免疫组化SP法检测46例子宫内膜样腺癌(A组),19例子宫内膜增生症(B组)以及17例正常子宫内膜(C组)组织中fascin和CD44V6的表达情况。结果:①A组中fascin的表达率(71.74%)明显高于B组(15.79%)及C组(5.88%)(P<0.01)。fascin在A组中的表达率与子宫内膜样腺癌的临床分期、组织学分级及淋巴结转移情况相关(P<0.05),而与肌层浸润深度无关(P>0.05)。②A组中CD44V6的表达率(43.48%)明显高于B组(5.26%)及C组(5.88%)(P<0.01)。CD44V6在A组中的表达率与子宫内膜癌的淋巴结转移情况及肌层浸润深度相关(P<0.05),而与临床分期、组织学分级无关(P>0.05)。③fascin与CD44V6在子宫内膜样腺癌组织中的表达呈正相关(r=0.453,P<0.05)。结论:fascin及CD44V6在子宫内膜样腺癌的发生、发展过程中起重要的作用。     

子宫内膜癌中Maspin的表达及其与雌激素受体表达的相关性研究

目的:检测Maspin蛋白在正常子宫内膜、不典型增生及内膜癌组织中的表达,及其与雌激素受体(ER)表达的关系,探讨Maspin在子宫内膜癌发生中的作用及其作用机制。方法:免疫组化SP法检测40例子宫内膜腺癌、18例不典型增生及10例正常子宫内膜(对照组)中Maspin蛋白的表达及其与子宫内膜癌患者临床病理特征和ER蛋白表达的关系。结果:Maspin阳性表达在正常子宫内膜组最高(9/10,90%),高于内膜不典型增生组(10/18,55.6%)和内膜癌组(17/40,42.5%),差异有统计学意义(P<0.05),在内膜癌中FIGOⅠ期的表达(13/20,65.0%)明显高于Ⅱ~Ⅲ期(4/20,20.0%;P<0.05),无淋巴结转移者(17/34,50.0%)明显高于有淋巴结转移者(0/6;P=0.030),但与组织学分级及肌层浸润程度无关(P>0.05)。ER在正常子宫内膜、内膜不典型增生及内膜癌组织的阳性表达率分别为(10/10,100.0%)、(13/18,72.2%)和(20/40,50.0%),各组间差异有统计学意义(P<0.05);内膜癌组织中FIGOⅠ期的表达(14/20,70.0%)明显高于Ⅱ~Ⅲ期(6/20,30.0%;P<0.05);内膜癌高、中、低分化组中ER表达率分别为(11/15,73.3%)、(8/18,44.4%)、(1/7,14.3%),组间差异有统计学意义(P<0.05);无淋巴结转移者(20/34,58.8%)明显高于有淋巴结转移者(0/6;P=0.020),肌层浸润≤1/2者(16/24,66.7%)明显高于肌层浸润>1/2者(4/16,25.0%;P<0.05)。子宫内膜癌中,Maspin的表达与ER的表达存在正相关关系(r=0.394,P<0.05)。结论:从正常子宫内膜、内膜不典型增生到内膜癌,Maspin蛋白表达逐渐降低,且其低表达与子宫内膜癌临床分期晚、淋巴结转移有关,并与ER蛋白表达呈一致性,提示Maspin蛋白的表达可能受雌激素调控,参与了子宫内膜癌发生发展和转移过程。     

血清YKL-40在诊断子宫内膜癌中的价值初探

目的:探讨血清甲壳质酶蛋白40(YKL-40)在子宫内膜癌诊断和疗效、预后评价的价值。方法:用酶联免疫吸附法(ELISA)测定子宫内膜癌患者33例,子宫肌瘤患者27例及30例健康妇女血清中的YKL-40水平,比较血清YKL-40在3组间的差异,以及22例子宫内膜癌患者手术治疗前后该指标的变化。结果:子宫内膜癌组血清YKL-40水平显著高于子宫肌瘤组(P=0.001)和健康组(P=0.001),而子宫肌瘤组和健康组之间差异无统计学意义(P=0.661)。22例子宫内膜癌患者术后7天血清YKL-40水平显著低于术前水平(P=0.000);健康组与子宫内膜癌组评估YKL-40用于诊断子宫内膜癌的ROC曲线下面积为0.830,子宫肌瘤组与子宫内膜癌组评估YKL-40用于诊断子宫内膜癌的ROC曲线下面积为0.773。以血清YKL-40129.97μg/L为临界值时,其诊断子宫内膜癌的敏感性和特异性分别为75.8%和80.0%,阳性似然比为3.59,阴性似然比为0.31,准确度为77.8%,阳性预测值为67.6%,阴性预测值为85.0%。结论:血清YKL-40水平检测在子宫内膜癌的诊断,疗效和预后评价方面均有一定的临床价...     

B7-H4在子宫内膜异位症中的表达及意义

目的:研究子宫内膜异位症(EMs)患者在位、异位内膜组织中B7同源体4(B7-H4)的表达情况及血清sB7-H4的水平变化,探讨其在EMs发生、发展中的作用及意义.方法:免疫组化法检测43例卵巢子宫内膜异位组织、43例在位内膜组织及30例正常子宫内膜组织中B7-H4的表达情况;ELISA夹心法检测EMs患者血清中sB7-H4的表达水平.结果:B7-H4主要表达于子宫内膜细胞的胞浆和胞膜.异位内膜、在位内膜、正常内膜的B7-H4阳性率分别为62.8％、55.8％和30.0％,组间差异显著(x2=8.067,P=0.018);不同月经周期中B7-H4的表达无显著差异(P＞0.05).EMs患者血清中sB7-H4的表达水平显著高于对照组[(36.23±5.67)μg/L vs (31.24±4.56) μg/L,t=2.398,P＜0.05].结论:B7-H4蛋白的异常表达可能与EMs的发生、发展有关,其可能成为EMs诊断和治疗的一个新靶点.     

子宫内膜癌发生过程中自噬活性改变的初步探讨

目的:探讨正常子宫内膜、子宫内膜增生以及子宫内膜腺癌中自噬活性的变化。方法:收集2004年1月至2005年3月行子宫切除或诊断性刮宫的组织标本135例,其中正常子宫内膜43例,子宫内膜单纯性增生及复合性增生27例,子宫内膜不典型增生26例,子宫内膜腺癌39例。用免疫组化法检测全部组织中的Cathepsin-D和Rab7的表达。结果:(1)Cathepsin-D表达在正常子宫内膜增生期明显高于分泌期(0.244±0.091 vs 0.141±0.071,P<0.05);Rab7表达呈同一趋势(0.197±0.084 vs 0.114±0.060,P<0.05);(2)子宫内膜单纯性、复合性增生组的Cathepsin-D表达明显高于子宫内膜不典型增生组,子宫内膜腺癌细胞中Cathepsin-D表达则明显减弱(0.561±0.168 vs0.311±0.089 vs 0.055±0.044,P<0.001);Rab7的表达呈现与Cathepsin-D同一趋势(0.508±0.152 vs 0.281±0.076 vs 0.026±0.019,P<0.001)。结论:正常增生期子宫内膜细胞的自噬活性比分泌期子宫内膜细胞明显增强,子宫内膜增生的自噬活性比正常子宫内膜强,而子宫内膜腺癌细胞自噬活性明显减弱,提示自噬活性的改变可能参与了子宫内膜样腺癌的发生。     

子宫内膜癌γ-synuclein表达和血清CA125水平及与临床病理特征关系的研究

目的:研究乳腺癌基因1(γ-synuclein)表达和血清癌抗原125(CA125)水平及与子宫内膜癌临床病理特征的关系,探讨其在子宫内膜癌发生发展中的作用及对病情评估的意义。方法:采用免疫组化SP法检测50例子宫内膜样腺癌(子宫内膜癌组)、14例子宫内膜不典型增生(子宫内膜不典型增生组)、12例正常子宫内膜(对照组)组织中γ-synuclein的表达,用化学发光免疫分析法检测患者血清CA125的水平。结果:γ-synuclein阳性表达在子宫内膜癌组、子宫内膜不典型增生组及对照组间比较,差异有高度统计学意义(χ2=10.379,P<0.01),其中,γ-synuclein在子宫内膜癌组及子宫内膜不典型增生组中的阳性表达均显著高于对照组(P均<0.01)。在子宫内膜癌组γ-synuclein表达与临床分期、肌层浸润深度有关(P<0.05,P<0.01)。子宫内膜癌组血清CA125水平阳性率显著高于对照组及子宫内膜不典型增生组(χ2=7.040,P<0.01)。γ-sy-nuclein、血清CA125之间无相关性(r=0.201,P>0.05)。结论:γ-synuclein的表达与子宫内膜癌发生发展及侵袭有关,可能作为预后指标;血清CA125水平可能预示子宫内膜癌的恶性程度。     

子宫内膜癌组织中胰岛素受体底物1的表达与活化及其临床意义

目的 研究子宫内膜癌组织中胰岛素受体底物1(ⅡlS-1)mRNA、蛋白的表达水平及酪氨酸磷酸化程度,并探讨其临床意义.方法 选择63例子宫内膜癌(内膜癌组)、21例子宫内膜不典型增生(不典型增生组)及22例正常子宫内膜(正常内膜组)患者进入本研究.收集其临床病理资料,酶联免疫法检测空腹血清胰岛素C肽水平,RT-PCR技术和蛋白印迹法分别检测子宫内膜组织中1RS.1 mRNA及蛋白的相对表达量,免疫共沉淀法检测IRS-1酪氨酸磷酸化程度.结果 内膜癌组患者血清C肽水平为(3.2±1.1)μg/L,高于正常内膜组[(2.5±0.7)μg/L],两组比较,差异有统计学意义(P=0.007).内膜癌、不典型增生及正常内膜组IRS-l mRNA、蛋白的相对表达量比较,差异均无统计学意义(F=0.695、0.003,P=0.502、0.997).内膜癌组IRS-1酪氨酸磷酸化程度[(62±36)%]高于不典型增生及正常内膜组[分别为(53士34)%、(35±33)%],分别比较,差异均有统计学意义(P=0.048、0.002);不典型增生组与正常内膜组比较,差异也有统计学意义(P=0.045).子宫内膜样腺癌患者IRS-1酪氨酸磷酸化程度[(69±33)%]高于非内膜样癌[(34±31)%],两者比较,差异有统计学意义(t=2.300,P=0.025).高手术病理分期、细胞分化不良、深肌层浸润及盆腔淋巴结转移者IRS-1酪氨酸磷酸化程度增高(P均<0.05).子宫内膜组织中IRS-1酪氨酸磷酸化程度与空腹血清C肽水平呈正相关关系(r=0.491,P=0.001).结论 子宫内膜癌组织中IRS-1的表达无明显变化,但存在IRS-1酪氨酸磷酸化程度增加,并与手术病理分期高、细胞分化不良、深肌层浸润及盆腔淋巴结转移等不良的临床病理特征相关.     

AngⅡ及AT1R在子宫内膜腺癌的表达及临床意义

目的:探讨AngⅡ及AT1R在子宫内膜腺癌中的表达及其临床意义。方法:采用免疫组织化学SP法检测50例子宫内膜腺癌,15例子宫内膜非典型增生及10例正常子宫内膜组织中AngⅡ及AT1R蛋白的表达。结果:AngⅡ及AT1R主要定位在细胞浆及胞膜中,大都呈弥漫性表达,在正常子宫内膜,非典型增生内膜及子宫内膜腺癌的阳性表达率分别是10%/20%,47%/33%,86%/72%。AngⅡ及AT1R在子宫内膜腺癌的表达显著高于非典型增生及正常子宫内膜组(P<0.05),AngⅡ及AT1R在非典型增生内膜组及正常子宫内膜组的表达无显著差异(P>0.05);AngⅡ在各期子宫内膜腺癌组织的表达无显著差异(P>0.05),AT1R在Ⅰ、Ⅱ期子宫内膜腺癌组织的表达显著高于Ⅲ期子宫内膜腺癌组织(P<0.05);AngⅡ及AT1R在子宫内膜腺癌侵及肌层深层组及浅层组,有淋巴结转移组和无淋巴结转移组的表达均无显著差异(P>0.05)。结论:AngⅡ及AT1R可能参与了子宫内膜腺癌的发生和发展,选择性拮抗AT1受体可能为子宫内膜腺癌的预防及治疗提供新的靶点。     

Plasma YKL-40, as a prognostic tumor marker in recurrent ovarian cancer

BACKGROUND: YKL-40, a member of family 18 glycosyl hydrolases, is secreted by cancer cells. The function of YKL-40 in cancer diseases is unknown, but it is a growth factor of connective tissue cells and probably has a role in inflammation and remodeling of the extracellular matrix, a process also involved in metastatic malignant diseases. High serum YKL-40 has been associated with poor prognosis for patients with colorectal and recurrent breast cancer. AIM OF THE STUDY: The purpose of the present study was to examine the prognostic value of plasma YKL-40 in patients presenting with recurring ovarian cancer. METHODS: YKL-40 was determined by ELISA in plasma samples from 73 patients with relapse of ovarian cancer shortly before start of second-line chemotherapy. The endpoint used was death because of ovarian cancer. RESULTS: Plasma YKL-40 was increased in ovarian cancer patients (median 94 micro g/L, range 20-1970 micro g/L) compared with age-matched controls (33 micro g/L, range 20-130 micro g/L) (p < 0.001). Fifty-five per cent of the patients had a plasma YKL-40 level above the upper normal 95th percentile of controls. Patients with high plasma YKL-40 (i.e. > 130 micro g/L or > 160 micro g/L) at the time of relapse had significantly shorter survival than patients with normal levels (respectively p = 0.007 and p = 0.004). Plasma YKL-40 proved to be an independent prognostic factor in a multivariate Cox analysis (YKL-40 > 160 micro g/L; HR = 2.27) (p = 0.006), including serum CA-125 and clinical/histological parameters. CONCLUSION: High plasma YKL-40 is related to short survival in patients with recurrent ovarian cancer.     

Preoperative serum YKL-40 is a marker for detection and prognosis of endometrial cancer

OBJECTIVE: YKL-40 is a secreted glycoprotein of the chitinase family that has been previously described as a diagnostic and prognostic marker for a number of cancers, including epithelial ovarian cancer. In this study, we examined the frequency of serum elevation as well as the diagnostic and prognostic significance of this serum marker in endometrial cancer. MATERIALS AND METHODS: Preoperative serum levels of YKL-40 and CA125 were evaluated by enzyme-linked immunosorbent assay (ELISA) for all endometrial cancer patient samples (34) available in the Memorial Sloan-Kettering Cancer Center Gynecology Service Tissue Bank between the years 1987 and 2002, and compared to a cohort of normal individuals. A YKL-40 value of 61 ng/mL has previously been determined to represent the upper limit of normal. YKL-40 values were correlated with clinical characteristics, including patient age, tumor grade, histology, clinical stage, and clinical outcome (progression-free survival [PFS] and overall survival [OS]). RESULTS: YKL-40 was elevated (>61 ng/mL) in 26 (76%) of 34 endometrial cancer patients compared with elevations of CA125 in 21 (62%) of 34 patients (P=0.09). Twenty-eight (82%) of all 34 patients had elevations of either CA125 or YKL-40 or both; 16 (89%) of 18 advanced-stage endometrial cancer patients had elevation of at least one of these two markers. Median preoperative YKL-40 value was 137 ng/mL (range, 22-1738 ng/mL) for endometrial cancer patients compared with 28 ng/mL (range, 15-72 ng/mL) for normal healthy subjects (P<0.0001). There was no statistically significant association of YKL-40 with patient age, tumor grade, histology, or stage. Elevation of YKL-40 (>80 ng/mL) was correlated with poor clinical outcome in univariate analysis, but was not demonstrated in multivariate analysis. At 5 years' follow-up, the PFS rate was 80% for patients with YKL-40<80 ng/mL compared with 43% for patients with YKL-40>80 ng/mL (P=0.004). The 5-year OS rate for patients with YKL-40<80 ng/mL was 79% compared with 48% for patients with YKL-40>80 ng/mL (P=0.047). CONCLUSION: Preoperative serum YKL-40 is frequently elevated and may represent a novel marker for the detection of endometrial cancer and the identification of high-risk subsets of patients with worse clinical outcome. Further investigation of this promising endometrial cancer marker in larger studies is warranted.     

二甲双胍对高胰岛素血症肥胖儿童糖代谢和血清脂源性激素的影响

目的观察二甲双胍治疗对高胰岛素血症肥胖患儿血清脂源性激素脂联素、抵抗素、瘦素水平的影响。 方法2004 01—2005 02将武汉市儿童医院和同济医院54例高胰岛素血症肥胖患儿分为轻、中度肥胖组及重度肥胖组,均以二甲双胍治疗12周，测量治疗前后体重、空腹血糖、空腹胰岛素及脂源性激素脂联素、瘦素、抵抗素的变化。 结果治疗前轻、中度肥胖组和重度肥胖组高胰岛素血症患儿空腹血糖水平与健康对照组比较差异无显著性(P>0.05)，血清胰岛素、瘦素、抵抗素及胰岛素抵抗指数(HOMA IR)均高于健康对照组(P<0.01)，脂联素水平明显低于健康对照组(P<0.01)。二甲双胍治疗12周后与治疗前相比,血清胰岛素水平、胰岛素抵抗指数明显降低(P<0.01)，轻、中度肥胖组及重度肥胖组血清瘦素水平分别由治疗前的(24.3±1.8)μg/L、(30.2±5.1)μg/L降低为治疗后的(19.6±6.3)μg/L、(24.7±5.3)μg/L，差异有统计学意义；抵抗素水平分别由治疗前的(16.5±6.0)μg/L、(22.3±5.2)μg/L升高为(22.0±5.1)μg/L、(30.6±11.7)μg/L，差异有统计学意义；轻、中度肥胖组和重度肥胖组血清脂联素水平治疗前分别为(8.4±3.2)mg/L、(6.5±1.2)mg/L，治疗后分别为(8.9±2.3)mg/L、(7.03±3.0)mg/L，治疗前后相比,P>0.05。体重指数(BMI)下降,但差异无显著性。 结论二甲双胍能显著改善肥胖患儿胰岛素抵抗。降低血清瘦素水平可能是其改善胰岛素抵抗机制之一，但在对脂源性激素脂联素、抵抗素水平的改善上，有其局限性。     

The diagnostic and prognostic value of serum YKL-40 in endometrial cancer

Purpose

To evaluate the diagnostic and prognostic value of serum YKL-40 in endometrial cancer (EC).

Methods

Serum YKL-40 levels were detected and compared in 34 of the 50 cases with EC before surgery, in 22 of the 34 with EC after surgery, in 30 cases with uterine myoma, and in 30 healthy women as normal controls. Receiver operating characteristics (ROC) curves were adopted for diagnosis and calculation of area under each ROC curve in EC. The progression-free survival (PFS) and overall survival (OS) between YKL-40 positive and negative patients were compared in the follow-up.

Results

The mean pre-operative serum YKL-40 values were significantly higher than that in the uterine myoma cases and in the healthy women (P = 0.000). The mean post-operative serum YKL-40 in the 22 EC cases was significantly lower than pre-operative serum YKL-40 levels in these cases (P = 0.000). There were critical differences between the area under ROC curve for YKL-40 and CA125 (P = 0.053). The PFS and OS for the YKL-40-positive patients were significantly shorter than those for the YKL-40-negative patients.

Conclusion

Preliminary investigations have shown that serum YKL-40 level may have a definite clinical value in the diagnosis and prognosis of EC.     

Serum YKL-40 levels in gestational diabetes mellitus

Objective: Serum YKL-40 levels are elevated in patients with type 1 and 2 diabetes. However, the correlation between YKL-40 and gestational diabetes mellitus (GDM) remains unknown. The present study compared serum YKL-40 levels in pregnant women with GDM and those with normal glucose tolerance and evaluated the relationship between YKL-40 and insulin-resistant syndrome.

Methods: Thirty-five patients with GDM and 43 age-matched healthy pregnant women at 24–28 weeks of gestation were studied. In addition to anthropometric assessments, serum glucose, insulin, YKL-40, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein and glycated hemoglobin were measured in all subjects. All subjects underwent a 2-h 75-g oral glucose tolerance test (OGTT). Body mass index (BMI) and the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.

Results: Fasting and 2?h serum YKL-40 levels were significantly higher in pregnant women with GDM compared with controls (77.3?±?29.3 versus 50.9?±?16.7 ng/mL, p?<?0.001, fasting concentrations; 63.5?±?20.1 versus 40.6?±?10.7 ng/mL, p?=?0.009, 2?h concentrations). OGTT had no effect on YKL-40 levels in either group (p?>?0.05). There were significant correlations between YKL-40 and glycated hemoglobin (β?=?0.37, p?=?0.006), fasting insulin (β?=?0.49, p?=?0.001) and HOMA-IR (β?=?0.18, p?=?0.015) in the GDM group.

Conclusions: Serum YKL-40 levels are elevated in patients with GDM but are unaffected by OGTT. YKL-40 levels are related to glycated hemoglobin, fasting insulin and HOMA-IR. These results suggest that YKL-40 may be a major contributor to GDM.     

血清瘦素及瘦素受体基因Gln223Arg多态性与妊娠期糖尿病的相关性研究

目的:探讨血清瘦素水平及瘦素受体基因Gln223Arg多态性与妊娠期糖尿病的相关性。方法:应用放射免疫分析法(RIA)及聚合酶链反应-限制性内切酶片段长度多态性(PCR-RFLP)技术,检测62例妊娠期糖尿病(GDM)患者及60例正常孕妇(NGT)血清瘦素及瘦素受体基因Gln223Arg多态性。结果:(1)GDM组血清瘦素水平为14.2±4.3μg/L,NGT组为10.1±2.6μg/L,二者差异有统计学意义(P<0.05)。(2)GDM组孕妇瘦素受体基因Gln223Arg基因型GG、(GA+AA)频率分别为61.29%、38.71%,正常孕妇组分别为81.67%、18.33%,两组比较差异有统计学意义(P<0.05);GDM组孕妇瘦素受体基因Gln223Arg等位基因频率G、A分别为77.42%、22.58%,正常孕妇组孕妇分别为89.17%、10.83%,两组比较差异有统计学意义(P<0.05);(3)GDM组中基因型为GA+AA的孕妇瘦素水平为15.3±4.1μg/L,GG基因型为13.5±3.7μg/L,二者差异有统计学意义(P<0.05)。结论:瘦素,瘦素受体基因Gln223Arg多态性与GDM相关,GDM患者瘦素受体基因Gln223Arg变异可能影响血清瘦素水平。     

孕妇血清中可溶性endoglin水平变化与重度子痫前期及子痫患者发病的关系

目的 探讨孕妇血清中可溶性endoglin水平变化与重度子痫前期及子痫发病的关系.方法 2005年12月至2007年12月在北京大学第一医院分娩的重度子痫前期孕妇42例和子痫孕妇4例为研究组,孕(35±4)周,年龄(29.3±5.7)岁,体系指数(30.1±4.1)ks/m2;其中早发型子痫前期25例,晚发型子痫前期21例,并发胎儿生长受限(FGa)8例,并发溶血、肝酶升高和低血小板计数(HELLP)综合征5例.选择同期妊娠结局正常的29例孕妇为对照组,孕(33±4)周,年龄(30.7±3.4)岁,体重指数(27.2±2.2)ks/m2.采用酶联免疫吸附试验检测两组孕妇血清中可溶性endoglin水平,分析血清中可溶性endoglin水平变化与孕周的相关性.结果 (1)对照组孕妇在27～37孕周血清中可溶性endoglin水平与孕周有正相关关系(r=0.79,P<0.05),研究组无明显相关性(r=0.31,P>0.05).(2)研究组孕妇血清中可溶性endoglin水平为(14.2 ±5.6) μg/L,高于对照组的(10.9±4.2)μg/L,两组比较,差异有统计学意义(P<0.01).(3)研究组中早发型子痫前期孕妇血清中可溶性endoglin水平为(14.3±5.7)μg/L,晚发型子痫前期孕妇为(13.6±5.0)μg/L,两者比较,差异无统计学意义(P>0.05).(4)并发HELLP综合征孕妇血清中可溶性endoglin水平为(10.1±2.9)μg/L,无HELLP孕妇为(14.4±5.4)μg/L,两者比较,差异无统计学意义(P>0.05).(5)并发FGR孕妇血清中可溶性endoglin水平为(17.3±6.1)μg/L,无FGR孕妇为(13.0±4.8)μg/L,两者比较.差异有统计学意义(P<0.05).结论 孕妇血清中可溶性endoglin水平升高,可能与重度子痫前期及子痈、FGR的发病有关,但与发病时间无明显关系.     

先天性心脏病婴幼儿体外循环术后血清S100B蛋白动态变化的临床价值

目的探讨婴幼儿先天性心脏病体外循环(CPB)术后血清S100B蛋白动态变化的临床价值。 方法随机选择2005 01—2005 06在山东大学齐鲁医院心脏外科住院的先天性心脏病患儿32例(年龄1~3岁)，分别在手术前及体外循环结束后2h、5h、12h、24h、48h和7d抽血，采用ELISA法定量检测血清S100B的水平，进行统计学分析和描述。 结果在CPB结束后血清S100B的水平先上升\[从CPB结束后2~5h，由(2.13±0.67)μg/L升至(2.97±0.82)μg/L，P<0.01\]，再迅速下降\[CPB结束后5~12h，由(2.97±0.82)μg/L降至(1.07±0.26)μg/L，P<0.01\]，然后平稳下降\[在之后的1~7d内，由(0.87±0.21)μg/L降至(0.14±0.11)μg/L，P<0.01\]。在CPB结束后7d\[(0.14±0.11)μg/L\]仍稍高于术前水平\[(0.08±0.04)μg/L\](P<0.01)),恢复至术前水平者占53.1%(17/32)。 结论婴幼儿体外循环术后脑损伤主要是由于体外循环本身所造成的,术后脑损伤部分为可逆性的。动态观察S100B的水平变化，对预测婴幼儿患者体外循环术后脑损伤的发展趋势、评价治疗效果等具有重要的临床价值。